Why are we allowing those that had an infection after completion of their primary series to defer their booster dose?
There has been a growing body of evidence suggesting that a combination of history of SarsCoV2 vaccination and infection can lead to a strong "hybrid" immunity after recovery from infection. Additionally, there is immunological data suggesting that allowing an adequate interval between an infection and a COVID-19 vaccination dose may be important to allow quality immune memory. Thus CDPH is updating its order requiring health care workers to be fully vaccinated and boosted by March 1, 2022 to allow delay of the March 1, 2022 deadline for receiving a booster for covered workers with proof of a recent infection for up to 90 days from date of infection. This update reflects the current science and understanding as it relates to hybrid immunity in those who are fully vaccinated and then become infected.
If a worker is not eligible for a booster dose by March 1st, can they still defer any future booster doses by 90 days if they become infected with COVID-19?
Yes, if a covered worker is not eligible for a booster dose by March 1st, but then becomes infected with COVID after March 1st, but before the recommended timeframe indicated in Table A in the order, they may still defer their booster dose by 90 days from the date of infection.
For example, if a worker is not eligible for a booster dose until June 1st, but is infected with COVID-19 on May 1st, they may defer their booster dose to August 1st. Workers with a deferral due to a proven COVID-19 infection must be in compliance with the booster requirement no later than 15 days after the expiration of their deferral.
How can a worker provide proof of prior infection?
Workers must provide documentation (including date of infection) of previous diagnosis from a healthcare provider or confirmed laboratory results to provide proof of COVID-19 infection.
When does this amended order go into effect?
Effective February 22, workers who provide documentation of previous infection (after having received their full primary series of COVID-19 vaccine) may defer their booster dose for up to 90 days from date of infection. Workers with a deferral due to a proven COVID-19 infection must be in compliance no later than 15 days after the expiration of their deferral.
Those who are booster eligible, and do not provide proof of recent infection, must receive their booster dose by March 1, 2022, or within 15 days of becoming eligible for a booster if they are not eligible as of March 1, 2022.
Is contracting COVID-19 the best way to gain immunity from subsequent infection?
No. Completing the COVID-19 vaccination series, including a booster, is the safest and more dependable way to build immunity to COVID-19 than getting sick with COVID-19. The level of protection people get from infection may vary widely depending on how mild or severe the illness was, the time since infection, the variant that caused the infection, and the individual's age. Vaccine-derived immunity is much more predictable and dependable. In addition, people who get COVID-19 are at risk for potentially severe outcomes.
If I had COVID-19, why do I need the vaccine at all?
California health officials strongly recommend getting vaccinated even after a COVID-19 infection. Research shows that the vaccine is effective and can further boost your immunity. For example, some people who have had a COVID-19 infection do not produce the same antibody levels as those who got the vaccine. However, not everyone infected will develop the ability to prevent getting infected again.
Are there health risks if someone receives their booster after completing their vaccine series and recovering from COVID-19 infection?
There are no known health risks with receiving a booster dose after testing positive or receiving a clinical diagnosis of COVID-19, and information is evolving regarding the development of optimal immune memory for evolving SarsCOV-2 virus variants.
Will there be more changes to healthcare workers' requirements to get booster doses?
California has always made decisions based on science. As we continue to learn more about post-Omicron infection immunity, waning immunity in general, and what new variants may evolve, we will continue to reassess and provide updates as appropriate.
Why are we requiring booster doses?
Current vaccine requirements of staff in health care settings did not prove sufficient to prevent transmission of the more transmissible Omicron variant. Although COVID-19 vaccination remains effective in preventing severe disease, data suggest vaccination becomes less effective over time at preventing infection or milder illness with symptoms, especially in people aged 65 years and older. Boosters have been available in California since September 2021.
Accordingly, making boosters mandatory and additional testing of workers eligible for boosters who are not yet boosted are necessary.
The CDC recently updated their timeframe for those that received the Pfizer-BioNTech or Moderna vaccine to five months after receiving the second dose, but the Table in the Order still reflects six months. Which timeframe should I follow?
The Order was written based on the most current information from the CDC at the time it was issued. Covered facilities should continue to use the timeframe provided in the order. However, CDPH encourages all persons to get boosted as soon as they become eligible.
Will all vaccinated workers who have not yet received their booster be required to test?
Not necessarily. Those who are currently eligible for a booster, according to Table A in the order, would be required to test on the cadence specified in the order, until such time as they become boosted. For those workers who are vaccinated, but not yet eligible for a booster, they are not required to test, but will be required to test once they become eligible for a booster but remain unboosted.
For example, if a worker received their full series of the Moderna vaccine within the last two months, they would not be considered booster-eligible and therefore would not be required to test but will be required if they remain unboosted 6 months after they complete the second dose of the Moderna vaccine.
In addition, vaccinated workers that defer their booster dose based on documented previous infection in the last 90 days do not have to test during those 90 days, but must self-monitor for symptoms and continue to follow all other infection control requirements, including masking, as stated in the July 26 Order. Such workers must resume testing immediately after the 90 days if they are booster eligible, but have not yet received their booster dose.
Which tests qualify for workers who have a valid exemption or for booster-eligible workers who have not yet received their booster (e.g., point of care tests, rapid tests, community testing sites)?
Antigen, PCR, or any Nucleic acid amplification (NAAT) test would qualify.
Do tests need to be approved by the FDA?
Tests must be cleared, approved, or authorized, including in an Emergency Use Authorization (EUA), by the United States Food and Drug Administration (FDA) to detect current infection with the SARS-CoV-2 virus or be operating per the Laboratory Developed Test requirements by the U.S. Centers for Medicare and Medicaid Services.
Can a worker opt to regularly test instead of getting vaccinated or boosted?
No. For workers covered by this Order, testing will be an alternate means for satisfying this Order only for those who qualify for an exemption pursuant to the Order.
Does the Order apply to workers that conduct autopsy?
Coroner's offices and those conducting autopsy would not be considered health care workers for purposes of this Order but are covered under the July 26 Order as a covered worker in a correctional facility. However, CDPH strongly recommends all eligible staff to be vaccinated.
Does this apply to all correctional staff or just the medical staff?
Covered staff includes workers providing health care to inmates, prisoners, and detainees. In correctional hospitals, skilled nursing facilities, intermediate care facilities, or the equivalent, it also applies to persons not directly involved in delivering health care, but who could be exposed to infectious agents that can be transmitted in the health care setting (e.g., clerical, dietary, janitorial services, laundry, correctional officers, facilities maintenance staff, administrative, inmate workers, and volunteer personnel).
Does the Order only apply to correctional facilities that have integrated hospitals, skilled nursing facilities or intermediate care facilities, or does the Order also apply to correctional and detention facilities that have clinics or provide other healthcare services (that don't fall into the category of hospital, skilled nursing or intermediate care)?
The Order applies to (1) all paid or unpaid workers who provide healthcare or healthcare services to inmates, which would include healthcare services in a clinic setting or any other healthcare setting, and (2) all workers who are regularly assigned to work within hospitals, skilled nursing facilities, intermediate care facilities, or the equivalent that are integrated into the correctional facility or detention center in areas where health care is provided.
Are there any exemptions to the vaccination mandate?
The Order allows for two exemptions: (1) the worker is declining vaccination based on sincerely held religious beliefs or (2) the worker is excused from receiving any COVID-19 vaccine due to Qualifying Medical Reasons. To receive an exemption, a worker must participate in their employer's interactive process.
What are Qualifying Medical Reasons?
To determine qualifying medical reasons, the physician, nurse practitioner, or other licensed medical professional practicing under the license of a physician should refer to guidelines from the CDC, Clinical considerations, as well as, COVID-19 vaccine Contraindications and Precautions which also includes:
- Documented history of severe allergic reaction to one or more components of all the COVID-19 vaccines available in the U.S.
- Documented history of severe or immediate-type hypersensitivity allergic reaction to a COVID-19 vaccine, along with a reason why you cannot be vaccinated with one of the other available formulations.
Additionally, the linked reference above provides information on what are neither contraindications nor precautions to COVID-19 vaccination, which include:
- Allergic reactions (including severe allergic reactions) not related to vaccines (COVID-19 or other vaccines) or injectable therapies, such as allergic reactions related to food, pets, venom, or environmental allergies, or allergies to oral medications.
Will CDPH be providing a template declination / exemption form for use?
No, CDPH will not be providing a template declination/exemption form for use. Facilities may use any existing form or process previously used for other mandated vaccines, or any process to ensure that the requirements as stated in the Order are met, including for a written health care provider's statement where applicable, and testing records pursuant to section (3) of the Order.
Who is authorized to provide a Qualified Medical Reason exempting a worker from the COVID-19 vaccine requirements?
Only a physician, nurse practitioner, or other licensed medical professional practicing under the license of a physician can provide a Qualified Medical Reasons exemption. In this context, the term "physician" refers specifically to an individual having a valid certificate or license to practice medicine and surgery issued by the Medical Board of California or the Osteopathic Medical Board of California.
How will you verify workers are vaccinated, boosted or tested?
Each facility will be required to verify and keep record of vaccination status or test results. Pursuant to the CDPH Guidance for Vaccine Records Guidelines & Standards, facilities have multiple options to verify vaccine status.
Who is responsible for enforcement of the requirements under this Order?
Each covered facility is required under the Order to enforce the vaccine mandate and testing requirements of their respective staff (including any staff that may come from a contracted staffing agency).
To the extent that the covered facilities are subject to state regulation, the state's regulating entities will ensure each facility is meeting the requirements for vaccine verification/exemptions. Local health jurisdictions may also enforce the orders with respect to local facilities.
What should a facility do if they suspect a fraudulent vaccine card is being presented as proof?
Facilities should work with their legal counsel, and may report suspected cases of healthcare fraud to the federal Health and Human Service through their website or through their tip line at 1-800-HHS-TIPS.
When did the original Order take effect?
The original Order went into effect August 19, 2021.
Will the July 26 Public Health Order continue to apply?
Yes. The July 26 Public Health Order for Health Care Worker Protections in High-Risk Settings requiring all unvaccinated workers to be tested weekly remains in effect and applies to any worker not subject to the State and Local Correctional Facilities and Detention Centers Health Care Worker Vaccination Requirement of December 22, 2021.
Originally published on December 22, 2021