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Indoor mask mandates are knocking slowly at our doors once again, as the number of COVID cases and hospitalizations continue to rise.

Health officials are recommending people to wear masks indoors, as the Centers for Disease Control said the risk of transmitting COVID-19 in San Diego County is high.

With the highly infectious BA.4 and BA.5 sub-variants driving up case and hospitalization numbers, San Diego County moved into the “high” COVID-19 activity level on July 14, however, unlike Los Angeles County, no indoor mask-wearing mandate has been announced.

As of July 14, the average daily rate of COVID-19-positive patients being hospitalized in the county rose to 11.5 per 100,000 residents. That topped the U.S. Centers for Disease Control and Prevention’s threshold for “high” virus activity. The county was previously in the “medium” category.

“I strongly recommend that actually everybody wear masks indoors in closed settings, especially when there’s poor ventilation, while transmission levels are high,” said Doctor Erica Pan with the California Department of Public Health.

According to the county’s Health and Human Services Agency (HHSA), lab-confirmed coronavirus cases remain near 10,000 per week, a number that does not include at-home tests, which are not always reported to the county. The HHSA also reported it has also seen an increase in re-infections of San Diegans who have tested positive for COVID-19 several times throughout the pandemic. Prior infection does not necessarily prevent re-infection with some of the newer virus variants, according to national data.

Additionally, hospitalizations for COVID-related illnesses are also on the rise, up 66% in the last 30 days, the HHSA said last week. New ICU admissions rose 68% during that same time frame.

The county reported 1,311 new infections and six deaths related to the virus on July 11, increasing the cumulative totals to 851,528 cases and 5,363 deaths.

The San Diego Unified School District reintroduced its indoor mask mandate for students and staff, and is expected to last until at least the end of summer school.

However, that decision seems to not be supported by all.

Sharon McKeeman, founder of the anti-mask mandate group Let Them Breathe, said the district’s decision is harmful and isn’t based on science.

“San Diego Unified’s return to masking Monday July 18 is not supported by science and will be harmful to students in summer school who are trying to recuperate from learning loss incurred during school closures. Studies show that masking children makes NO difference in transmission rates, but it does harm social and linguistic development. Let Them Breathe and local families will oppose any returns to forced masking and SDUSD needs to follow the science and revise their policy,” a statement from McKeeman read.

Los Angeles County is already on the verge of a universal mask mandate that could be implemented on July 29 if the county continues in the Centers for Disease Control’s “high” transmission threshold.

Masks are already still mandated in some indoor spaces – health care facilities, transit hubs, on transit vehicles, airports, correctional facilities and shelters. A universal mandate would spread the requirement to all indoor public spaces, including shared office spaces, manufacturing facilities, retail stores, indoor events, indoor restaurants and bars and schools.

If the county is in the “high” COVID community level for two consecutive weeks, a universal indoor mask-wearing mandate will possibly be in the works.

The new Omicron sub-variants of Omicron, B.4 and B.5, will probably become the dominant variant in California in the coming weeks, Dr. Pan believes.

“It seems to be more infectious than prior versions, but thankfully we have not seen any indications, here or globally, that it’s more severe because of our immunity with vaccines and prior infections,” she said.

BA.5 is now the dominant strain of the coronavirus circulating. The World Health Organization reports it was behind 52% of cases sequenced in late June, up from 37% in one week. In the United States, it is estimated to be causing around 65% of infections.

Health officials said the variants are dramatically more contagious than previous strains thanks to their ability to infect people who were previously infected with other variants.

Even those vaccinated or with prior protections can catch the new variant.

It is unclear what will exactly happen next, but let us hope that things will not dramatically change or we will once again have to start back to 0.