While California, Oregon, and Washington plan to drop requirements that healthcare workers wear face masks in indoor health facilities on April 3, San Francisco continues to enforce this rule, along with vaccine requirements.
In the first of two orders issued February 28, Susan Philip, MD, MPH, health officer for the city and county of San Francisco, said healthcare workers must continue “to wear a well-fitted mask at all times when in the same room as patients, clients, residents, or people who are incarcerated,” and strongly recommended use of non-vented N95, KN95, or KF94 respirator masks.
The second order called for healthcare workers to be vaccinated and, when eligible, to receive a booster.
Both orders noted that “violation of or failure to comply … is a misdemeanor punishable by fine, imprisonment, or both.”
San Francisco’s orders on masking and vaccination apply to personnel who work in healthcare facilities, including hospitals, skilled nursing facilities, intermediate care facilities, ambulatory care settings, congregate and jail healthcare facilities, and other parts of jails.
The masking order also applies to people who visit these locations intermittently or for short periods of time, such as delivery people, contractors, regulators, firefighters, EMTs, paramedics, and police and other law enforcement personnel. It does not apply to patients, clients, residents, or people who are incarcerated and their visitors, although they are strongly recommended to wear a well-fitted mask.
Around the country, mask and vaccine guidance comprises a patchwork of varying state mandates or guidelines. Delaware, Washington, D.C., and Massachusetts, for example, still require masks in healthcare facilities.
For Jeoff B. Gordon, MD, MPH, a retired family doctor in Santa Cruz, San Francisco’s orders are “imperative, and the most basic, wisest guidance there is.”
“I have four high-risk medical conditions, and I find it irresponsible that after the ending of the public health emergency, if I am ill for any reason and call 911, I will be exposed to police, firefighters, paramedics, and facility medical personnel who may not have been vaccinated and most likely are not required to be,” Gordon, who is 81, said.
Many people who are infectious have no symptoms, he added, “and there are obviously more people at risk of COVID than I am.”
Philip’s two orders came on the same day that she issued a third order terminating the county’s COVID-19 public health emergency declaration and rescinding most other pandemic-related directives for the general population. That directive was made possible due to the area’s high rate of vaccination among its more than 800,000 residents, greater availability of effective treatments, and effective use of mitigation such as testing and masking, Philip said.
But the virus still poses a particular risk to the medically vulnerable, she wrote. “Patients, clients, and residents in healthcare settings, as well as people who are incarcerated, have little choice about their potential exposure to COVID-19 when they seek care, and many of them are at greater risk for COVID-19-related complications.”
Bob Wachter, MD, chair of the department of medicine at the University of California San Francisco, said he hopes healthcare delivery organizations — especially those that take care of patients at high risk of serious complications if they get COVID — continue to require masks in patient care settings.
They should require masks “probably indefinitely, but at least until the prevalence is significantly lower than it is today,” he noted. Masking lowers the chances that healthcare workers will infect their patients, “which is really what a workplace requirement is all about.”
He thinks healthcare workers should also be strongly recommended to stay up to date on their vaccines and boosters, but that the justification for requiring workers to receive them is not as strong because the vaccines’ ability to prevent infection wanes fairly quickly, “although it still works very well in preventing severe infection.”
At Kaiser Permanente’s Northern California division, infectious disease specialist Michael Vollmer, MD, said the state document relaxing COVID restrictions came after San Francisco’s orders, but local county health officials “have the authority to order measures they feel important to protect the local population.”
He said Kaiser Permanente is reviewing the state’s March 3 order and will continue to assess for COVID risks in the region.
As of February 27, 2,530 people in California were hospitalized with COVID, and the state reported an average of 18 COVID deaths a day.
Gordon said he wonders why all counties aren’t similarly taking steps to prevent the continued spread of COVID. The fact that they aren’t, he added, has filled his sleepless nights with anxiety that he will get sick.
“The San Francisco health order is a ray of appropriate behavior in a gray wilderness,” he said.
In a statement emailed to MedPage Today, the San Francisco Department of Public Health said it has “led the nation in its response to COVID-19 because we followed the science and worked closely with community and health system partners to provide low-barrier access to resources such as vaccines and testing. Although state and local COVID-19 emergencies have ended, the virus has not gone away, and our commitment to working with our partners and serving those most in need remains.”
The California Department of Public Health said that while it is relaxing its mask and vaccination requirements, local health jurisdictions and organizations can customize their own policies in response to local conditions.
Cheryl Clark has been a medical & science journalist for more than three decades.
