Intended for healthcare professionals


Covid-19: Mask mandate is struck down although US cases are rising

BMJ 2022; 377 doi: (Published 19 April 2022) Cite this as: BMJ 2022;377:o998
  1. Janice Hopkins Tanne
  1. New York

Covid-19 cases in the US rose by 43% over the past two weeks, with especially high rates seen in north eastern states, according to the New York Times coronavirus tracker.1

Cases rose to a seven day average of 39 000 on 18 April, up from 27 000 on 4 April, although health officials say that the actual numbers are uncertain because the results of many home tests are not reported to public health authorities. The number of cases is far below that at the height of the latest wave, however, which stood at 806 795 new cases on 14 January. Both hospital admissions and deaths are trending downward, but the number of US deaths from covid-19 is expected to pass the one million mark in the next few weeks.

Despite the increase in cases, the requirement that people wear masks on aeroplanes and trains and in airports and railway stations was struck down on 18 April 2022 by a Trump appointed federal judge in Florida, Kathryn Kimball Mizelle. She said that the mask mandate by the Centers for Disease Control and Prevention (CDC) exceeded its authority. The CDC had recently extended the requirement until 5 May because of the rise in covid cases.

The four major US airlines immediately dropped their mask requirements, as did the Amtrak train system. The Transportation Security Administration stopped enforcing the rule.

Mask restrictions had already been abandoned in many areas as covid-19 cases had been dropping and the public became weary of mask requirements.

In Philadelphia, however, public health officials said on 18 April that people must wear masks again when in indoor public spaces, just a month after the city dropped its mask mandate. New York city mayor Eric Adams—himself newly infected with covid-19—was said to be considering bringing back stricter mask mandates in the city and its schools. Masks are still required on the city’s subways and buses.

New York City health commissioner Ashwin Vasan recommended that people once again wear masks at indoor gatherings where the vaccination status of other people is unknown. Cases have been rising in the city for the past six weeks. Positivity rates are close to 5% overall, and as high as 15% in some neighbourhoods.2

New York state governor Kathy Hochul said she would not impose a lockdown on the state although there are hotspots of covid infections in central and northern areas. Two omicron sub-variants, BA.2.12 and BA.2.12.1, which are thought to be more transmissible than the original BA.2 variant, may be causing the spread.

Other hotspots are in Washington, DC; Rhode Island; Vermont; and other north eastern states. Cases are also increasing in the mid-western states of Illinois, Michigan, and Wisconsin.

Nationwide, omicron is thought to be causing at least 80% of new covid infections.

Given that many home tests are not reported and several free public test sites have closed, public health authorities are looking at hospital admissions to indicate the current burden of the disease. The CDC has begun using local hospital admission rates and capacity to calculate its covid-19 community levels. People can use these to decide on their own risks.3

The CDC recently added wastewater sampling in an attempt at early detection of rising levels of infection. Participating health departments submit local data to the CDC, which standardises the data and adds them to its covid data tracker.4

The White House announced on 18 April that it would be co-hosting the second global covid-19 summit virtually on 12 May 2022 together with Belize, Germany, Indonesia, and Senegal.5

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