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(AP) — The St. Louis area has become one of the first in the U.S. to reinstate mask requirements amid a rise in cases that health officials are blaming on low vaccination rates and the highly contagious delta variant.

Despite pushback from some elected officials, face coverings became mandatory Monday in indoor public places and on public transportation in St. Louis city and St. Louis County for everyone age 5 or older — even for those who are vaccinated. Wearing masks outdoors is strongly encouraged, especially in group settings.

“For those who are vaccinated this may feel like punishment, punishment for doing the right thing,” St. Louis County Executive Sam Page, a Democrat, said at a news conference Monday. “I’ve heard that and I feel that frustration. While the vaccination can protect against serious illness, it can’t protect you from being infected with COVID-19 and passing it onto someone else, someone who may be more vulnerable.”

The decision comes as both of Missouri’s urban areas see a big uptick in coronavirus hospitalizations that began in rural parts of the state, especially southwestern Missouri.

Elsewhere in the state, Whiteman Air Force Base reinstated its mask mandate Monday and the Harry S. Truman Library & Museum in the Kansas City area said it was closing because of the increase in COVID-19 cases. Meanwhile, Truman Medical Center/University Health announced Monday that it will require all workers to be vaccinated against the COVID-19 virus, becoming one of the first in the Kansas City-region to do so.

And the two hospitals in the Springfield area reported an increase in COVID-19 deaths over the weekend.

“This is very hard for our team,” tweeted Erik Frederick, chief administrative officer of Mercy Springfield, where 12 died. “I said the same last year. The difference now is that most of this could be prevented. That adds an extra layer of anguish.”

Missouri ranks fourth nationally in new cases per capita in the past 14 days, according to data from Johns Hopkins.

Just 47.2% of Missouri residents have received at least the first dose of the vaccine, which is far below the national rate of 56.8%, state and federal data shows.

But since the mask requirement was announced last week, there has been a steady stream of objections, including from Republican Gov. Mike Parson, Missouri Attorney General Eric Schmitt and St. Louis County Councilman Tim Fitch.

“Dictating mask mandates when we have the vaccine is ignoring the real solution and eroding public trust,” Parson tweeted Monday. “These policies that don’t consider vaccination status reduce the incentive of getting the vaccine and undermine its integrity.”

Fitch urged people to get vaccinated but said Page was wrong to act without the support of the county commission.

“Let us have the conversation,” he said, noting that state law changed in June to put new restrictions on the imposition of public health restrictions.

Schmitt, who is seeking the GOP nomination for U.S. Senate, said he planned to sue Monday to block the city and county from enforcing the renewed mandate.

St. Louis Mayor Tishaura Jones said Schmitt would not be successful. She noted that he filed an unsuccessful lawsuit last year against the Chinese government over the coronavirus, alleging that nation’s officials are to blame for the pandemic.

“I wish that he would put more of his attention toward serving the people of the state of Missouri,” she said, “and holding our health and safety paramount instead of filing frivolous lawsuits that waste taxpayer dollars.”

Page, a Democrat, was critical of what he described as “creating distractions for political gain.”

“As some passionate supporters of the previous president hold on tight to bombast and misinformation, we are laser focused on protecting the health and welfare of people in our communities,” he said. “Masks provide the freedom to move about in our community as vaccinations continue and our efforts continue to get as many people vaccinated as possible in our community and across the country.”

Page, who also is an anesthesiologist, said colleagues are telling him about people begging to be vaccinated while hospitalized in intensive care, struggling to breathe and facing the prospect of being placed on a ventilator.

“Then is not the time to get a vaccine,” he said. “Don’t think this won’t happen to you.”

Dr. Clay Dunagan of the St. Louis Metropolitan Pandemic Task Force said the situation is growing dire.

“We simply have contagion rates that are unacceptably high and unless we do something to put a barrier between the infected and the uninfected, we are going to see that rate escalate,” he said.

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