Mandatory wearing of masks in hospitals and skilled nursing facilities in Marin County will return in November to curb an anticipated spread of respiratory diseases, including COVID-19, according to county officials.

The masking requirement will take effect from Nov. 1 through March 31, 2024, Marin Health and Human Services officials said Wednesday.

Once the measure has taken effect, all individuals within higher-risk health care settings in Marin County, especially in patient care areas, will be required to wear masks. Children below the age of 6 and those with valid medical reasons are exempted from the mandate, county officials said.

Under the order, masks will be recommended but not required in medical clinics and other outpatient health care settings.

According to Marin Health and Human Services, historical case rates and virus levels in the county’s wastewater show a clear seasonal spike in RSV and influenza during November or December followed by a decline into spring.

“Since the start of the pandemic, COVID-19 cases have spiked in late fall. The simultaneous circulation of three respiratory viruses contributes to a seasonal rise in sick days from work and school, and increased hospitalizations and deaths,” county health officials said.

Similar orders have been issued in other Bay Area counties, including Contra Costa and Sonoma.