In light of the new and recent State Public Health Officer COVID-19 orders regarding vaccine verification and testing requirements for certain facilities (issued July 26, 2021), visitation requirements for certain health care settings (issued August 5, 2021), vaccine requirements for health care workers (issued August 5, 2021), vaccine verification and testing for workers in schools (issued August 11, 2021), vaccine requirements for local correctional facilities and detention centers (issued August 19, 2021), as well as the new face covering guidance by the California Department of Public Health (CDPH) (issued July 28, 2021), the following Orders and Strong Recommendations shall revise and replace the prior Orders and Strong Recommendations of the County Health Officer that were issued on August 17, 2021. The Orders and Strong Recommendations issued on August 17, 2021, are no longer in effect as of August 20, 2021.
Pursuant to California Health and Safety Code sections 101030, 101040, 101470, 120175, and 120130, the County Health Officer for County of Orange orders and strongly recommends the following:
ORDERS
Effective immediately, and continuing until further notice, the following shall be in effect in unincorporated and incorporated territories of Orange County, California:
I. Self-Isolation and Self-Quarantine Orders:
- Self-isolation of Persons with COVID-19. All Orange County residents and visitors who have been diagnosed with or are likely to have COVID-19, as defined below, shall immediately isolate themselves in their home or another residence under the following criteria, as applicable: a. Individuals with COVID-19 symptoms shall isolate themselves until: (i) at least 24 hours after they have recovered, meaning their fever has resolved without use of fever- reducing medications and their respiratory symptoms (e.g., cough, shortness of breath) have improved; AND (ii) at least 10 days has elapsed from when their symptoms first appeared. b. Individuals who have a positive COVID-19 PCR or rapid antigen laboratory test result and are without COVID-19 symptoms shall isolate themselves for 10 days from the date when the first specimen for the positive COVID-19 laboratory test result was obtained.
Unless one of the criteria, above, applies, i.e., 1.a) or 1.b), the individual may not leave his or her place of isolation except to receive necessary medical care.
If a more specific isolation order is issued by the County Health Officer for any county resident, the specific order shall be followed instead of this order #1.
This self-isolation order DOES NOT in any way restrict access by first responders to an isolation site during an emergency.
2. Self-Quarantine of Persons Exposed to COVID-19. All Orange County residents and visitors who know that they have been in close contact, as defined below, with a person diagnosed with or likely to have COVID-19 (as defined in Order #1, above) shall be deemed exposed to COVID-19 and shall take the following actions:
Not Fully Vaccinated Persons
- All asymptomatic persons shall quarantine themselves in their home or another place of residence for 10 Days after the date of last exposure. They may not leave their place of quarantine except to receive necessary medical care or to obtain such other goods or services necessary for their basic subsistence.
- All asymptomatic persons (i) who reside or work in a high-risk congregate living setting (e.g., skilled nursing facilities, prisons, jails, shelters) or (ii) who reside or work with severely immunosuppressed persons (e.g., Bone marrow or solid organ transplants, chemotherapy) shall quarantine themselves in their home or another place of residence for 14 Days from the date of last exposure. They may not leave their place of quarantine except to receive necessary medical care or to obtain such other goods or services necessary for their basic subsistence.
All persons quarantined must take the following additional actions:
- Self-monitor for COVID-19 symptoms through Day 14 and if symptoms occur, contact the Orange County Health Care Agency or their healthcare provider and seek COVID-19 testing. They should remain at home or another place of residence and away from others pending the results of their testing.
- Stay at least 6 feet from others through Day 14;
- Wear face coverings at all times through Day 14 and adhere to the face covering order (see Section II) below, after Day 14;
- Avoid crowds through Day 14 after the date of last exposure.
If a more specific quarantine order is issued by the County Health Officer for any county resident, that order shall be followed instead of this order #4.
This self-quarantine order DOES NOT in any way restrict access by first responders to a quarantine site during an emergency.
Exemptions:
- Asymptomatic persons who are fully vaccinated for COVID-19 are not required to quarantine after exposure to COVID-19.
- People are considered fully vaccinated for COVID-19:
- 14 days or more after they have received the second dose in a 2-dose series (Pfizer-BioNTech or Moderna); or
- 14 days or more after they have received a single-dose vaccine (Johnson and Johnson/Janssen).
2. Asymptomatic Persons Previously Infected. If an exposed person tested positive for COVID-19 before their new, recent exposure and it has been less than 3 months since they started having symptoms from that previous infection (or since their first positive COVID-19 test if asymptomatic), they do not need to quarantine, as long as they have not had any new symptoms since their recent exposure to COVID-19.
3. During critical staffing shortages, as determined by organization’s/entity’s management, the following asymptomatic persons who are not fully vaccinated for COVID-19 are not required to quarantine after Day 7 from the date of last exposure if they have received a negative PCR COVID-19 test result from a specimen collected after Day 5:
- Health care providers who did not develop COVID-19 symptoms;
- Emergency responder who did not develop COVID-19 symptoms; and
- Social service workers who did not develop COVID-19 symptoms and who work face to face with clients in the child welfare system or in assisted living facilities.
All individuals who fall under Exemptions categories 1, 2, and 3, shall also do as follows:
- Test for COVID-19 3-5 days after last date of exposure (note: this requirement does not apply to Asymptomatic Previously Infected Individuals); AND
- Self-monitor for COVID-19 symptoms through Day 14 and if symptoms occur, immediately isolate as per Self-Isolation Order herein and contact the Orange County Health Care Agency or your healthcare provider for further care.
4. Quarantine Exemption for Students in both Private and Public Transitional Kindergarten through Grade 12.
Modified Quarantine.
Unvaccinated students who are exposed (i.e., more than 15 minutes over a 24-hour period within 0-6 feet indoors) to a COVID-19 infected individual may continue to attend school if the following conditions are met:
- Both the exposed student and COVID-19 infected individual were wearing a face covering;
- The exposed student is asymptomatic;
- The exposed student continues to appropriately wear face covering, as required under Section II, below;
- The exposed student is tested for COVID-19 at least twice weekly for ten consecutive days; and
- The exposed student continues to quarantine (i.e., refrains from participation) for all extracurricular activities at school, including sports, and activities within the community setting for 14 consecutive days following exposure. The exposed student may participate in all required instructional components of the school day, except activities where a mask cannot be worn, such as while playing certain musical instruments. Exposed student may also eat meals on campus.
School districts may elect to forego the Modified Quarantine Exemption and may instead elect to comply with the General Quarantine Order (10 Day Quarantine), herein.
Shortened Quarantine.
When either the unvaccinated student or the COVID-19 infected individual (or both) were not wearing a face covering during student's exposure (i.e., more than 15 minutes over a 24-hour period within 0-6 feet indoors) to the COVID-19 infected individual, the exposed student may discontinue self-quarantine at home or another place of residence as follows:
- After Day 10 from the date of last exposure without testing; OR
- After Day 7 if a diagnostic specimen is collected after Day 5 from the date of last exposure and tests negative.
This shortened quarantine may apply ONLY IF the following criteria are met:
- The exposed student remains asymptomatic; and
- The exposed student continues to quarantine (i.e., refrains from participation) for all extracurricular activities at school, including sports, and activities within the community setting for 14 consecutive days following exposure. The exposed student may participate in all required instructional components of the school day, except activities where a mask cannot be worn, such as while playing certain musical instruments. Exposed student may also eat meals on campus.
School districts may elect to forego the Shortened Quarantine Exemption and may instead elect to comply with the General Quarantine order (10 Day Quarantine), herein.
For both Modified and Shortened Quarantine the following also apply:
- The exposed student shall: (i) continue daily self-monitoring for symptoms through Day 14 from last known exposure; and (ii) follow all recommended non-pharmaceutical interventions (e.g., wearing a mask when around others, hand washing, avoiding crowds) through Day 14 from last known exposure.
- If the exposed student develops any COVID-19 symptoms during this 14-day period, the exposed student shall immediately isolate, get tested for COVID-19 and contact their healthcare provider with any questions regarding their care.
II. Face-Covering Order:
- Wear a Cloth Face-Covering. To help prevent the spread of droplets containing COVID-19, all County residents and visitors shall wear face coverings in accordance with and as required by the Guidance for the Use of Face Coverings issued by CDPH, effective July 28, 2021. The Guidance is attached herein as Attachment “A” and can be found at:
https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/COVID-19/guidance-for-face-coverings.aspx. The Guidance orders, as follows:
Masking Requirements.
Masks are required for all individuals in the following indoor settings, regardless of vaccination status:
- On public transit (examples: airplanes, ships, ferries, trains, subways, buses, taxis, and ride-shares) and in transportation hubs (examples: airport, bus terminal, marina, train station, seaport or other port, subway station, or any other area that provides transportation)
- Indoors in K-12 schools, childcare
- Emergency shelters [4] and cooling centers
Masks are required for all individuals, in the following indoor settings, regardless of vaccination status (and surgical masks are recommended):
- Healthcare settings
- State and local correctional facilities and detention centers
- Homeless shelters
- Long Term Care Settings & Adult and Senior Care Facilities
Additionally, masks are required for unvaccinated individuals in indoor public settings and businesses (examples: retail, restaurants, theaters, family entertainment centers, meetings, state and local government offices serving the public).
Guidance for Businesses, Venue Operators or Hosts
In settings where masks are required only for unvaccinated individuals, businesses, venue operators or hosts may choose to:
- Provide information to all patrons, guests and attendees regarding vaccination requirements and allow vaccinated individuals to self-attest that they are in compliance prior to entry.
- Implement vaccine verification to determine whether individuals are required to wear a mask.
- Require all patrons to wear masks.
No person can be prevented from wearing a mask as a condition of participation in an activity or entry into a business.
Exemptions to masks requirements.
The following individuals are exempt from wearing masks at all times:
- Persons younger than two years old. Very young children must not wear a mask because of the risk of suffocation.
- Persons with a medical condition, mental health condition, or disability that prevents wearing a 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.
- 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.
- 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.
Face shields may be considered for members of the public who cannot wear a face covering due to a medical condition or other exemption, although they may not work as well as face coverings in their ability to prevent the spread of COVID-19 to others. A cloth “drape” should be attached to the bottom edge of the face shield and tucked into the shirt to minimize gaps between the face and face shield.
III. Vaccination and Testing for COVID-19 Orders:
- COVID-19 Vaccination for Workers and Service Providers of Certain Facilities. To help prevent transmission of COVID-19, all workers who provide services or work in facilities described below shall comply with the vaccination requirements as set forth in the August 5, 2021, State Health Officer Order. A copy of the State Health Officer Order is attached herein as Attachment “B” and can be found at the following link:
https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/COVID-19/Order-of-the-State-Public-Health-Officer-Health-Care-Worker-Vaccine-Requirement.aspx
The State Health Officer Order orders, as follows:
All workers who provide services or work in facilities described below shall have their first dose of a one-dose regimen or their second dose of a two-dose regimen by September 30, 2021:
- General Acute Care Hospitals
- Skilled Nursing Facilities (including Subacute Facilities)
- Intermediate Care Facilities
- Acute Psychiatric Hospitals
- Adult Day Health Care Centers
- Program of All-Inclusive Care for the Elderly (PACE) and PACE Centers
- Ambulatory Surgery Centers
- Chemical Dependency Recovery Hospitals
- Clinics & Doctor Offices (including behavioral health, surgical)
- Congregate Living Health Facilities
- Dialysis Centers
- Hospice Facilities
- Pediatric Day Health and Respite Care Facilities
- Residential Substance Use Treatment and Mental Health Treatment Facilities
Two-dose vaccines include Pfizer-BioNTech or Moderna or vaccine authorized by the World Health Organization. The one-dose vaccine is Johnson and Johnson [J&J]/Janssen.
"Worker" refers to all paid and unpaid individuals who work in indoor settings where (1) care is provided to patients, or (2) patients have access for any purpose. This includes workers serving in health care or other health care settings who have the potential for direct or indirect exposure to patients or SARS-CoV-2 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 health care facility, and persons not directly involved in patient care, but who could be exposed to infectious agents that can be transmitted in the health care setting (e.g., clerical, dietary, environmental services, laundry, security, engineering and facilities management, administrative, billing, and volunteer personnel).
Exemption from Vaccination. Workers may be exempt from the vaccination requirements under only upon providing the operator of the facility a declination form, signed by the individual stating either of the following: (1) the worker is declining vaccination based on Religious Beliefs, or (2) the worker is excused from receiving any COVID-19 vaccine due to Qualifying Medical Reasons.
Eligibility for Qualified Medical Reasons Exemption. To be eligible for a Qualified Medical Reasons exemption, the worker must also provide to their employer a written statement signed by a physician, nurse practitioner, or other licensed medical professional practicing under the license of a physician stating that the individual qualifies for the exemption (but the statement should not describe the underlying medical condition or disability) and indicating the probable duration of the worker’s inability to receive the vaccine (or if the duration is unknown or permanent, so indicate).
Condition of Entry into Facility for Exempted Workers. If an operator of facility deems a worker to have met the requirements of an exemption, the unvaccinated exempt worker must meet the following requirements when entering or working in such facility:
- Test for COVID-19 with either PCR or antigen test that either has Emergency Use Authorization by the U.S. Food and Drug Administration or be operating per the Laboratory Developed Test requirements by the U.S. Centers for Medicare and Medicaid Services. Testing must occur twice weekly for unvaccinated exempt workers in acute health care and long-term care settings, and once weekly for such workers in other health care settings.
- Wear a surgical mask or higher-level respirator approved by the National Institute of Occupational Safety and Health (NIOSH), such as an N95 filtering facepiece respirator, at all times while in the facility.
2. Requirements for COVID-19 Vaccination Status Verification, COVID-19 Testing, and Masking for Certain Facilities. To help prevent transmission of COVID-19, all facilities described below shall comply with the State Health Officer Order, effective August 9, 2020. A copy of the State Health Officer Order is attached herein as Attachment “C” and can be found at the following link:
https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/COVID-19/Order-of-the-State-Public-Health-Officer-Unvaccinated-Workers-In-High-Risk-Settings.aspx
Acute Health Care and Long-Term Care Settings:
- General Acute Care Hospitals
- Skilled Nursing Facilities (including Subacute Facilities)
- Intermediate Care Facilities
High-Risk Congregate Settings:
Other Health Care Settings:
- Acute Psychiatric Hospitals
- Adult Day Health Care Centers
- Adult Day Programs Licensed by the California Department of Social Services
- Program of All-Inclusive Care for the Elderly (PACE) and PACE Centers
- Ambulatory Surgery Centers
- Chemical Dependency Recovery Hospitals
- Clinics & Doctor Offices (including behavioral health, surgical)
- Congregate Living Health Facilities
- Dental Offices
- Dialysis Centers
- Hospice Facilities
- Pediatric Day Health and Respite Care Facilities
- Residential Substance Use Treatment and Mental Health Treatment Facilities
3. Requirements for COVID-19 Vaccine Status Verification and COVID-19 Testing for School Workers in Transitional Kindergarten through Grade 12. To prevent the further spread of COVID-19 in K-12 school settings, all public and private schools serving students in transitional kindergarten through grade 12 shall comply with the State Health Officer Order, effective August 12, 2021, regarding verification of COVID-19 vaccination status and COVID-19 testing of all workers. A copy of the State Health Officer Order is attached herein as Attachment “D” and can be found at the following link:
https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/COVID-19/Order-of-the-State-Public-Health-Officer-Vaccine-Verification-for-Workers-in-Schools.aspx
This Order does not apply to (i) home schools, (ii) child care settings, or (iii) higher education.
4. Local Correctional Facilities and Detention Centers Health Care Worker Vaccination Requirement. To prevent the further spread of COVID-19 in local correctional facilities and detention centers, all individuals identified in the State Health Officer Order, effective August 19, 2021, regarding obtaining COVID-19 vaccination shall comply with the State Health Officer's Order. A copy of the State Health Officer Order is attached herein as Attachment "E" and can be found at the following link:
https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/COVID-19/Order-of-the-State-Public-Health-Officer-Correctional-Facilities-and-Detention-Centers-Health-Care-Worker-Vaccination-Order.aspx
IV. Visiting Acute Health Care and Long-Term Care Setting Order:
1. Requirements for Visiting Acute Health Care and Long-Term Care Settings. To help prevent transmission of COVID-19, all acute health care and long-term care settings shall comply with the indoor visitation requirements set forth in the State Health Officer, effective August 11, 2021. A copy of the State Health Officer Order is attached herein as Attachment “F” and can be found at the following link:
https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/COVID-19/Order-of-the-State-Public-Health-Officer-Requirements-for-Visitors-in-Acute-Health-Care-and-Long-Term-Care-Settings.aspx
V. Seasonal Flu Vaccination Order:
- Seasonal Flu Vaccination for Certain Individuals. All individuals who reside or work in Orange County and fall under one of the following categories, shall obtain the seasonal flu vaccination unless a medical or religious exemption applies: (i) current providers for congregate settings; (ii) current health care providers; and (iii) current emergency responders. However, nothing herein shall be construed as an obligation, on the part of employers, public or private, to require employees obtain the seasonal flu vaccination as a term or condition of employment. For definition of the terms, “health care provider” and “emergency responder,” refer to the definitions provided for these terms in Section I.2 (“Self-Quarantine of Persons Exposed to COVID-19”), above.
For more information, visit OC Health Officer's Orders & Recommendations | Novel Coronavirus (COVID-19) (ochealthinfo.com).
Guidance For the Use of Masks
Background
The COVID-19 vaccines are effective in preventing serious disease. Unvaccinated persons are more likely to get infected and spread the virus which is transmitted through the air and concentrates indoors. About 15% of our population remains without the option for vaccination (children under 12 years old are not yet eligible) and risk for COVID-19 exposure and infection will remain until we reach full community immunity.
The purpose of this guidance is to provide information about higher risk settings where masks are required or recommended to prevent transmission to persons with higher risk of infection (e.g., unvaccinated or immunocompromised persons), to persons with prolonged, cumulative exposures (e.g., workers), or to persons whose vaccination status is unknown. When people who are not fully vaccinated wear a mask correctly, they protect others as well as themselves. Consistent and correct mask use by people who are not fully vaccinated is especially important indoors.
With the emergence of the more contagious Delta variant in California which now accounts for over 80% of cases sequenced, cases and hospitalizations of COVID-19 are rising throughout the state, especially amongst those that remain unvaccinated.
Despite ongoing outreach and improving COVID-19 vaccine access, as of July 27, 2021, a significant proportion of Californians throughout the state are not yet fully vaccinated. The Delta variant is two times as contagious than early COVID-19 variants, leading to increasing infections.
In California, unvaccinated persons continue to be required to wear masks in all indoor public settings. This guidance is an update, in light of review of the most recent CDC recommendations. To achieve universal masking in indoor public settings, we are recommending that fully vaccinated people also mask in indoor public settings across California. This adds an extra precautionary measure for all to reduce the transmission of COVID-19, especially in communities currently seeing the highest transmission rates. Local health jurisdictions may be more restrictive than this guidance.
In California, fully vaccinated people might choose to wear a mask in indoor non-public settings, particularly if they are immunocompromised or at increased risk for severe disease from COVID-19, or if they have someone in their household who is immunocompromised, at increased risk of severe disease, not fully vaccinated, or not yet eligible for vaccination.
In workplaces, employers are subject to the Cal/OSHA COVID-19 Emergency Temporary Standards (ETS) or in some workplaces the Cal/OSHA Aerosol Transmissible Diseases (ATD) Standard and should consult those regulations for additional applicable requirements.
Masking Requirements
Masks are required for all individuals in the following indoor settings, regardless of vaccination status:
- On public transit[1] (examples: airplanes, ships, ferries, trains, subways, buses, taxis, and ride-shares) and in transportation hubs (examples: airport, bus terminal, marina, train station, seaport or other port, subway station, or any other area that provides transportation)
- Indoors in K-12 schools[2], childcare[3]
- Emergency shelters[4] and cooling centers[5]
Masks are required for all individuals, in the following indoor settings, regardless of vaccination status (and surgical masks are recommended):
Additionally, masks are required* for unvaccinated individuals in indoor public settings and businesses (examples: retail, restaurants, theaters, family entertainment centers, meetings, state and local government offices serving the public).
See State Health Officer Order, issued on July 26, 2021, for a full list of high-risk congregate and other healthcare settings where surgical masks are required for unvaccinated workers, and recommendations for respirator use for unvaccinated workers in healthcare and long-term care facilities in situations or settings not covered by Cal OSHA ETS or ATD.
For additional information on types of masks, the most effective masks, and ensuring a well-fitted mask, individuals should refer to CDPH Get the Most out of Masking and see CDPH Masking Guidance Frequently Asked Questions for more information.
For more information, go to this link guidance for face coverings (ca.gov).