COVID-19 Mask Guidance

 
Updated August 31, 2023 
DOH 820-131 
 
 
This guidance document is being reviewed for updates. The Washington State Department of 
Health has updated its guidance for what to do if you are sick with COVID-19 or were exposed 
to COVID-19. This document may have content that is inconsistent with the new guidance. 
 
COVID-19 Mask Guidance  
Summary of August 31, 2023 Changes  
•  Updated the Washington State Labor and Industries and Local Public Health Officials 
sections  
•  Updated recommendations for non-health care congregate settings and for individuals  
Introduction  
When you wear a mask or respirator (i.e., specialized filtering masks such as N95s), you help 
protect others around you as well as yourself. Wearing a mask or respirator can reduce the 
spread of COVID-19, saving lives and keeping the economy open. Combined strategies, such as 
staying up to date on vaccines, improving ventilation, staying home when you are sick, and 
wearing masks or respirators, can help prevent severe illness and lower the burden on the 
healthcare system. 
When you choose to wear a mask or respirator, use the best-fitting and highest quality one 
available to you. When worn properly, respirators approved by the National Institute for 
Occupational Safety and Health (NIOSH) (such as N95s) offer the most protection, followed by 
international respirators (such as KN95s and KF94s), surgical masks, and then cloth face 
masks. If you are at risk of severe COVID-19 disease, consult with your healthcare provider 
about whether you should get fit tested for a NIOSH-approved respirator or if you should 
consider other respirator options that do not require fit testing. For more information on fit 
testing and mask selection, visit Washington State Department of Labor and Industries (L&I) 
webpage on voluntary masking. When respirators are required, they must be worn according to 
Chapter 296-842 WAC and as part of a respiratory protection program. 
For more information about different types of masks and respirators and how to improve fit, 
see types of masks and respirators. This webpage provides some information on how well 
different types of masks and respirators filter out particles, including when modifications are 
made to masks to improve fit.  
People who cannot wear a mask due to developmental, behavioral, or medical conditions can 
use a face shield with a drape. These may also be used by children in child care, day camp, and 

K-12 settings if a well-fitting mask is not tolerated. However, a face shield with a drape does

not provide the same level of protection for the wearer as a well-fitting mask or respirator.

See the Washington State Department of Health (DOH) K-12 School and Child Care guidance.

Also see CDC’s Considerations for specific groups of people. DOH recommends not using masks

with exhalation valves or vents, single layer cloth masks, single layer bandanas, or gaiters.

Please visit DOH’s webpage on masks for a list of frequently asked mask questions.

Throughout the rest of this document, mask is used to refer to both masks and respirators.

COVID-19 guidance is subject to change because of changing circumstances, such as strains on

the healthcare system or new COVID-19 variants.

Current Requirements

The Secretary of Health Mask Order that established statewide requirements for masking in

specific indoor settings has been rescinded. However, you may still be required to wear a mask

in certain circumstances or settings.

Washington State Labor and Industries (L&I)

Although masks are not generally required in most workplaces, employers remain obligated to

follow L&I Requirements and Guidance for Preventing COVID-19. Additionally, private

businesses can choose to require masks, and visitors should respect the rules of the room.

Local Public Health Officials

Public health authorities may require masks in some situations, such as outbreaks. Because of

local circumstances, they may recommend masking in situations beyond those described in this

guidance. Local health officials have the authority to issue health orders to control diseases

within their jurisdiction. Check with your local health jurisdiction and follow all health orders in

place for that area.

Recommendations

Below are public health recommendations in addition to the requirements above.

Public Transportation Settings

DOH recommends that workers and passengers aged two years or older wear a well-fitting

mask or respirator in indoor public transportation settings, including conveyances (such as

airplanes, buses, trains, ferries, subways, taxis, rideshares, and non-emergent medical

transportation) and hubs (such as airports, bus or ferry terminals, train or subway stations, and

seaports). These are settings that many people pass through, and they can be crowded and/or

poorly ventilated (such as airport jetways). Travelers and workers can protect themselves and

those around them by wearing a well-fitting mask or respirator to help keep travel and public

transportation safer for everyone. Information about when masking is most useful during travel

can be found in CDC guidance about masking during travel. DOH encourages operators of public

transportation to support mask wearing by all people.

     
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Masking in Health Care Settings 
All health care settings can access personal protective equipment and source control guidance 
in COVID-19 Infection Prevention in Healthcare Settings. Licensed health care facilities are 
required to have infection prevention policies and systems in place. Any health care facility may 
choose to require workers and visitors to wear masks.  
 
Masking Recommendations for Non-health Care Congregate Settings 
Non-health care establishments (such as businesses and organizations) may require that people 
wear masks in their facilities. These establishments should consider each of the following 
factors when deciding whether to require masks in their setting: 
•  Vulnerability of people in the setting 
o  People not up to date on COVID-19 vaccines are more likely to get COVID-19 and 
to get very sick. 
o  People with certain medical conditions are at higher risk of severe COVID-19.  
•  Quality of ventilation in the setting - see Ventilation and Air Quality for Reducing 
Transmission of Airborne Illnesses, CDC Ventilation in Buildings Guidance, and the EPA 
Clean Air in Buildings Challenge for information and ventilation options, including for 
facilities with and without heating, ventilation, and air conditioning (HVAC) systems 
•  Ability of people to physically distance in the setting 
•  Suspected or confirmed outbreak of COVID-19 in the setting 
o  Indoor mask use is strongly recommended when there is an outbreak in a non-
health care congregate setting. The definition of an outbreak in such settings can 
be found in Guidance for Non-Healthcare Businesses and Organizations during 
COVID-19. 
When CDC COVID-19 hospital admission level is high, CDC and DOH recommend that all people 
wear masks indoors, regardless of vaccination status. Establishments should not discourage 
individuals from wearing masks if they choose to do so. See below for individual masking 
recommendations and risk-based considerations. 
Individual Mask Recommendations 
People aged two years or older with symptoms, a positive test, or exposure to someone with 
COVID-19 should wear a high quality mask or respirator, in accordance with COVID-19 Decision 
Trees for the General Public, What to do if you test positive for COVID-19, and What to do if you 
were potentially exposed to someone with COVID-19. Mask use is not recommended for 
children less than two years of age.  
You can choose to wear a mask at any time. Consider the following factors when deciding 
whether to wear a mask: 

     
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•  Your vaccination status and the vaccination status of those around you. People who are 
not up to date on COVID-19 vaccines and boosters are more likely to get COVID-19 and 
to get very sick.   
•  Your medical conditions and the medical conditions of those around you that are at 
increased risk of severe COVID-19 disease. People with certain medical conditions are 
more susceptible to COVID-19 and to getting very sick.   
•  The characteristics of the setting you are in (e.g., crowded, poorly ventilated, indoors)  
•  CDC COVID-19 hospital admission level 
o  When hospital admission level is high, CDC and DOH recommend wearing masks 
indoors, regardless of vaccination status.  
o  When hospital admission level is medium or high, CDC and DOH recommend that 
people at high risk of getting very sick from COVID-19 wear a high-quality mask 
or respirator when indoors in public. People who have household or social 
contact with someone at high risk of getting very sick should consider wearing a 
high-quality mask when indoors with them. 
•  Other metrics besides hospital admission level, such as emergency department visits 
and wastewater COVID-19 detection, can help identify early changes in COVID-19 in the 
community. 
Mental and Behavioral Health Resources  
Please visit the DOH Behavioral Health Resources and Recommendations webpage. 
More COVID-19 Information and Resources 
Stay up-to-date on the current COVID-19 situation in Washington, symptoms, how it spreads, 
how and when people should get tested, and where to find vaccines. See our Frequently Asked 
Questions for more information.   
A person’s race/ethnicity or nationality does not, itself, put them at greater risk of COVID-19. 
However, data are revealing that communities of color are being disproportionately impacted 
by COVID-19 - this is due to the effects of racism, and in particular, structural racism, that leaves 
some groups with fewer opportunities to protect themselves and their communities. Stigma 
will not help to fight the illness. Share accurate information with others to keep rumors and 
misinformation from spreading. 
•  WA State Department of Health COVID-19 Response 
•  Find Your Local Health Department or District 
•  CDC Coronavirus (COVID-19) 
Have more questions? Call DOH at 1-800-525-0127.  
For interpretative services, press # when they answer and say your language. For questions 
about your own health or testing results, please contact a health care provider.  
To request this document in another format, call 1-800-525-0127.  

Deaf or hard of hearing customers, please call 711 (Washington Relay) or email

[email protected].

Appendix A

Health Care Setting

Health care settings and long-term care settings are any public or private setting that is

primarily used for the delivery of in-person health care services to people, with some

exceptions. If located in a facility that is primarily used for the delivery of health-care services,

such as a hospital, then the entire facility is a health care setting or long-term care setting. If

located in a facility that is primarily used for another purpose, such as a pharmacy within a

grocery store or a school nurse’s office, the health care setting or long-term care setting

includes only the areas that are primarily used for the delivery of health care, but not the other

areas of the facility. Unless excluded below, health care providers include individuals with

credentials listed in the Healthcare Professional Credentialing Requirements list as well as

individuals who are permitted by law to provide health care services without holding a

credential.

The following is a non-exclusive list of health care settings and long-term care settings:

• Acute care facilities, including, but not limited to, hospitals;

• Long-term acute care facilities;

• Inpatient rehabilitation facilities;

• Inpatient behavioral health facilities, including, but not limited to, evaluation and

treatment facilities, residential treatment facilities, secure detox facilities;

• Residential long-term care facilities, including, but not limited to, nursing homes,

assisted living facilities, adult family homes, settings where certified community

residential services and supports are provided, and enhanced services facilities;

• Mobile clinics or other vehicles where health care is delivered;

• Outpatient facilities, including, but not limited to, dialysis centers, infusion centers,

physician offices, and behavioral health facilities (including offices of psychiatrists,

mental health counselors, and substance use disorder professionals);

• Dental and dental specialty facilities;

• Optometry and ophthalmology facilities;

• Pharmacies (not including the retail areas);

• Massage therapy offices (this includes designated areas where massage is administered

within non-health care settings like spas and wellness/fitness centers);

• Chiropractic and physical therapy offices;

• Midwifery practices and stand-alone birth centers;

• Isolation and/or quarantine facilities;

• Ambulatory surgical facilities;

• Urgent care centers;

• Hospice care centers; and

• Settings where home health care, home care, personal care, or hospice care services are

delivered by paid providers.

Health care settings and long-term care settings do not include:

• Settings where sports and spectator events or other gatherings are held (including when

credentialed athletic trainers are providing care to players), other than areas primarily

used for the delivery of health care services, such as designated first aid areas (which

are health care settings);

• Department of Children, Youth & Families (DCYF)-licensed foster homes that do not

primarily provide health care services;

• Research facilities where no health care is delivered to people;

• Veterinary health care settings;

• Animal control agencies;

• Non-profit humane societies; and

• Marijuana retail outlets, including those where medical marijuana consultants provide

services.

If the health care facility requires masks outdoors, you must adhere to their business rules. See

the “rules of the room” information below for more information. Please visit the COVID-19

Infection Prevention in Healthcare Settings page for detailed guidance including source control

guidance and visitation guidance to certain health care facilities.

Rules of the Room

Businesses, organizations, facilities, and establishments have the right to set their own rules for

wearing masks in their establishment or facility. Businesses are required to follow all

requirements in L&I requirements and may choose to require masks in settings.

Local public health officials may also put more protective mask orders in place to limit

transmission in the community.

Additionally, some individuals may need to, or choose to, continue to wear a mask. They have

the right to choose to wear masks in public even when state or local masking mandates are not

active. Please respect their choice to wear masks to protect themselves, their family, and

communities. Note that if you choose to wear a mask you may be asked to briefly remove it in

situations such as those for identification purposes.