Officials in a large swath of the Bay Area announced Monday that residents will again need to wear masks in indoor public settings regardless of vaccination status amid a surge in COVID-19 cases fueled by the highly transmissible Delta variant.

The move comes several weeks after Los Angeles County became one of the first in the nation to return to an indoor mask mandate, and Monday’s move greatly expands the number of people in California covered by such rules.

Health officers from Alameda, Contra Costa, Marin, San Francisco, San Mateo, Santa Clara and Sonoma counties and the city of Berkeley made the joint announcement Monday afternoon. They said the Delta variant is causing cases and hospitalizations to escalate and predicted that deaths also will rise in the coming weeks.

Most Bay Area residents who have been hospitalized were unvaccinated, but the elderly and people with underlying conditions who were fully vaccinated also are succumbing to the Delta variant, the officers said. They said the new mandate arose from a rise in hospitalizations and a new understanding that even the vaccinated may spread the virus.

“This is not the same virus we were combatting last year,” said Sonoma County Health Officer Dr. Sundari R. Mase, noting that it is 60% more infectious than previous variants.

“Quite frankly,” added Dr. Lisa Hernandez, Berkeley’s health officer, “vaccines are keeping thousands out of Bay Area hospitals and morgues right now.”

The order will go into effect Tuesday at midnight, and officials said they intended it to be temporary, although they did not provide a timeline. They also said they hoped requiring masks would preempt the need for more drastic restrictions such as closures of public spaces and businesses.

“The goal of these orders is to avoid disrupting our businesses’ continued operations and residents’ everyday activities,” Dr. Lisa Santora, deputy health officer for Marin County, said at a news conference.

She said the number of breakthrough infections among the fully vaccinated has doubled every month since April.

Restaurants and bars for indoor service will remain open, but patrons will have to wear masks when they are not eating or drinking, the officers said. The officers said they also continue to support the reopening of schools as long as students and staff wear masks.

Dr. Chris Farnitano, Contra Costa’s health officer, said unvaccinated people should avoid indoor dining, gyms and theaters until they are immunized. Four out of 5 people hospitalized for COVID-19 in the county have been unvaccinated, he said.

In Marin County, where vaccinations rates are high, about 1 out of every 7 to 8 people hospitalized for COVID-19 were vaccinated.

In Sonoma, 86% of those in the hospital now for COVID-19 are unvaccinated. Two fully vaccinated individuals have died in Sonoma. Both were older than 90 and had underlying health ailments.

In San Francisco, 9.3 people out of every 1,000 people are contracting the disease, even though they are fully vaccinated. The number for the unvaccinated is at 78.2 for every 1,000 people.

Farnitano said most of the COVID-19 patients in Contra Costa hospitals are in their 40s, 50s, and early 60s because most older people have been vaccinated. He described the patients as gasping for breath, with tubes down their throats and hooked up to machines.

“Even if you survive a COVID hospitalization, it is terrible experience,” he said.

San Francisco’s mask mandate came just as the city was celebrating the return of its iconic cable cars, which were shut down in the pandemic.

Dr. Naveena Bobba, San Francisco’s acting health director, stressed that the vaccines continue to be protective. Those who are fully vaccinated remain less likely to contract the disease and more likely to have only mild disease if they do, she said.

On July 17, Los Angeles County started requiring all residents, regardless of vaccination status, to again wear masks in indoor public spaces as case counts ticked upward. Some local governments and business owners are going a step further with more stringent rules such as requiring people to show proof of vaccination before being allowed to enter a place.

While Los Angeles County officials are hoping the mask rules will slow the new surge, it will take at least several more days to know if the measure is effective.

Based on assessment of transmission rates this week, county health officials said in statement they “will have a more complete picture to inform this discussion by the end of the week.”

The current surge in cases is hitting the those who are unvaccinated community hard. People who are vaccinated enjoy are strong protected strongly against contracting the coronavirus and, if they do contract it, have less serious illnesses.

“The tragic reality is that almost every single person hospitalized and dying from COVID-19 is unvaccinated and these hospitalizations and deaths are, for the most part, preventable,” Dr. Barbara Ferrer, the Los Angeles County public health director, said in a statement.

According to data compiled by the The Times, 76.7% of San Francisco County residents have received at least one dose of a COVID-19 vaccine and 70.5% are fully vaccinated — well above the 61.5% of Californians who have received at least one dose. Meanwhile, 61.9% of L.A. County residents have received at least one dose of vaccine, and 54.2% are fully vaccinated, according to Times data.

Last week, California urged everyone — even those fully vaccinated against COVID-19 — to wear masks indoors while in public, joining a renewed national push to increase protection amid an ongoing spike in cases. But the ultimate goal is to persuade those who have not been vaccinated to get their shots, which experts say is vital to reversing the surge.

“As always, as occurred in parts of the Bay Area today, local health jurisdictions may put in place guidance more restrictive than the state based on local conditions,” the California Department of Public Health’s communications office said in a statement.

From July 18 to 24, providers throughout the state administered an average of just more than 64,000 vaccines a day — about 3,100 more daily doses than the week before.

An increasing number of institutions are requiring proof of vaccination in hopes of protecting both workers and the public.

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