COVID battle lines: California orders masks; New York requires vaccines. Who’s right?

The battle lines are drawn. New York City and California’s big metropolitan cities have issued new orders to fight back against the COVID-19 summer surge. In the Big Apple, you’ll need to be vaccinated to eat in a restaurant or work out in the gym. In the Bay Area, Los Angeles and Sacramento, you must wear a mask to step inside, vaccinated or not.

Is one strategy better than the other in repelling the aggressive delta variant?

Dr. Kirsten Bibbins-Domingo, an epidemiologist at the University of California-San Francisco, said that while neither strategy is wrong, if she had to choose one mandate, it wouldn’t be masks.

“The only short and long term solution is to get more people vaccinated, and if I could do one thing, it would be to take steps to get more people vaccinated,” Bibbins-Domingo said.

New York City — which issued its first-in-the-nation vaccine mandate Tuesday — hasn’t thrown masks out the window, and recommends face coverings for everyone indoors. And California — where a new mask mandate came Monday — is requiring all state employees and healthcare workers to provide proof of vaccination or submit to regular testing. But there is a stark difference in what each region has chosen to make an order.

Contra Costa County Health Officer Dr. Chris Farnitano, asked Monday whether vaccine mandates soon will follow the Bay Area’s seven-county mask mandate he was announcing, said he and other health officials have encouraged employers to require vaccination, but the aim with masks is to avoid stress on hospitals now filling with COVID-19 patients.

The delta variant’s blitzkrieg across the country presents a monumental challenge for public health and government officials. As summer began and cases plummeted, they were so confident that potent vaccines would put the pandemic in the past that they dropped mask requirements and other activity restrictions on June 15.

But now infection rates and hospitalizations are soaring again — mostly, though not entirely, among those who’ve yet to get the shots — even with nearly half of the U.S., 53% of Californians and 57% of New Yorkers fully vaccinated.

On Friday, the U.S. Centers for Disease Control and Prevention released a worrisome study on a massive outbreak in Cape Cod over the Independence Day holiday indicating that although the vaccinated are much less likely to become infected, those who do may be just as capable of spreading the virus.

The CDC cited that study last week in recommending that everyone, vaccinated or not, wear masks indoors, where the virus spreads more easily, reversing its May guidance that the vaccinated could go without masks in most indoor settings.

In California, Los Angeles County on July 15 mandated masks for everyone indoors, followed by Sacramento and, starting Aug. 3, the seven Bay Area counties which include the cities of San Francisco, San Jose and Oakland.

In New York City, Mayor Bill de Blasio issued an order Monday requiring proof of at least one dose of COVID-19 vaccine from employees and customers at indoor eateries, fitness and entertainment facilities starting Aug. 16, with enforcement beginning Sept. 13. Unlike in San Francisco, where hundreds of bars and restaurants announced last week that patrons would have to show proof of vaccination or a negative COVID test to come inside, NYC offers no test option.

De Blasio explained that the goal was to spur vaccinations — which have slowed across the country in recent weeks.

“This is the whole ballgame, everyone,” de Blasio said. “It’s time for people to see vaccination as literally necessary to living a good and full and healthy life.”

Dr. Michael Lin, associate professor of neurobiology and bioengineering at Stanford University, said Monday that the effectiveness of masks or vaccinations in keeping cases in check vary by indoor setting.

“Compared to requiring masks indoors, well that doesn’t apply when eating or drinking in restaurants, so a vaccination policy would be better for restaurants,” Lin said. “Overall requiring a vaccine card to dine indoors seems like a good idea to me, and is something restaurants can require on their own without waiting for guidance from government agencies. The increasing rates now and New York taking the lead should make it more palatable. Since the vast majority of Californians are vaccinated, this might be a very popular policy among diners.”

For gyms, however, “whether the net risk is greater in a gym with everyone masked and some people unvaccinated, or with everyone vaccinated and some people unmasked, is really impossible to know,” Lin said. “I think it’s best to keep masking in gyms which at least provides a known amount of protection. However if gyms were to require both vaccination and masks, that would of course be the safest.”

Andrew Noymer, associate professor of population health and disease prevention at UC-Irvine, said he’s “not particularly impressed by either approach.”

“It’s really virtue signaling, not epidemiology,” Noymer said. “Is the bouncer going to ask if your photo ID matches your vaccine card? How long before motivated people who disagree with the vaccine mandate are going to fake a vaccine card? At least with masking, you can verify, but there’s no such thing as masking when you’re drinking or eating. The safe money is just not going to these places right now until things get better. Avoid these indoor activities, full stop.”

Bibbins-Domingo said mask orders are a better short-term answer to sharply rising cases — vaccines, especially the two-dose shots, can take 5-6 weeks to produce immunity. But mask orders risk confusing people about the effectiveness of vaccines, which most health experts say should remain the primary goal.

Vaccine passports like New York City’s, however, face implementation challenges. After de Blasio’s announcement, the National Restaurant Association pushed back, arguing it would be a burden to enforce.

“I think that’s what’s hard and subtle to communicate — neither of these are wrong,” Bibbins-Domingo said. “The question is whether it leads people to be more confused about what the short, medium and long-term goal is. Right now, the thing really fueling rising cases everywhere is there are still lots of people who are not vaccinated.”