Why are testing requirements for exempt covered workers being rescinded?
California has seen a dramatic increase in the percentage of Californians that are fully vaccinated and boosted. Vaccine coverage is high among workers in high-risk settings, and the proportion of unvaccinated workers is low. As we’ve seen, the Omicron subvariants have shown immune escape and increased transmissibility, and while unvaccinated individuals still have higher risk of infection, previously infected, vaccinated and boosted persons have also been infected. Consequently, mandated testing of the small number of unvaccinated workers is not effectively preventing disease transmission as with the original COVID-19 virus and prior variants earlier in the pandemic.
Accordingly, amendments to the State Public Health Officer Order of February 22nd, 2022 regarding required testing for exempt covered workers are needed at this time, to reflect recent CDC recommendations, the current science of the Omicron subvariants, the increases in community immunity from vaccination and infection, and increases in vaccine coverage of our healthcare workforce.
When does this amended order go into effect?
This amended order is effective September 17th, 2022.
Are covered facilities still recommended to test workers?
Covered facilities should maintain capacity at their worksite, to continue to test as recommended during outbreaks, and in the event it is required again at a future date. Facilities may also still consider various screening testing strategies (point in time testing, serial testing, etc.) and based on concerning levels of transmission locally. Workers may also consider routine diagnostic screening testing if they have underlying immunocompromising conditions (e.g., organ transplantation, cancer treatment), due to the greater risks such individuals face if they contract COVID-19.
Are there specific facilities that will continue to have testing requirements?
Skilled Nursing facilities must continue to comply with current federal requirements that may require more stringent testing of staff, including QSO-20-38-NH REVISED (cms.gov) “Interim Final Rule (IFC), CMS-3401-IFC, Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency related to Long-Term Care (LTC) Facility Testing Requirements” or similar requirements that may be imposed in the future.
Vaccination and Boosters
Are the requirements for vaccination and booster for covered workers still in effect?
Current requirements regarding vaccination and booster for covered workers remains in effect. Additionally, facilities must continue to track worker’s vaccination or exemption status. Effective February 22, 2022 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.
Why are there new changes regarding the timing of when to get a booster dose?
California has always made decisions based on science. As we have continued to learn more about post-Omicron infection immunity, waning immunity in general, and what new variants may evolve, changes to timing of booster doses have been updated to reflect this new science.
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 are necessary.
How does the vaccination and booster requirement affect new covered workers coming into compliance? Will current covered workers be required to receive the bivalent booster?
CDPH continues to urge all individuals to remain up-to-date on the COVID-19 vaccines (including the bivalent booster when due) to protect themselves and reduce the spread of the virus.
For covered workers who are already in compliance with receiving the primary series and at least one booster, there is not a new requirement to receive the additional bivalent booster.
For covered workers who are newly coming into compliance with the COVID-19 vaccination requirement including a booster, receipt of the bivalent booster will be required, based on the timing included in Table A of the order, since it is the only currently authorized booster.
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 updated 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, 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, but then becomes infected with COVID 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.
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.
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?
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.
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.
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.
Will the State 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.
How will you verify workers are vaccinated or boosted?
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.
Covered Settings and Workers
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.
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.
Are there any requirements for exempt workers while in the facilities?
Exempt workers must wear a well-fitting respirator approved by the National Institute of Occupational Safety and Health (NIOSH), such as an N95 filtering facepiece respirator, or surgical mask, at all times while in the facility.
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?
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?
The July 26th Order has been rescinded.
Originally published on December 22, 2021