Philadelphia Reinstates Mask Mandate With Stricter Standards Than CDC

Philadelphia is the first major U.S. city to reinstate a mask mandate after restrictions were dropped nationally earlier this spring. The move, which will go into effect on April 18, demonstrates a larger display of caution than other localities with similar or higher risk levels. It goes beyond cautionary benchmarks set by the Centers for Disease Control and Prevention (CDC). 

In an email to Verywell, city spokespeople called the change a “relatively low barrier intervention” that they “hope will blunt the impact” of what’s to come.

“We believe that things aren’t at a crisis level right now, but that if we take action now, we can head off the worst of this wave,” wrote James Kyle, news media coordinator for the Philadelphia Department of Public Health. “We don’t yet know if BA.2 is going to cause a real surge in Philadelphia or just a brief increase in cases, and we don’t yet know the impact it will have on hospitalizations, although we are concerned based on what has happened in the U.K.”

A return to masking is part of the city’s move from a Level 1 to Level 2 COVID-19 response. In Philadelphia, response levels are cautionary guidelines set by the city health department based on three criteria: average number of new daily cases, number of hospitalizations, and percent increase of case counts in the last 10 days.

Philadelphia has four levels: All clear (Level 1), Mask precautions (Level 2), Caution (Level 3), and Extreme caution (Level 4).

When the change to Level 2 was announced on April 11, Philadelphia reported an average of 142 new daily cases, 44 hospitalizations, and a case increase of over 50% n the last 10 days.

But based on metrics set by the CDC, Philadelphia county remains a low-risk area, for which the CDC does not recommend indoor mask use.

How Do CDC Risk Levels Compare?

The CDC evaluates new case numbers, new hospitalization numbers, and staffed hospital bed numbers to classify an area’s risk as either low, medium, or high. It does not evaluate the percentage of case increase, as Philadelphia does.

Looking at rate of case increase is part of Philadelphia’s plan to stay on top of rising trends. It serves as a COVID-19 transmission warning sign that could otherwise be missed if looking at cases alone, Kyle said.

“We saw back in the winter how quickly things can get out of control in a short period of time, even when case counts seem to be low and insignificant,” Kyle said. “Seven-hundred and fifty of Philadelphia [residents] needlessly died because of how quickly COVID surged in our city. By using rate of rise, we are hoping to get ahead of surges like Omicron and prevent unnecessary deaths.”

Kyle added Philadelphia's formula will also prevent hospitals from becoming overwhelmed.

“If we wait until hospitals are already being affected, as the CDC’s risk levels do, there will already be widespread community spread and we’ll have no control over how bad things get,” he said.

Health Experts Are Divided

Philadelphia's deviation from CDC advice has received mixed responses from health experts. Some applauded the city's caution, suggesting it takes a strong stance in protecting residents.

Others criticized the move as overbearing and harmful to the public.

Whose Guidelines Are Right?

William Lang, MD, MHA, chief medical officer at WorldClinic and former White House physician, is in favor of the CDC community risk guidelines, calling them “arguably the most useful guidance that has come out of CDC since this started.”

“People had been trained to focus on case counts and trends, thinking that if cases go up, their risk goes up proportionally,” Lang told Verywell via email. “With Omicron, the CDC recognized that it needed to reintroduce the concepts of disease severity and impact into the discussion and begin to train people to think about risk differently.”

Lang said that relying too heavily on case numbers can skew data if cases are underreported due to asymptomatic or mild cases. Cases numbers can also be hard to quantify due to increased use of at-home testing.

As such, the CDC guidelines are a good format for most counties, Lang said. Adding metrics like a Philadelphia's trend requirement could be a good addition, but may not be necessary for all areas, he added.

“There may be others that follow Philadelphia’s lead, and that’s fine,” Lang said. “Governments need to continue to foster shifting the public focus from just case counts.”

Whether other major cities will follow in Philadelphia’s lead has yet to be seen. Kyle said the city hoped its move would set an example, but that each jurisdiction should have the flexibility to respond to trends on their own terms.

“We are hopeful that, as other cities and states start to see worrisome rises in COVID-19 cases, they will feel less pressure to be the first,” Kyle said.

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