As COVID cases rise, what will that mean for mask guidance and mandates?

Already, some U.S. schools and businesses have started bringing back mask mandates

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COVID cases are on the rise in Illinois and across the U.S., and while that has led some to bring back mask requirements or mandates, could public health guidance soon follow?

Already, some U.S. schools and businesses have started bringing back mask mandates.

Morris Brown College in Atlanta announced last week that it was reinstating its mask mandate "due to reports of positive cases among students."

A mask mandate was also reinstated for several employees at Lionsgate headquarters in Santa Monica, according to an internal memo obtained by the Los Angeles Times.

The Illinois Department of Public Health warned Friday that COVID cases are on the rise in the state.

Despite all of the state's 102 counties remaining at what the department said was a "low level" for hospital admissions, as of data from the middle of August, wastewater surveillance has detected "rising COVID-19 activity," the department said.

“Although hospitalization rates and deaths from COVID-19 remain low, it is important for our residents to know that we are seeing rising COVID-19 activity across Illinois,” IDPH Director Dr. Sameer Vohra said in a statement. “We are fortunate the vast majority of Illinoisians have received immunity from a COVID-19 vaccine or previous infection that protects them against severe disease. However, COVID-19 continues to pose a risk for our seniors, individuals with chronic medical conditions, and those who are immunocompromised. IDPH is closely monitoring COVID-19 hospitalizations and deaths, emerging variants, and a broad range of respiratory illnesses including flu and RSV. As we approach the fall, our residents will have access to a number of tools, including updated shots and treatments, that can help us avoid another ‘tripledemic.’ Please contact your primary care provider to learn about the options available to protect you and your loved ones this upcoming respiratory season.”

The latest alerts come weeks after experts indicated a potential climb in both cases and hospitalizations in what was being described as a "mini-surge" ahead of the new school year.

"We're starting to see an increase," Dr. Mark Loafman, assistant chair of Family and Community Medicine at Cook County Health, told NBC Chicago in early August. "I mean, the cases are ticking up, we're looking at a positivity rate - you know, with COVID and the rate of tests that are positive - has increased up, it's almost up to 7% now. So it's that combination of that, and we know hospitalizations lag a little bit behind, but we're starting to see an uptick in hospitalization as well."

In Chicago, hospitalizations remain low, but have seen a rise, with a 42% increase reported week over week for data reported on Aug. 23. In that same time frame, cases rose 22%, data from the Chicago Department of Public Health showed.

But with at-home testing now common, experts said the total number of cases is likely higher.

Meanwhile, hospitalizations have been increasing since the beginning of July, according to data from the Centers for Disease Control and Prevention, which reported 12,613 new hospital admissions for the week ending Aug. 12, a 21.6% increase.

The numbers remain low, however, when compared to earlier in the pandemic.

“The U.S. has experienced increases in COVID-19 during the last three summers, so it’s not surprising to see an uptick after a long period of declining rates,” CDC spokesperson Kathleen Conley said in an email to NBC News.

In a statement to NBC Chicago, the CDC said its "advice for individual and community actions around COVID-19 is tied to hospital admission levels, which are currently low for more than 97 percent of the country."

The Illinois Department of Public Health has also not indicated the potential for returns of masking guidance from a state level.

That is consistent with what public health officials have stressed during the recent uptick.

"I don't think that we're at a place anywhere in the United States, where we're going to see mask mandates," said Marcus Plescia, chief medical officer at the Association of State and Territory Health Officials. "Again, you know, I just don't think that the rates are high enough that we could do that. And I also think that now with vaccination treatment, and also the fact that many, many people in the public who are supposed to have had COVID itself, you know, our immunity is much higher and the likelihood of people getting hospitalized or getting really ill if they get COVID is much less."

What would it take for mask mandates to return from a public health perspective?

"The biggest thing we're concerned about in public health is the capacity of our hospital systems," Plescia told NBC Chicago. "So if we got to a place where there were so many people getting respiratory illnesses - and I don't think we would get there with COVID alone because there is such such stronger immunity to COVID now - but in the fall if we have COVID, influenza, and respiratory syncytial virus, which is RSV, you know, it is possible in the fall that we get to a place where if we had a bad season in the fall and the winter for RSV and flu together, with maybe an uptick in COVID, when you get to a place where some of our hospital systems would really be in danger of becoming overcrowded and overwhelmed. And that's the only time that I think public health officials might step in, and, you know, do some kind of mandates or requirements, either using masking or any other types of, you know, ways that we have to limit the spread."

Experts say masking will likely be done more on a voluntary basis going forward, based on an individual's personal health or the activities they are doing.

"For people who have underlying health conditions that would put them at higher risk if they got COVID, or for people who are in sort of older age brackets ... those are individuals that really might want to consider beginning to wear masks, and particularly in crowded settings, because COVID seems to be on the rise, and these are people that if they did get COVID, they, you know, might be more likely to have a severe case."

Currently, much of the country is awaiting vaccination guidance surrounding a potential fall booster.

The FDA in June advised manufacturers to update their vaccines to target the XBB 1.5 variant, aiming for a fall 2023 rollout. But no guidance has so far been given surrounding updated vaccinations.

Guidance is expected from the CDC’s Advisory Committee on Immunization Practices in the coming weeks, according to a statement.

Does that mean residents should get a booster shot now or wait until the fall when an updated vaccine is expected?

"You should wait," former Chicago Department of Public Health Commissioner Dr. Allison Arwady told NBC Chicago. "We anticipate a new vaccine available probably late-September or early-October. That is going to be an update that will be the newest version to help fight off omicron, the type of omicron subvariants we're seeing more recently. And it'll be important that everybody get that booster. That's what helps get us through the fall. That's what's turned COVID. Even during this time of increased cases, we are seeing zero to one deaths a day. We are seeing handfuls of Chicagoans being hospitalized. When I compare that to the more than 50 Chicagoans a day who were dying during COVID, the, at some points, more than 300 Chicagoans being newly hospitalized every day, it is vaccines and it is treatments that have turned this into a disease that we can coexist with."

Currently, COVID booster shots and initial doses are formulated as “bivalent” vaccines, meaning they offer protection both against the original strain of COVID that impacted the U.S. in 2020, and the Omicron variants known as BA.4 and BA.5, which were the most-recent dominant strains of the virus.

The new monovalent vaccine doses will specifically target the XBB.1.5 strain, according to officials.

CDC data shows the current variant dominating U.S. cases is EG.5, followed by FL.1.5.1 and XBB.1.16.

At the same time, CNBC reports health experts and initial data suggest the new shots will also be effective against the Eris, or EG.5, variant, along with other circulating variants.

"I think that these vaccines will provide very substantial protection against EG.5. Maybe just a little bit of loss, but it's nothing that I'm very concerned about," Dr. Mark Mulligan, director of the NYU Langone Vaccine Center, told CNBC. "It looks like we're going to be OK."

In addition to COVID booster shots, IDPH urged residents to also follow guidelines surrounding the flu and recently-authorized RSV vaccines.

"We've got ... people going back to school, people starting to do indoor activities, we have flu and RSV season coming to start as well," Loafman said. "And we have, you know, a real fatigue with masking, we are very, very under vaccinated for COVID. So we've got a lot of ingredients, you know - a so-called 'perfect storm' - to see some things get worse," he said. "So I would say we're vigilant, we're on the lookout, we hope people aren't so fatigued that they won't take precautions, but that's the biggest concern is the numbers go up and people are just tired and they won't follow some good self management. I think we need people to do this on their own so we don't have to rely on mandates and, and rules and regulations. So hopefully people will follow the rules on their own. And we could keep this thing at bay."

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