Should masks return in fall and winter to prevent a COVID surge?
As the United States heads into the fall and winter, questions are arising about whether the return of masks is needed to stem a potential COVID-19 surge.
Evidence has shown COVID cases and hospitalizations tend to rise during the colder months when people congregate indoors. Some health officials warn the virus could surge again in December and January.
Currently, cases and hospitalizations are on the decline in the U.S. after having peaked in late July, according to data from the Centers for Disease Control and Prevention.
Those who are vaccinated and boosted are at much lower risk of falling severely ill and dying from COVID-19. CDC data shows unvaccinated Americans have a five times higher risk of dying compared to those who've received just a primary series and a seven times higher risk of dying compared to those who also received at least one booster dose.
Experts told ABC News that while vaccination is the best protection against COVID-19, some people may need to consider masking to protect themselves in case infections rise.
"My recommendation to people would be to mask when in indoor crowded spaces," Dr. Stuart Ray, a professor of medicine at Johns Hopkins University, told ABC News. "I've spent a great deal of time with patients who have COVID and have not contracted the infection from what I can tell, both from antibody testing and from a lack of syndrome."
Dr. Shira Doron, an infectious disease physician and hospital epidemiologist at Tufts Medical Center in Boston, told ABC News that masks have helped reduce COVID transmission in health care settings.
"I've worked in a respiratory infection clinic with COVID patients at the height of their contagiousness and they're breathing in my face, and I haven't gotten COVID from patients," she said. "I really do believe that PPE works, that masks work."
However, experts admitted it will be hard to convince Americans to wear masks again after so many cities and states have done away with mandates.
Los Angeles, San Francisco and Denver remain the three biggest cities in the U.S. where masks are still required on public transit. In most cities, only health care environments still require mask mandates.
Ray said he believes a surge, similar to those caused by the delta and the omicron variants, would be the only thing drum up support of mandates.
"I think that people are really tired of this pandemic and there is, culturally, very little appetite for mandates, for masking," Ray said. "And so, it's a steep climb to tell people unless there's a particular context in which it's important, like a health care setting when there are many vulnerable people."
He added, "If we were to come into a highly disruptive surge, then the appetite for a mandate might change, because people realize that a bunch of essential services are being disrupted. If hospitals got stressed by the surge, then I think we might see mandates returned."
Doron said that although she supports masking, she doesn't believe that cities and counties should reinstate mask mandates because many people take them off indoors for prolonged periods of time anyway, increasing the risk of transmission.
"In the community, we had mask mandates where you wear masks unless you're eating or drinking and if you've ever traveled in an airport or on an airplane, where there when there was a mask mandate, you know that, you know, people are pretty much eating and drinking the entire time," Doron said. "And so, it just doesn't have the ability to do what it's meant to do."
In the absence of mask mandates, the experts said people may need to assess their individual risk level and decide if wearing a mask will help protect themselves and those around them.
"You to weigh your own susceptibility, your own tolerance for the risk of the long-term complications, which are still somewhat unknown and the risks that you might pose to people you care for either professionally or personally at home," Ray said. "Now, some people may decide -- and this is the judgment part -- that they just don't care that they don't think that this is a big deal, and that they'll just get infected and that they're likely not to be hospitalized."
Dr. Thomas Murray, an associate professor of pediatrics at Yale School of Medicine, said assessing the risk level also applies to kids in school, where many mask mandates have been lifted.
"Children who have higher risk, like asthma, might be an example of that," Murray said. "What we're really trying to balance is having kids enjoy a normal in-person school experience with the risks that go with congregating in classes when we have lots of respiratory viruses circulating."
He said if schools don't reimplement masking, other strategies "become critically important" for children, such as screening, testing and keeping them home if they have symptoms.
However, not all masks are created equally. For those who plan to keep wearing masks or choose to start wearing them again heading into the colder months, the experts recommend wearing a high-quality mask.
"I think that single-layer cloth masks really don't provide much protection," Ray said.
Doron said if you cannot get a N95 or KN95, or cannot wear one for long periods of time, a surgical mask will provide protection.
"The surgical mask does provide protection, especially if it fits you well," she said. "And then there are ways to make it fit better, ways to fold it or and tuck it and tie the strap for your ears."