Chinese health authorities have issued new guidelines upping the requirement of mask wearing for the public — including in outdoor areas, as the country grapples with its worst resurgence of Covid-19 in more than a year

Authorities are on high alert due to the spread of the Delta variant in more than half of China’s provinces. They have imposed travel restrictions on tens millions of Chinese residents as well as strict lockdowns and mass testing.

China’s life was almost back to normal before the current outbreak. Small, isolated outbreaks of illness were rare. People were no longer wearing face masks in many cities. International headlines have been made repeatedly about photos of people without masks at music festivals and tourist hotspots.

China’s National Health Commission released revised guidelines on Friday, requiring that the public wear face masks not only in indoor venues or public transport but also in crowded outdoor areas.

As the pandemic drags along, “the public…has become less conscious of Covid-19 prevention.” The National Health Commission stated Friday that some people believe they don’t need to wear a mask once they have been vaccinated. This leads to loopholes in epidemic prevention, personal protection and personal safety.

China’s tightening of mask requirements come as other countries also move to revise mask guidance, with authorities in the US now recommending that fully vaccinated people wear masks indoors when in areas with “substantial” and “high” transmission of Covid-19.

The US is not like China in that the topic of mask-wearing remains contentious. Throughout the pandemic, US public health officers have reported receiving death threats and harassment in response to their recommendations to wear masks and follow certain Covid-19 mitigation measures.

China has updated its guidelines to require that all people wear masks in public places such as shopping malls, supermarkets or cinemas. In crowded outdoor areas such as parks and public squares, masks are now required.

The May 2012 guidelines did not require the wearing of a mask in outdoor areas or indoors with good ventilation.

The guidelines tightened the requirements for masks for those who work with foreign personnel or goods as well as drivers, cleaners, security officers, and drivers at ports, airports customs and hospitals.

The ongoing epidemic began last month in Nanjing in Jiangsu, eastern China. Nine airport cleaners were infected in a routine test. The authorities claim that the cleaners failed to follow the epidemic prevention guidelines following cleaning a Russian flight and then contracted the virus before spreading it among their colleagues.

In separate guidelines issued Friday, the National Health Commission included Mahjong parlors, gyms, milk tea stores and tutoring institutions in its expanded list of “key venues” for epidemic prevention and control.

Authorities say that Mahjong parlors are popular among older people and played a key role in spreading Covid in Yangzhou’s eastern city. This area is a hotspot for the ongoing epidemic. Within two weeks, the city will conduct its seventh round mass testing and has reported 25 new cases Friday.

According to the National Health Commission, 47 cases of locally transmitted symptomatic infection were reported in China on Friday. Although the country has already seen over 1,000 cases of symptomatic infections since the outbreak began, the number of new cases per day has dropped to the low tens in recent days.

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Concerns have been raised about the protection offered by Chinese vaccines in the face of the spread of the deadly Delta variant, which is highly contagious.

The National Health Commission announced Friday that 55% of China’s population, 770 million, had been fully vaccinated. That puts it ahead of the US, where just over 50% of the population are fully vaccinated.