LOS ANGELES – As has happened each December, Covid-19 cases are ratcheting up in Los Angeles County, with hospitalisations nearly tripling in the past month – a signal that another mask mandate could be on the horizon.

The region is no stranger to pandemic orders, having experienced stringent lockdowns and a state-imposed curfew in late 2020.

But this time around, even as the numbers in Los Angeles become the highest in California, many have grown weary of warnings and talk of precautions. Covid-19 updates do not elicit the unease they once did – in part because cases and hospitalisations during the current outbreak are nowhere near where they were during the worst stretches. But also because the subject has grown tiresome, residents said.

“I think it’s just kind of run its course with me,” said Mr Kirk Carter, 60, a retired television writer who lives in Los Angeles. “It’s become normalised.”

The perception of the coronavirus, in the age of vaccines and survival stories, has seemingly evolved from a deadly threat to an annoyance for the healthy. And health officials noted that, at some point over the past year, indifference supplanted fear, and face coverings became a casual accessory, often tucked under a chin if worn at all.

When Mr Carter, who is vaccinated and boosted, recently took a trip to New York to visit his daughter, he felt no need to don a mask while on the plane, which he had always found uncomfortable.

“I’m less worried about getting sick by Covid than I am about being inconvenienced by Covid,” he said.

That feeling is reflected across the United States, even as it is once again experiencing an uptick in cases in the weeks after Thanksgiving. New case reports and hospitalizations are up by more than 25 per cent, and test positivity rates are rising quickly, particularly in major urban areas.

The virus is likely spreading faster than case numbers suggest because people are increasingly relying on at-home tests and are not reporting the results. And public health researchers warn that it is too early to declare that this winter will be less severe than during the past two years, especially as Americans gather again for the holidays later in December.

While healthy individuals seem less concerned about Covid-19 this December, the virus spread poses serious risks for older people and those who are immunocompromised.

What surge?

New York has the highest per-capita daily case rate of all the states, with New York City showing the highest rates of new cases and hospitalizations. In both the city and the state, more people are hospitalised with Covid-19 than at any point this summer, when the BA.5 subvariant drove a notable increase.

In California, hospitalisations have risen by more than 60 per cent in recent weeks, a sharper increase than in almost any other state, which could be a sign of an impending larger surge.

But the rising rates are also a fraction of last winter’s numbers. Deaths from Covid are nearly as low as they have been since the start of the pandemic, with about 290 reported across the country each day. Fatalities, however, typically rise weeks after an increase in cases.

And reports of a surge have not had the same effect they did a year ago, when the Omicron variant caused many people to cancel travel plans and pare back holiday gatherings. That shift in attitude could be a tension point should officials attempt to reinstate mask mandates.

Dr Barbara Ferrer, director of the Los Angeles County Department of Public Health, said a mandate would happen if thresholds for case rates, as well as two hospital indicators – the rate of admissions and the proportion of beds used by Covid-19 patients – were surpassed. As of this week, only the metric for hospital admissions has been met, she said.

“We’ll wait, but, you know, from my perspective, I wish it was less focused on whether it’s mandatory or whether it’s a strong recommendation,” Dr Ferrer said. “What it is, is this is the time for everyone to put their mask back on right now. Not two weeks from now, not four weeks from now. If we want to make a difference and start reducing community transmission, we need to get the mask back on.”

Difficult to mandate now

The idea of a mandate was floated by the county when Covid-19 cases rose in the summer. The notion was immediately met with criticism.

“The early days of ‘What I do affects you, and what you do affects me’ – there are very few people who still think that way,” said Dr Robert Wachter, chair of the department of medicine at the University of California, San Francisco. “It’s a natural phenomenon to move from a communal point of view to this individual risk benefit point of view.”

Dr Wachter said mask mandates has been about signalling a level of seriousness and creating a social standard.

“I don’t think it was ever enforceable. I think it was just a consensus that it was the right thing to do, and there was a lot of social pressure to do it,” he said.

Nowadays, that pressure seems to have reversed. “I’ve seen people go into a space, see that no one is masking and take off their mask,” Dr Sara Cody, the Santa Clara County public health director, told reporters on Tuesday.

Dr Cody also announced that wastewater numbers in her area, which includes the Silicon Valley, were “absolutely skyrocketing”, indicating a high spread of Covid-19. She encouraged people to mask. although she did not anticipate making anything official.

“Three years in, it is extraordinarily difficult to mandate,” she said. NYTIMES