Order of the Health Officer of the County of Sonoma No. RVP23-01

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DATE OF ORDER: September 19, 2023

Please read this Order carefully.  Violation of or failure to comply with this Order is a misdemeanor and may be punishable by fine, imprisonment, or both.  (California Health and Safety Code § 120275, et seq.)

UNDER THE AUTHORITY OF CALIFORNIA HEALTH AND SAFETY CODE SECTIONS 1288.7, 101040, 101085, AND 120175, AND 8 CAL. CODE REGS SECTION 5199, THE HEALTH OFFICER OF THE COUNTY OF SONOMA (“HEALTH OFFICER”) ORDERS:

1. Summary. This Order of the Health Officer requires Health Care Delivery Facility personnel  to wear a Face Mask in Patient Care Areas of specified health care delivery locations, subject to medical and other specified exemptions, during the time period listed below.
2. Effective Date and Duration of this Order: This Order takes effect at 12:01 a.m. on November 1, 2023 and shall remain in effect until April 30, 2024. The Health Officer may adjust these dates based on respiratory virus surveillance data. If the Health Officer changes the dates of this Order, the Health Officer will notify Health Care Delivery Facilities through a Health Advisory and a notice posted on the County Department of Health Services website.
3. Basis for Order.Historical data demonstrates that higher rates of influenza, COVID-19, and other respiratory viruses that can cause severe respiratory infections occur annually between late fall and spring. Influenza and other seasonal respiratory viruses infect tens of millions in the United States each year and can result in serious medical outcomes, including hospitalizations and death. Patients and residents in our health care and congregate facilities, especially young children, pregnant women, the elderly, and those with chronic health conditions, are at greater risk for respiratory virus-related hospitalizations and death. Workers in direct care, health care, and congregate facilities are at risk for respiratory illness and can transmit the viruses to their clients, patients, and coworkers.  Moreover, respiratory virus-related illness in health care workers can cause absenteeism, placing further strain on our limited health care resources. The Health Officer makes this Order in light of ongoing transmission of SARS-CoV-2 (also referred to as “COVID-19”), and recurrence of seasonal influenza and other respiratory infections. The co-occurrence of influenza season with a possibility of another late fall/winter surge of COVID-19 may increase the risk of our health systems being overwhelmed with patients with critical respiratory illness.  The widespread availability of COVID-19 testing and treatment, the high level of community vaccination in the County, and the lower death rate seen in the most recent surges of COVID-19, Have diminished the necessity for year-round mandatory orders related to masking in multiple high-risk settings.  However, the risk to vulnerable patients of COVID-19, influenza, and other respiratory viruses in Health Care Settings, including skilled nursing facilities, remains significant, and so it continues to be important for Face Masks to be used in Patient Care Areas of these settings when seasonal risk of exposure to one or multiple viruses is at its highest.
   
   Since at least 2017, Sonoma County required that all Health Care Facilities establish an influenza vaccination program requiring that all health care workers providing direct patient care receive an annual influenza vaccine or wear a mask (https://sonomacounty.ca.gov/public-health/vaccination-of-healthcare-workers-for-influenza-masking-order.pdf).  The order applied to every influenza season thereafter.
   
   In 2020, Sonoma County Public Health expanded the order to require that all health care and specified congregate care facilities establish an influenza vaccination program requiring all staff to receive an annual influenza vaccination, subject to medical exemptions and religious accommodation. (https://sonomacounty.ca.gov/Mandatory-Flu-Vaccines-for-Healthcare-Staff/.)
   
   In 2021, Sonoma County Public Health expanded the order to include certain specified health care and congregate care facilities. (https://socoemergency.org/order-of-the-health-officer-of-the-county-of-sonoma-mandatory-influenza-vaccination-of-workers-at-health-care-facilities/.)
   
   In recognition that the risk posed by co-circulation of multiple respiratory viruses is not fully mitigated by influenza vaccination, this Order differs from previous Orders in that it introduces a new requirement for the use of Face Masks in Health Care Delivery Facilities as set forth in Section 4 below.

4. Mandatory Requirement to Wear a Face Mask in Patient Care Areas of Health Care Delivery Facilities.  Regardless of vaccination status, all personnel in Patient Care Areas of Health Care Facilities must wear a Face Mask through the duration of this Order.  All businesses and governmental entities with Health Care Delivery Facilities must enforce this Face Mask Requirement for all personnel entering Patient Care Areas within the Health Care Delivery Facility, regardless of vaccination status, except as otherwise provided in this order.  All such businesses and governmental entities must post clearly visible and easy-to-read signage at all entry points to Patient Care Areas to communicate the Face Mask Requirements to all personnel entering the Patient Care Areas of the Health Care Delivery Facility.  In addition, those responsible for Health Care Delivery Facilities are required to provide Face Masks to personnel who will be in an area where Face Masks are required.
5. Exceptions and Accommodations.The following personnel may be exempt from wearing masks:
   1. Persons with a diagnosed medical condition, mental health condition, or disability that prevents the individual from wearing a face mask. This includes persons with a medical condition for whom wearing a mask could obstruct breathing or who are unconscious, incapacitated, or otherwise unable to remove a mask without assistance.
   2. Persons who are hearing impaired, or communicating with a person who is hearing impaired, where the ability to see the mouth is essential for communication.
   3. Persons for whom wearing a mask would create a risk to the person related to their work, as determined by local, state, or federal regulators or workplace safety guidelines.
6. Definitions. For purposes of this Order, the following terms have the meanings given below.
   1. “Business” includes any for-profit, non-profit, or educational entity, whether a corporate entity, organization, partnership, or sole proprietorship, and regardless of the nature of the service, the function it performs, or its corporate or entity structure.
   2. “Face Mask” means a surgical mask, KN95, KF94, or N95 respirator. A scarf, ski mask, balaclava, bandana, turtleneck, collar, cloth mask, or any mask that has an unfiltered, one-way exhaust valve does not qualify as a Face Mask under this order.
   3. “Health Care Delivery Facility” means a setting where patient care is provided indoors. Health Care Facilities include hospitals, clinics, surgery centers, infusion centers, dialysis centers, sites that provide inpatient or outpatient health care, skilled nursing facilities, portions of long term care facilities where nursing care is provided, and other facilities where patient care is provided indoors.
   4. “Patient Care Area” means any area that patients regularly access in order to receive healthcare within a Health Care Delivery Facility. Patient Care Areas include lobbies, waiting rooms, examination rooms, patient wings, elevators, and hallways used by patients. Patient Care Areas do not include areas such as cafeterias or gift shops that are not used for the provision of healthcare or access to areas where healthcare services are provided.
   5. “Personnel Subject to the Order” shall mean, except where otherwise specified below in Facilities Subject to the Order, all paid and unpaid persons who work in indoor settings where (1) health care is provided to individuals, or (2) persons in care have access for any purpose. This includes workers in health care or other health care settings as well as workers in other direct care settings who have the potential for direct or indirect exposure to patients/clients/residents or influenza airborne aerosols. Workers include, but are not limited to, nurses, nursing assistants, physicians, technicians, therapists, phlebotomists, pharmacists, students and trainees, contractual staff not employed by the covered facility, and persons not directly involved in patient care, but who could be exposed to infectious agents that can be transmitted in the covered setting (e.g., clerical, dietary, environmental services, laundry, security, engineering and facilities management, administrative, billing, cosmetology, personal training, and volunteer personnel). To the extent that remote workers, or those not working within these facilities, do not meet this definition, then they would not be covered by this order.
7. Facilities subject to this Order may refer any interpretation questions to Sonoma County Public Health, Disease Control Unit, at PHNurse@sonoma-county.orgor (707) 565-4567.
8. More Restrictive Order.Where a conflict exists between this Order and any state or federal public health orders, then the most restrictive provision (i.e., the more protective of public health) controls.
9. Public Distribution.Copies of this Order shall promptly be: (1) made available at the County Administration Center at 575 Administration Drive, Santa Rosa CA 95403; (2) posted on the County Public Health Department website (https://sonomacounty.ca.gov/Health/Public-Health/) and (https://socoemergency.org/); and (3) provided to any member of the public requesting a copy of this
10. Severability. If any provision of this Order to the application thereof to any person or circumstance is held to be invalid, the reminder of the Order, including the application of such part or provision to other persons or circumstances, shall not be affected and shall continue in full force and effect.  To this end, the provisions of this Order are severable.

IT IS SO ORDERED:

Karen L. Smith, MD MPH, Interim Health Officer of the County of Sonoma

September 19, 2023