Many major brick-and-mortar stores are not requiring customers nationwide to wear masks as states lift lockdown measures and COVID-19 hospitalizations reach crisis levels in new hot spots across the country.

Of 15 major retailers that responded to CQ Roll Call, four require masks be worn in stores: Costco, Apple, T.J. Maxx and Walgreens. Another 11 of the country’s largest retailers – including Walmart, Target, Starbucks, CVS, Macy’s and Trader Joe’s – say they don’t require them except when state or municipal regulations mandate it. Five other major retailers, including major grocery chains Food Lion and Albertsons, did not reply to multiple requests for comment.

Further evidence emerged in recent weeks that masks are effective at preventing COVID-19 transmission. A meta-analysis in The Lancet of 172 observational studies in 16 countries found that using a multilayer cloth mask could reduce the risk of infection, while a Health Affairs study found mask mandates in 15 states and the District of Columbia were associated with as many as 450,000 fewer cases over five weeks.

Wearing a mask is among the few nonpharmaceutical interventions, along with social distancing and washing hands, that can protect people until a vaccine or effective treatments are discovered.

The Centers for Disease Control and Prevention advocates wearing masks in stores and pharmacies and other times when social distancing is difficult. But President Donald Trump has often declined to use masks and described wearing masks as a political issue instead of a public health measure.

In the absence of national policy, companies and customers must navigate a jumble of state and local rules. Workers in one state may have more protections than those in another area.

Meanwhile, COVID-19 cases are climbing in 35 states, according to the New York Times. Many states allowed the resumption of shopping, eating out and vacationing before meeting the public health goals recommended by experts.

Without widespread acceptance of masks, workers face two risks: a greater threat of being exposed to the coronavirus and the potential of a conflict over whether they should be worn.

Retailers have been reluctant to enforce mask wearing when it’s not required by state or local law. In some cases, the uniquely American polarization over masks has placed workers in dangerous situations.

Media reports and social media posts have shown workers being verbally attacked or deliberately coughed on after asking customers to wear masks. A private security guard at a Family Dollar store in Flint, Michigan – 43-year-old Calvin Munerlyn – was reportedly shot and killed in May after a dispute arose over mask requirements.

“It’s very common in retail to instruct employees not to try to stop or chase shoplifters in order to avoid an unnecessary risk of violence, and many retailers have applied the same theory to masks,” J. Craig Shearman, a spokesman for the National Retail Federation, said in an email. “Given the incidents of violence we have seen when some customers object to wearing masks, retailers do not want to let disagreements escalate to the point of confrontations.”

The toll of the pandemic on retail workers – and the ripple effect on their communities – is unknown. Major nonunion employers have not released the number of workers who tested positive or died.

The United Food and Commercial Workers International Union says 11,507 of its grocery store workers have been infected or exposed and 82 workers have died.

Data compiled by Walmart employees and the nonprofit United for Respect workers’ rights group indicate that an estimated 805 cases were reported among employees, including 22 deaths.

Unions are calling on companies and municipalities and states to mandate wearing masks and enforce the rules, rather than asking rank-and-file employees to do so.

“State, federal and local leaders are failing to establish clear and enforceable safety standards. Instead we’re seeing a mix. In some states and cities and counties, they’ve established some safety standards like requiring masks and others don’t have any standards at all and no requirements,” UFCW President Marc Perrone said on a call with reporters recently. “Even when there are requirements, nobody’s doing enforcement.”

Perrone called on employers to hire security guards, especially grocers that have seen increasing sales.

Anecdotal reports and photos on social media from all corners of the country suggest some customers are not wearing masks if it’s not required.

Adam Ryan, a Target employee in southwestern Virginia and an advocate for more protections against the virus at stores, said he cannot maintain a 6-foot distance from customers and about half of them are not wearing masks.

Virginia currently requires people to wear masks inside public places.

Ryan said Target issues regular messages over a sound system reminding people to maintain a 6-foot distance and wear masks, has distributed stickers to employees to wear reminding customers of social distancing, and put up signs in stores.

But, he said, “it feels like a losing battle.”

“The aisles are not 6 feet wide. They’re 4 feet wide. And if someone wants to come down the aisle and you’re stocking, they’re not going to wait for you to finish,” he said.

Target spokesman Drew Halunen said the company supplies disposable face masks and gloves to employees, limits foot traffic and has added signs.

Candice Oglesby, a Kroger worker in Dallas, estimated on the UFCW call that about 15% of customers are not wearing masks. She sees the rising number of cases in Texas as a “serious threat.”

“If there’s one thing I could say to customers or anybody in the grocery store, it would be that coming in with a mask and covering your face is just something we’ve got to do now. It’s part of our life,” said Oglesby, who worries about bringing the virus home to her family.

Oglesby called for a mask mandate and reinstated hazard pay. Although the virus is still a threat, Kroger ended an extra $2-per-hour hazard pay in mid-May.

Kroger spokeswoman Kristal Howard said the company is requiring its employees to wear masks and supplying them unless workers prefer to wear their own. The company will “continue to closely monitor events and adjust our policies and protocols accordingly,” Howard said in an email.

In states that do require masks, stores like Walmart and CVS put up signage outside to remind customers of the rule. Many stores say they meter foot traffic to limit crowds.

But a Walmart associate who asked to remain anonymous for fear of retaliation said crowding is routinely present at her Washington, D.C., store.

A United for Respect survey in early May reported that 2 in 5 associates said they trusted Walmart to keep workers and customers safe.

“We encourage customers to be especially mindful of one another during this unprecedented time and adhere to recommendations and decisions made by local officials regarding the use of protective facial coverings while in public spaces,” Walmart spokesman Casey Staheli said in an emailed statement.