‘I’m tired of all this’: Even in Bay Area, mask fatigue is rising fast – San Francisco Chronicle

Dr. Grant Colfax was about halfway into a community meeting on how San Francisco has weathered the pandemic when the topic of masks, perhaps inevitably, came up.

Wearing them indoors, in spaces where everyone is vaccinated, feels performative, said Manny Yekutiel, owner of Manny’s, the Mission District restaurant hosting the event last week with San Francisco’s head of public health. Yekutiel gestured around the space, where three-dozen people — all of whom had provided proof of vaccination before coming inside, all wearing face coverings — gathered on sofas and folding chairs to listen.

Colfax couldn’t say when mask mandates might be lifted, though he and his peers are now expected to offer some guidance on Thursday. At the meeting, Colfax conceded masks might be around in some high-risk settings for the foreseeable future. Yekutiel said he understood, but after nearly two years of living under the fear and uncertainty of a pandemic and facing down four surges, he was exhausted.

“Not being able to plan for what a future looks like … not being able to go into a shop because I forgot my mask, that not knowing — it’s grinding down on me,” Yekutiel said. “I’m proud of San Francisco, I’m proud to be here. And also I’m tired of all this.”

Even in the Bay Area, where people have largely supported, and even celebrated, public health restrictions that have likely saved thousands of lives, masks have become the target of more than 18 months of cumulative, communal frustration.

On Thursday, Bay Area health officials are expected to reveal the criteria that counties need to meet before they can lift, or at least loosen, indoor mask mandates. The criteria likely will include case, hospitalization and vaccination rates. It’s not clear yet if any counties will immediately meet those metrics and lift mandates right away.

Customers wear masks while waiting in the checkout line at Cliff's Variety on Castro Street in San Francisco, Calif. Wednesday, October 6, 2021.

Customers wear masks while waiting in the checkout line at Cliff’s Variety on Castro Street in San Francisco, Calif. Wednesday, October 6, 2021.

Jessica Christian / The Chronicle

Colfax and others have implied that mandates will be loosened in phases — perhaps dropped in places where people have to prove vaccination. They may remain in places where vaccinated and unvaccinated people mingle. Due to state orders, unvaccinated people will still be required to wear masks even if the local mandate is lifted, though that requirement is often poorly enforced.

Setting goals should help alleviate some of the public backlash to masks that has escalated in recent weeks, public health experts said.

“I don’t know what criteria they will come up with, but I will say it’s the right thing. You should always have clear ideas,” said Dr. Monica Gandhi, an infectious disease expert at UCSF. If health officials can’t give people goals, if they can’t explain the decisions they make, “people get frustrated, and at some point it will boil over,” she said.

That’s already happening. At a public meeting in late August, a Santa Clara County supervisor pressed Dr. Sara Cody, the widely popular health officer, on when mandates might be lifted there, arguing that setting goals is critical for maintaining public trust. In mid-September, Mayor London Breed — who’s been famously supportive of her public health department — came under scrutiny when she was spotted in a club without a mask, and she lashed out in response; this week she said revisiting the mandate was “overdue.”

Santa Cruz County last week became the first county in the Greater Bay Area to drop its indoor mask mandate after it reached “moderate” transmission levels as defined by the Centers for Disease Control and Prevention. Though the county still urges all residents wear masks indoors, most businesses immediately stopped requiring them.

When the county health department reinstated the mask mandate on Aug. 19, it included criteria for ending the mandate. That was deliberate, said Dr. David Ghilarducci, the deputy health officer.

Larry and Robin Freitas, visiting from Stockton, walk around the Santa Cruz Boardwalk on Tuesday. Last week Santa Cruz County became the first California county to drop its mask mandate.

Larry and Robin Freitas, visiting from Stockton, walk around the Santa Cruz Boardwalk on Tuesday. Last week Santa Cruz County became the first California county to drop its mask mandate.

Clara Mokri/Special to the Chronicle

“We felt it was important to communicate to the community that there was a shutoff switch to it, that it wasn’t perpetual,” he said. “We felt it was important to give the public a break, to give them some credit for their collective action that helped things improve. And, of course, if things get bad again we still have that tool in our back pocket.”

Masks have come under scrutiny lately in part because they’re among the last universal pandemic protocols in play in the Bay Area. There’s no more social distancing or capacity limits. Vaccine mandates apply, but impact only those who haven’t been vaccinated.

And masks are also the most visible sign that the region is still under attack in this pandemic.

“We’ve had relatively little of that libertarian idea of ‘freedom’ and ‘liberation’ with masks in the Bay Area,” said Dr. Robert Wachter, chief of medicine at UCSF. “But the psychological piece of ‘I want my life back,’ it’s a powerful human instinct. This whole thing sucks and we’ve been going on a long time. Masks have taken on a symbolic role as the most visible day-to-day sign we’re still in it.”

Bay Area counties were among the first in California to reinstate mask mandates in early August, when cases began to soar in the delta surge. The California Department of Public Health never did bring back universal masking, though state orders requiring masks in schools and health care settings are expected to remain in place for the foreseeable future.

Like the rest of the state, the Bay Area had largely dropped its mandates when California reopened June 15. Health officials were buoyed by early reports that the highly effective vaccines could prevent infections and stop the spread of disease.

But delta quickly undermined the state’s reopening and forced many health experts to reevaluate their understanding of vaccine effectiveness. The vaccines continue to protect strongly against severe illness and death, but don’t do as well at halting infection or transmission. That meant everyone needed to mask up again.

In some ways, determining when masks can come off again is a far more complicated challenge. Masks are appealing for pandemic control because of their cost-benefit ratio — it’s not that hard to ask people to wear masks, and they clearly help slow the spread of disease.

Signage reminds customers to wear masks while inside Cliff's Variety in San Francisco. Terry Asten Bennett, a co-owner, said the city's mask mandate has helped her stay open and keep her staff and customers safe.

Signage reminds customers to wear masks while inside Cliff’s Variety in San Francisco. Terry Asten Bennett, a co-owner, said the city’s mask mandate has helped her stay open and keep her staff and customers safe.

Jessica Christian/The Chronicle

“The moment you give up a mask mandate you’re giving up one of your key interventions,” said Dr. Abraar Karan, a Stanford infectious disease expert. Bringing back masks this summer likely played an important role in squashing the delta surge before it could overwhelm hospitals, he said. “It worked, and I understand why many health departments are hesitant to pull back on that.”

The Bay Area is currently averaging about 10 coronavirus cases per 100,000 residents a day — less than half of the summer peak in August, but still three or four times higher than the rate when the state reopened in June. Hospitalizations similarly have dropped rapidly from the summer peak — from about 1,100 in mid-August to under 500 this week — and are still three times higher than June.

And the region is heading into another fall and winter, when most experts are predicting another swell in cases. Waning immunity may also present challenges, with boosters having only just started rolling out — and kids under 12 still not eligible for the vaccine. “It may not be the best time to be hasty pulling back on masks,” Karan said.

To many people who are experiencing mask fatigue, the frustration is less about wanting to take off their face coverings right away and more about not understanding how decisions about mandates are being made.

When Yekutiel asked Colfax at the Mission District event when the mandate might be lifted, Colfax was vague in his reply. At one point he implied he might wait until children ages 5-11 become eligible for vaccination, which could happen as soon as this month — but those kids won’t be fully vaccinated until November or December at the earliest.

“It feels like the goal posts keep moving,” Yekutiel said in an interview this week. “I don’t envy folks in public health because their job is to keep everyone safe, and they’re using the best information they have. But there’s this feeling of, ‘you told us all to get vaccinated, and we did. You asked us to restrict our spaces to be vaccine-only, and we are.’ But we’re running out of things to do on our part.”

Even those who support masks in general say they’re struggling with not knowing how long the mandates will be in place. Terry Asten Bennett, who co-owns Cliff’s Variety, a gift shop in the Castro District, said San Francisco’s mask mandate has helped her stay open and keep her staff and customers safe. Keeping the mandate around through the winter would help give her stability during the critical holiday shopping season.

“There’s already a whole lot of uncertainty about this winter,” said Bennett, who is dealing with inventory shortages for Halloween and bracing for a chaotic Christmas. “Financially, we need this winter to be successful. We need to keep our economy open and healthy. And masks are the easiest way to do that.”

Erin Allday is a San Francisco Chronicle staff writer. Email: eallday@sfchronicle.com Twitter: @erinallday