Washington's final mask mandate ends Monday. But guidance has been fuzzy

Three years into the Covid-19 pandemic, Washington state is doing away with its last masking order. This is one of the final vestiges of the state’s most noticeable pandemic emergency measures.

Effective April 3, masks will no longer be mandated statewide in health care, long-term care, and correctional settings, although individual institutions can still choose to require face coverings moving forward.

State officials announced the end to the order several weeks ago, citing a downward trend in infections and hospitalizations coming out of virus season.

Julia Barcott is a nurse at a hospital near Yakima. As of last week, she said her hospital was still waiting to see updated guidance from the state department of health before finalizing its masking policy.

But Barcott said she and many of her colleagues will be keeping masks on for the time being.

“Many of us feel uncomfortable still not being masked up,” Barcott said.

“Going into patient rooms or interacting with patient families I, personally, as well as many of my co-workers, are going to continue to mask up.”

Barcott said a few of her colleagues have tested positive for Covid-19 in recent months and there are other viruses that they’re exposed to at work as well.

A cohort of hospitals and clinics in the Puget Sound region said last month that they’ll continue to require masks for staff, visitors, and patients in patient care settings after the statewide mandate expires Monday.

Leaders at institutions including UW Medicine, Seattle Children’s Hospital, and MultiCare Health System signed on to the decision in a statement.

“Unlike many other activities, health care is not optional, but essential; and every patient deserves to feel safe from acquiring a preventable infection when seeking health care,” the statement said.

It also emphasized the need for frontline health care workers to have the safest possible working environment.

Local health departments across the region, including in King, Pierce, Snohomish, and Kitsap counties, support the decision to continue requiring masks.

“Masking is an important way we can help make visiting health care facilities safer for the many people in our community of all ages who are at increased risk for severe infections,” said Dr. Jeff Duchin, health officer for Public Health – Seattle & King County, in a statement.

Public health officials say the risk for severe disease from Covid-19 remains a threat for older adults, those with weakened immune systems, pregnant people, infants, and those with underlying health conditions.

The risk of long Covid also remains for those who are infected or re-infected.

Health officials continue to recommend staff, patients and visitors wear high-quality, well-fitted masks in health care settings.

Not all health care facilities will require masks

But outside the hospital setting, some health care providers in the region are choosing to make masks optional for staff and patients.

At Sound Physical Therapy in West Seattle, co-owners and physical therapists Ingrid Sparrow and Chris Zang are cautiously optimistic about the option to drop masks.

“We're very much presenting it as an option,” Sparrow said. “And we're very happy to continue to use masks for anyone who feels that they would like to do that.

“We would all prefer not to get Covid. But I think we prefer to be able to go back to being non-masked with our patients where it's appropriate,” Sparrow said.

Sparrow and Zang said they will re-evaluate the policy if they start to see cases rising and staff getting sick.

They say they're trying to find a balance between allowing staff and patients to make their own choices, and not wanting to see an economic impact if lots of people are unable to come in.

“As a business, it definitely puts us back on guard again and, paying attention as to how things change over the next month — we'll see how that is playing out,” Zang said.

Sparrow said there is some financial anxiety. In the early days, she said financial relief options like the federal Paycheck Protection Program kept the business afloat.

“It's really been three years of [questioning] if we were going to make it,” Sparrow said.

The difference now is that those kinds of relief programs have largely ended and seem unlikely to return.

Zang said he feels masks have protected their staff and patients, and helped the practice remain open.

But there’s a flip side: Zang and Sparrow say some patients struggle to do the exercises they’re given while masked, and the loss of non-verbal communication has been hard.

The co-owners have discussed their masking policy with peers in the industry, but they feel they’re making the choice without a lot of solid guidance from the state.

Physical therapy is part of the health care continuum and was deemed an essential service in 2020 when stay at home orders were in place. But it’s a far cry from the hospital setting.

Sparrow said, in those early days, there were a lot of unanswered questions, and she feels they’re in a similar situation now where there’s no clear guidance for her specific practice.

And she’s not alone in wanting more guidance.

In the long-term care setting, many facilities also felt a lack of guidance in the weeks leading up to the expiration of the masking order.

A joint letter sent by the Adult Family Home Council of Washington and the Washington Health Care Association, which represent many of the long-term care facilities in the state, implored the state Department of Health to update their guidance on situations where masking may still be necessary ahead of the Monday, April 3 deadline.

As of last week, the Department of Health anticipated that new guidance would be available on, or close to, the day the order lifted.

A spokesperson said it had not been published earlier due to the need for a lengthy internal review process.

As nursing homes, assisted living facilities, and other entities await the update, leaders of the Washington Health Care Association say some have already decided to keep masks, while others are hoping they can make them optional. They say there’s likely to be a mix of policies across the state.

What’s happening outside of health care?

Just as health care providers are faced with updating their policies around masking, so too are correctional facilities.

The state had previously relaxed mask requirements slightly in settings like jails, only requiring them universally when cases hit high levels in the surrounding county, or if there was an outbreak in the jail itself.

King County’s Department of Adult and Juvenile Detention will continue to require masks inside jail medical clinics after April 3.

However, masking will now be optional under most circumstances for staff, visitors, and people in custody.

As of the end of March, a spokesperson for the state Department of Corrections said they were waiting to see updated guidance before finalizing a policy.

As some institutions across the state begin to relax masking, at least one advocacy group is pushing back against the end to the masking order.

A group called Seattle Still Cares says the move is “unacceptable” and has been calling on members of the public to email state leaders and urge them to keep masking in place in health care, long-term care, and correctional settings.

At the time this story was published, 1,860 letters had been sent in support of the cause. However, state officials seem unlikely to reverse course.

Covid hits a lull as the federal emergency nears its end

The end to the state’s final masking mandate comes as Covid-19 cases and deaths have been trending downward.

The most recently available data statewide shows that 34 Covid-19 deaths occurred in Washington over the period of a week at the end of February.

That number was at 435 deaths statewide during the largest omicron surge early last year.

While cases, hospitalizations and deaths remain far lower than they were during the largest Covid-19 peaks, the virus is not gone.

According to data published by the Centers for Disease Control and Prevention, community transmission remains substantial or high in several areas of the state, including Okanogan, Grant, and Kitsap counties.

The continued presence of the virus is something health officials want the public to keep in mind as the nation barrels toward another milestone in May: the end of the federal Covid-19 emergency.

Leading up to the federal expiration, Washington is ramping down some pandemic-era programs. Among them, access to monthly shipments of free at-home tests for most households.

Testing, vaccines, and treatment access will also change after the federal emergency declaration expires, with an end to many free public programs and a shift to coverage through health care insurance.

Public health officials are urging the public to take lessons learned in the past few years forward. They strongly recommend people continue to stay up-to-date with Covid-19 vaccines and boosters, mask when appropriate, test, stay home when sick, and pay attention to indoor ventilation.