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Pima County now 'strongly recommends' indoor mask wearing as variant cases rise
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Pima County now 'strongly recommends' indoor mask wearing as variant cases rise

Though broad mask mandates have not been reinstated, the city of Tucson is requiring that masks be worn in city-owned buildings, and Pima County is recommending masks be worn indoors regardless of vaccination status.

Pima County is changing its COVID-19 guidance to “strongly recommend” mask-wearing in indoor settings regardless of vaccination status amid new CDC guidance, Dr. Theresa Cullen, director of the county Health Department, announced Wednesday.

The CDC changed its masking guidance Tuesday as cases of the highly contagious delta variant rise throughout the United States. The new recommendation is for fully vaccinated people to wear masks indoors in areas with moderate or substantial COVID-19 transmission, including Pima County.

Dr. Theresa Cullen, the county's public health director, says the health department is "strongly recommending" mask-wearing indoors. Video courtesy of Pima County.

The federal health agency said in May that fully vaccinated individuals no longer had to wear masks in most settings, causing both Pima County and the city of Tucson to rescind their mask mandates. Now, with cases of the delta variant rising in the county, the Health Department is recommending everyone resume wearing masks indoors.

The Health Department was to release an updated public health advisory later Wednesday, but Cullen said the mask mandate won’t be reinstated at this time.

About 52% of Pima County’s population has been fully vaccinated, according to CDC data, but Cullen says this is “not where we need to be.”

Only 0.1% of vaccinated individuals report breakthrough cases of COVID-19, according to Cullen, but the percentage of vaccinated people who are hospitalized for COVID is unknown. However, the emergence of the delta variant is suggesting while fully vaccinated individuals are less likely to experience severe COVID-19 cases, they can still transmit the virus.

“There was the belief up till very recently that if you were vaccinated, and you got COVID, that your ability to transmit the virus to others was very minimal,” Cullen said. “That is now changing based on increasing scientific evidence.”

She says the latest data for the number of delta-variant-caused cases in the county was 41 as of July 17, but the real amount is likely much higher. Delta cases are identified through random sequencing, and only 12% of all COVID-19 cases are sequenced.

The week ending July 24, the county’s COVID-19 case count increased by 27% from the week before, while the state’s count increased by 33%, according to data from the Arizona Department of Health Services.

Testing labs will likely report more cases over the coming days for the week ending July 24 due to standard lags in the reporting process.

Pima County jumped from moderate to substantial transmission on July 19 and is currently seeing about 65 new cases per 100,000 of the population in the last week, according to CDC data.

The CDC defines substantial transmission as counties with 50 to 100 new cases per 100,000 of the population within the past week. If more than 100 cases occur, transmission is considered high.

“If we continue to see the increases that we have seen in the last week in our caseload, it is very possible that we will get to high transmission,” Cullen said.

And with guidelines from the state limiting schools’ ability to mitigate COVID-19, the emergence of back-to-school season could influence that change.

School COVID-19 cases emerging

The county is following the CDC’s updated guidance recommending universal masking for all teachers, staff workers, students and visitors to schools regardless of their vaccination status.

According to Cullen, “There is potential for very significant impact on the community at large because of the school-based cases.”

Since July 20, the Health Department has already seen 56 COVID-19 cases in local schools and expects to have 10 more reported by the end of the day, Cullen said.

After reaching out to local pediatricians in hospitals, she said most are seeing increased admissions and more severe cases of COVID-19 among youth. Cullen said while experts “had this thought earlier that while kids will get sick, they may not even be symptomatic,” that sentiment is quickly changing.

From July 2020 to July 2021, 4% of COVID-19 cases fell within the K-12 age group at 4,096 cases, Cullen reports. She estimates 5% to 10% of current COVID-19 cases are happening in school settings.

Before most schools return from summer break, the Health Department has already identified eight outbreaks, which occur when two linked COVID-19 cases happen within 14 days. One classroom has been closed and its students sent home to quarantine.

While she couldn’t reveal which districts the cases are from, Cullen says they’re mostly from districts already back in session and in activities such as “football, cheerleading and freshman orientations.”

In response, the Health Department is increasing the size of its staff tracking infections in schools “because we believe there will be more outbreaks,” Cullen said.

However, Arizona has prohibited school districts from requiring face coverings in a new law passed with the Legislature’s annual budget in June. Gov. Doug Ducey said Tuesday that he will not change this policy despite new CDC guidelines.

“Arizona does not allow mask mandates, vaccine mandates, vaccine passports or discrimination in schools based on who is or isn’t vaccinated,” Ducey said in a prepared statement. “We’ve passed all of this into law and it will not change.”

But mitigating the spread of COVID-19 in schools is the authority of the Health Department, not school districts, Cullen says. As it closely tracks COVID-19 cases in the classroom, the Health Department makes the call on declaring an outbreak in a classroom that could require quarantine.

“(School districts) have limited ability to do certain things, and that’s why we believe it is our responsibility to do the strong recommendation about masking,” she said. “We are cognizant of what the governor has stated. We believe that our approach to this takes the onus off the school and basically says the follow-up is due to us.”

Mask mandates

Although Cullen said reinstating the local mask mandate isn’t yet on the table, Tucson Mayor Regina Romero took action Wednesday to require mask-wearing in all city facilities. The mandate applies only to city-owned buildings, and not private businesses and establishments.

“According to the CDC, Pima County is an area of ‘substantial transmission,’ with COVID-19 cases increasing locally and statewide,” Romero said in a news release. “I strongly encourage all Tucsonans to continue to follow CDC guidelines and wear a mask whenever indoors in public, regardless of whether you are vaccinated.”

Cullen hopes the updated county Health Department guidance coupled with the CDC’s update will be enough to encourage people to follow the non-mandated recommendations.

“We are strongly recommending (masks) with the hope that as we increase our education of the community, we encourage people to get vaccinated, that there will be increased adherence to these recommendations,” she said.

All Tucson buildings are now mandating mask-wearing. Video courtesy of City of Tucson.

Contact reporter Nicole Ludden at

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Nicole joined the Star in 2021. She earned her bachelor’s degree in journalism at ASU’s Cronkite school in 2020 and has won awards from the Society of Professional Journalists, AC Press and Arizona Press Club.

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