The board of health in Salem, Massachusetts, met Tuesday night to discuss a more broad indoor mask mandate and vaccine requirements amid an uptick in COVID cases.
Officials were also weighing imposing other requirements, such as vaccine proof to enter businesses in the city.
While the Salem Board of Health did not make a ruling on expanding the mask mandate that went into effect on Monday, it did vote at Tuesday night's meeting to endorse the mayor's recommendation of a COVID vaccine mandate for all city and school employees.
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Dr. David Roberts, president of North Shore Medical Center, sounded the alarm Tuesday night when he told the city's board of health that Salem Hospital often operates at 98% capacity.
“I’m a lot worried that we’re going to get overwhelmed if we have another wave of COVID on the North Shore,” Roberts said. “We’re kind of overwhelmed in current state. We don’t have the capacity to take care of patients coming to us now.”
Most patients aren't COVID cases. Currently there are 23 COVID patients in the hospital, with nine in the ICU and six on ventilators.
“I just think these next three months, if we’re not vigilant it could be bad,” Roberts said, which is why he encouraged the board to mandate masks inside all Salem businesses. "I would do it for December, January, February, and if March comes along and it turns out we’re ok, I would then change my mind.”
What's not changing is the consistency with which nurses are leaving Salem and regional hospitals.
“Every day of being overwhelmed another nurse says, 'Okay, that's it. I’m out. I’m not doing this anymore.' Then the burden on the remaining nurses doubles,” Roberts shared.
In downtown Salem, business managers and owners spoke to NBC10 Boston Tuesday night about the possible return of a mask mandate in their stores.
“If you feel like you should wear a mask then you can go right ahead and wear it if you want to but I don't think it should be mandated by the town of Salem," one man said at the Army Barracks store.
“I think it’s a great idea," Laura Lanes said. "We have to keep it with masking and being vaccinated, it's been working for us.”
Salem just implemented a new mask mandate for public buildings that went into effect on Monday. It remains to be seen if the city will expand that mandate to all buildings.

The mask mandate that took effect Monday will continue "until further notice," the city said. Masks are required inside all city buildings in Salem, for both employees and the public. This includes people who have been vaccinated.
The buildings covered by the mandate include City Hall, City Hall Annex, the Community Life Center, the Salem Public Library, the On Point Center, Old Town Hall, park buildings, the Salem Police Station, and all Salem fire stations.
With the holidays coming up and cases at current levels, it is important to have this conversation now, Mayor Kim Driscoll said.
"We are seeing an uptick in case counts, there is no doubt about that," Driscoll said in an interview. "We don't want to wish we acted three weeks from now and be faced with a situation that isn't good for our community."
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Salem had an indoor mask mandate in place from August through November.
Other cities and towns have mask mandates in place for municipal offices, and some even have them in place for all indoor spaces.
Massachusetts Gov. Charlie Baker has said he has no plans to bring back a statewide mask mandate, as he thinks that's a decision that should be handled locally. He reiterated that position during a news conference on Monday.
"Keep in mind, we are in a very different place than we were in before," Baker said.
During a television appearance on Sunday, New Hampshire Gov. Chris Sununu also said he has no plans to implement a mask mandate despite a spike in COVID cases, comparing it to being put "in the penalty box" in ice hockey.
The Associated Press contributed to this report.