The COVID-19 pandemic may be over but a familiar and controversial pandemic-era mandate is making a return in some states. Mask mandates are back at some hospitals in the United States.

Hospitals in a handful of states are requiring staff to wear masks following a rise in the JN-1 variant, the most prevalent form of COVID-19 this winter.

Hospitals in California, Illinois, Massachusetts, New York and Washington D.C. have all brought back mask requirements for selected people in medical settings, according to Newsweek.

Some medical facilities are revisiting mask mandates after the Centers for Disease Control and Prevention (CDC) reported a 10.4% increase in COVID-19 hospitalizations in the week leading up to Dec. 16. CDC data also shows a 3.4% increase in deaths from the virus.

The agency reports the new variant accounted for 44% of infections nationwide by mid-December. That number is up 7% from late-November.

Mask mandates have been controversial since the day they were first implemented.

In early 2020, medical professionals and the CDC advocated for masking in everyday life from grocery stores and airplanes to religious services. As the pandemic waned, so did mandates.

However Massachusetts’ largest health system, Mass General Brigham, said masks will be mandated effective Jan. 2. The hospital said masks will be necessary until respiratory illnesses decline.

The rule is enacted when respiratory illnesses constitute more than 2.85% of patients visiting the hospital or outpatient clinics with respiratory symptoms for two consecutive weeks. The mandate is lifted when the hospital falls below 2.85% for one week.

The hospital “strongly recommends” patients and visitors wear masks. Staff in hallways and common areas are exempt from wearing masks.

Some medical facilities took action even earlier when it comes to masks. The Dana-Farber Cancer Institute in Boston began requiring masks for patients and staff on Dec. 18.

The facility said the policy will be in place for the “foreseeable future,” and it has no gauge for when to rescind the mandate.

However, the hospitals implementing these policies remain in the minority. Most hospitals eased or eliminated masking requirements last spring, according to a report by The Hill.

The topic of masking is bringing focus to the personal protective equipment (PPE) supply in the states returning to the mandates.

An investigative report by The Associated Press found at least 15 states tossed PPE because of expiration dates, surpluses and people unwilling to use them.

States trashed more than 18 million masks, 22 million gowns, 500,000 gloves and more. Rhode Island reported tossing or recycling more than 829 tons of PPE. Maryland got rid of more than $93 million in supplies.

The AP found that Ohio auctioned off 393,000 gowns for just $2,451, and it ended up throwing away another 7.2 million, along with expired masks, gloves and other materials. The now-expiring supplies cost the government $29 million.

In 2020, states spent more than $7 billion in a few months on PPE, ventilators and some other high-demand medical devices. The federal government paid for much of the supplies.

With larger surges of COVID-19 over, expiration dates are passing and fewer requests to tap into the stockpile are coming in.

“What a real waste,” said Dr. George Benjamin, the executive director of the American Public Health Association. “That’s what happens when you don’t prepare, when you have a bust-and-boom public health system. It shows we really have to do a better job of managing our stockpiles.”

However, states claim to have distributed far more gear than they discarded and maintain that they’ve gone to lengths to donate leftovers.

Washington state donated hundreds of thousands of supplies to the Marshall Islands in 2022. Pennsylvania said it offered PPE to 10,000 cities, health facilities and more throughout the pandemic. Both states still ended up throwing out expired items.

Some states have found limited post-expiration uses, such as training exercises.

Many states keep at least a portion, and sometimes all, of their remaining stockpile of PPE. States like Minnesota even plan to update their stockpiles.

While mask requirements go into place at some hospitals, the states seeing the largest increase in COVID-19 are steering clear of any mandates in hospitals.

Newsweek reports Nebraska, Iowa, Kansas and Missouri have seen the largest number of positive cases. CDC data from the week ending on Dec. 23, 2023, shows these states with an 18.3% COVID positivity rate.

No state in the country has a mandatory mask policy for any indoor and outdoor setting.