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Background​

Effective May 11, 2023 the CDC will no longer calculate the COVID-19 Community Levels as a result of the sunsetting of the federal public health emergency. As a result, CDPH is sunsetting its Guidance for the Use of Face Masks and is recommending all Californians consider the following:

• Wear a mask around others if you have respiratory symptoms (e.g., cough, runny nose, and/or sore throat),
• If you've had a significant exposure to someone who has tested positive for COVID-19, wear a mask for 10 days.
• When choosing to wear a mask, ensure your mask provides the best fit and filtration (respirators like N95, KN95 and KF94 are best).  

In addition, wearing a mask is increasingly important for those that are at higher risk for getting very sick from COVID-19, and as the risk for transmission increases in the community:

• Examples of settings to consider wearing a mask include: indoor areas of public transportation (such as in airplanes, trains, buses, ferries) and transportation hubs (such as airports, stations, and seaports), and other crowded indoor settings, especially where higher risk individuals are present. 

Local health jurisdictions and other entities may have requirements in specific settings based on local circumstances. 

For more tips and resources for face masks, visit the CDPH resource hub here: Get the Most Out of Masking (ca.gov).​

Consistent with the SMARTER Plan and our adaptation of the SarsCoV-2 virus into our lives, California updated its masking guidance. Effective April 3, 2023,  the updated guidance is intended to provide information that each Californian should consider based on their unique circumstances. The updated guidance is unchanged for general community settings and continues to use a framework based on the CDC COVID-19 Community Levels. The updated guidance replaces mandatory masking requirements in high-risk settings with recommendations, which are also based on the CDC COVID-19 Community Levels. 

High-risk settings include:

• Healthcare Settings
• Long-Term Care Settings & Adult and Senior Care Facilities
• Homeless shelters, emergency shelters and cooling and heating centers
• State and local correctional facilities and detention centers

Persons may use information about the current CDC COVID-19 community levels in their county to guide which prevention behaviors to use and when (at all times or at specific times) based on their own risk for severe illness and that of members of their household, their risk tolerance, and setting-specific factors. COVID-19 community levels are b​ased on hospitalization rates, hospital bed occupancy, and COVID-19 incidence during the preceding period.

Questions & Answers

Why are we issuing updated mask guidance now?

With the end of the California COVID-19 State of Emergency, it is appropriate to update our current masking framework.  California's path forward will be predicated on individual actions that will collectively help protect our neighborhoods, communities, and state.   Individual healthcare and other high-risk facilities will have flexibility to develop and implement plans customized to their needs, populations served, facility configurations, and local conditions.  These recommendations continue to use a framework based on the CDC COVID-19 Community Levels. ​​

Do face ma​sks work to prevent respiratory infections?

Yes, face masks are effective at reducing the risk of transmission of respiratory infections, including COVID-19. Face masks work best when they are high-quality, well-fitting, and worn correctly, and are an important component of a comprehensive strategy to reduce the risk of illness, hospitalization, and death from COVID-19 and other respiratory infections.  

Conducting studies on face mask use can be challenging, especially during a pandemic. Differences in the designs of these studies can lead to variable or inconsistent findings. These differences might include variability in who is wearing face masks, the type of face mask used, where face masks are worn, how often people wear their face masks, if they do so properly, and whether effects are studied at the individual or community level.  

A Cochrane review meta-analysis of interventions to prevent the spread of respiratory viruses published in 2023 received attention for creating doubt about the effectiveness of face masks. In this Cochrane review investigators only considered a single study design, called a randomized-control trial or RCT. While RCTs are the preferred study design when reviewing the effectiveness of medical treatments given to persons with a confirmed disease, this type of study is not always the best choice for evaluating community behavioral interventions like face masking where there is uncertainty about adherence to the intervention (masking) or exposure to disease risk (low infections or immunity). It can be very difficult to determine whether someone in the group assigned to wear face masks did so consistently, correctly, and for the length of time recommended. Additionally, RCTs might not detect the ways wearing a face mask can prevent a sick person from infecting others. Finally, most of the studies in the Cochrane review were conducted before the COVID-19 pandemic. Because the Cochrane meta-analysis has been misinterpreted, the Cochrane Review has issued a clarifying statement. Since the start of the pandemic, new information has been learned about the differences in the effectiveness of different types of face mask and how aerosol transmission of viruses occurs in different environments.  

The California Department of Public Health (CDPH) and the Centers for Disease Control and Prevention (CDC) develop guidance based on a broad range of available literature. This literature encompasses many face mask studies not included in the Cochrane review, including those conducted in controlled laboratory settings, hospitals, schools, and communities to determine how face masking affects the spread of SARS CoV-2, the virus that causes COVID-19. Taken as a whole, the body of research on face masking and aerosol transmission shows that well-fitting, high quality face masks reduce transmission of SARS CoV-2 and serve as one component in an effective overall strategy to prevent the spread of illness. More information, along with citations to the literature, can be found in the: Science Brief: Community Use of Masks to Control the Spread of SARS-CoV-2 | CDC.  

If many peop​le are vaccinated, why is it still recommended to wear face coverings?

Masking continues being an important prevention tool and is consistent with the  SMARTER Plan and with CDC guidance to prevent COVID-19. Everyone, regardless of vaccination status, is recommended to make informed masking decisions based on the CDC COVID-19 Community Levels as described in the table in the CDPH Guidance for Face Coverings.

Masks are especially important in settings where vulnerable people are residing or being cared for, and increasingly important when the risk for transmission increases in the community. 

For additional information on types of masks, the most effective masks, and ensuring a well-fitted mask, individuals should refer to CDPH Get the Most out of Masking.

Why is masking no longer required in high-risk or healthcare settings?

While masking is no longer required in healthcare and high-risk settings, CDPH recommends masking in certain settings based on the CDC COVID-19 Community Levels, especially when the level is high. Masking continues to be important in settings where vulnerable people are residing or being cared for and is increasingly important when the risk for transmission increases in the community. CDPH continues to follow the framework based on the CDC COVID-19 Community Levels .

Healthcare facilities and other high-risk settings should develop and implement their own facility-specific plans based on their community, pa tient population, and other facility considerations incorporating CDPH and CDC recommendations.

Additionally, local health jurisdictions and other entities may continue to implement additional requirements that go beyond this statewide guidance based on local circumstances.​

What should healthcare facilities consider when assessing their local circumstances and developing t​heir own plans to recommend or require source control masking in healthcare settings?

CDPH's revised masking guidance replaces a requirement for masking in all indoor healthcare settings with recommendations for masking in high-risk settings tied to increasing CDC COVID-19 Community Levels. In addition, local health jurisdictions and entities can implement additional requirements that go beyond this statewide guidance based on specific settings and local circumstances. 

When developing healthcare facility specific plans for their own staff, healthcare personnel (HCP) use of masks or respirators for source control of respiratory viruses in healthcare settings serves two purposes:

1. Source cont​rol to protect patients/residents: Prevent HCP from infecting patients or residents, especially those who are unable to wear masks to protect themselves or have higher risk of severe illness or death from infection;
2. Source control to protect co-workers: Protect HCP from exposures when they are not otherwise wearing masks or respirators during care of patients/residents on Transmission-Based Precautions.

Note: Source control masking serves a distinct purpose that is separate from and in addition to requirements for HCP to use respiratory protection (e.g., N95 respirators, PAPRs) under the Cal/OSHA Aerosol Transmissible Diseases Standard. Respirators, such as N95s, are required to be worn:

• When entering a room with a patient who is known or suspected to have an airborne infectious disease, and​
• When transporting a patient ​who is not masked within the facility or in an enclosed vehicle and the patient is known or suspected of having an airborne infectious disease.

Local circumstances that healthcare facilities may consider when developing plans regarding source control masking for HCP include (but are not limited to):

• Vulnerability of patient/resid​ent population to COVID-19, influenza, and other respiratory viruses;
• Ability to maintain staffing le​vels if multiple staff were out sick with COVID-19, influenza, or other respiratory viruses;
• Local transmission of respiratory v​iruses; 
• The impact of new viruses, variants,​ or strains on existing immune protection.

Multiple reports describe decreases in healthcare-associated respiratory infections temporally associated with source control masking​[1]​[2]. Some infection control experts advocate for HCP masking as part of Standard Precautions for all pa​tient encounters[3]​. To promote patient/resident safety and prevent healthcare-associated transmission of respiratory viruses, healthcare facilities may consider implementing source control mas​king requirements for HCP. Different aspects of such requirements may include:

• Patient/resident interaction: require HCP mask during all patient/resident-care encounters, with or without a requirement wh​ile in any patient/resident care area. 
• Location within the facility and patient/​resident populations: apply to all patient/resident care areas and encounters facility-wide, or limit to areas of the facility housing the highest-risk patients or residents.
• Temporal: apply year-round, or tie to community measures of respiratory illness and/or COVID-19 and other respiratory virus (e.g​., influenza) circulation or season.
• Outbreak: intensify mask use during a facility outbreak response or elevated levels of patient/resident or HCP respiratory ill​​ness (even if a specific causal agent is not identified). Consider upgrading the level of source control and protection from a surgical mask to a fit-tested N95 respirator.

At a minimum, to prevent transmission of respiratory infections, healthcare facilities are required by the Cal/OSHA ATD regulation to incorporate the recommendations contained on the CDC webpage, Respiratory Hygiene/Cough Etiquette in Healthcare Settings.

Should h​ealthcare facilities continue to require source control for HCP following exposure to someone with COVID-19 infection?

 Healthcare facilities may continue to require source control for HCP following exposure to someone with SARS-CoV-2 virus. Additionally, CDPH continues to recommend that healthcare facilities require HCP who have had a higher risk exposure to someone with SARS-CoV-2 infection and are working during their post-exposure testing period to wear a N95 respirator for source control at all times while in the facility until they have a negat​ive test result on day 5.

My LHJ requires that all HCP be vaccinated against influenza, and that those who are not must wear a mask during the influenza season. Should this be required of HCP who are not up-to-date on their COVID-19 vaccines? How would such requirements apply in facilities where source control masking is required of all HCP?

LHJs may require source control masking for HCP who are not up-to-date on COVID-19 or influenza vaccines. In jurisdictions or facilities where source control masking is required of all HCP in patient/resident-care areas or interactions, such requirements for un/under-vaccinated HCP could apply throughout the facility, including non-patient/resident care areas.

When should o​ur healthcare facility implement policies for visitors to wear a mask for source control?

Healthcare facilities may consider implementing source control masking policies for visitors based on the same considerations as for HCP:

• Vulnerability of patient/re​sident population to COVID-19, influenza, and other respiratory viruses;
• Ability to maintain staffing levels​ if multiple staff were out sick with COVID-19, influenza, or other respiratory viruses;
• Local transmission of respirato​ry viruses; 
• The impact of new viruses, variants, or strains o​n existing immune protection.

 Different aspects of such policies may include:

• Location within the facility and patient/​resident populations: apply to visitors in all patient/resident care areas facility-wide, or limit to areas of the facility housing the highest-risk patients or residents.
• Temporal: apply year-round, ​or tie to community measures of respiratory illness and/or COVID-19 and other respiratory virus (e.g., influenza) circulation or season.
• Outbreak: intensify mask use during​ a facility outbreak response or elevated levels of patient/resident or HCP respiratory illness (even if a specific causal agent is not identified).

For facilities such as skilled nursing facilities that opt to implement masking policies for visitors, it would not be acceptable to deny visitation and infringe on resident rights because of masking. ​​In general, visitors should be asked to defer their visit if they have symptoms of a respiratory infection or other communicable disease, or have had recent close contact with someone with SARS-CoV-2 infection within the last 10 days. Otherwise, if visitation is essential (e.g., end-of-life) facilities should require that visitors don a mask if they have respiratory symptoms or infection, or have had a recent close contact with someone with SARS-CoV-2 infection within the last 10 days.

What are the masking recommendat​ions in K–12 schools and childcare settings?

K-12 schools and childcare settings may follow the general recommendations in the updated masking guidance. For additional considerations for children and masking, see COVID-19 Guidance for Child Care Providers and Programs and K-12 Guidance  for additional information in these settings. Additional guidance, including additional requirements, may be issued by local public health officials, local educational agencies, and/or other authorities.

For additional information on types of masks for children, the most effective masks, and ensuring a well-fitted mask, individuals should refer to CDPH Masks for Kids: Tips and Resources.

Are masks required in ​workplaces?

In workplaces, employers are subject to either the Cal/OSHA COVID Non-Emergency Regulations or t​he Cal/OSHA Aerosol Transmissible Diseases (ATD) PDF Standard and should consult those regulations for additional applicable requirements. In certain healthcare situations or settings and other covered facilities, services and operations, surgical masks (or higher filtration masks) are required.​

Does this guidance ​apply to visitors in correctional facilities and detention centers?

Yes, this guidance may apply to visitors in these settings. Additionally, local health jurisdictions and other entities may continue to implement additional requirements that go beyond this statewide guidance based ​on local circumstances.​

In situations where surgical masks are required for source control, can higher-level respirators (e.g., KN95s, KF94s, or N95s) be vo​luntarily used instead of surgical masks?

Yes, in situations where surgical masks are required for source control, voluntary use of a higher-level respirator (e.g., KN95s, KF94s, or N95s) ​provides inc​reased source control and protection for the wearer. This does not supersede any requirements for use of a respirator under Cal/OSHA COVID-19 Non-Emergency Regulations  or ATD.

If I test positive for COVID-19, when sh​ould I wear a mask?

It is strongly recommended that everyone who tests positive for COVID-19, regardless of vaccination status, previous infection or lack of symptoms isolate (stay home) for at least five days and wear a well-fitting mas​k when around others for a total of 10 days, especially in indoor settings. After ending isolation, persons may remove their mask sooner than Day 10 after two sequential negative tests at least one day apart. See CDPH Isolation and Quarantine Guidance for additional information. for additional information.

Employers must continue to ensure that workers comply with Cal/OSHA COVID-19 Non-Emergency Regulations  or in some workplaces the Cal/OSHA Aerosol Transmissible Diseases (ATD) Standard  and should consult those regulations for additional applicable requirements.  Workers leaving isolation are required to continue wearing a face covering in the workplace until 10 days have passed since the date that COVID-19 symptoms began or, if the person did not have COVID-19 symptoms, from the date of their first positive COVID-19 test.

In certain healthcare situations or settings and other facilities, services and operations covered by the Cal/OSHA ATD Standard, surgical masks (or higher filtration masks) are required.

If I was exposed to C​OVID-19, when should I wear a mask?

It is strongly recommended that everyone, regardless of vaccination or previous infection status, wear a well-f​itting mask around others in indoor settings for 10 days after exposure to someone with COVID-19. See CDPH Isolation and Quarantine Guidance for additional information.

Who should not wear a m​ask?

The following individuals should not wear a mask:

• Persons younger than tw​o years of age. Very young children must not wear a mask because of the risk of suffocation.
• Persons with a medical condition,​ mental health condition, or disability that prevents wearing a mask. This includes persons with a medical condition for whom wearing a mask could obstruct breathing or who are unconscious, incapacitated, or otherwise unable to remove a mask without assistance.
• Persons for whom wearing a mask would create a risk to the person related to their work, as determined by local, state, or federal regulators or workplace safety guidelines.

What should I do if ​my mask feels wet or gets saturated with sweat?

Any face mask t​hat feels wet or becomes saturated with sweat should be changed immediately.

Can busines​ses require masks?

Yes, businesses can require masks. 

In addition, when CDC COVID-19 Community levels are medium or high, businesses, venue operators, or hosts should consider:

• Providing information to all patrons, guests, and attendees regarding masking recommendations for all persons, regardless of vaccine status.
• Providing information to all patrons, guests, and attendees to consider better fit and filtration for masks. Respirators, e.g., N95s, KN95s, KF94s, are the most protective, followed by surgical masks with good fit; both are recommended over cloth masks.

How sh​ould businesses inform their customers about any requirements specific to their facilities?​