UPDATED AND AMENDED ORDER OF THE MARIN COUNTY PUBLIC HEALTH OFFICER REQUIRING COVID-19 VACCINATION OF LAW ENFORCEMENT, FIRE, AND EMERGENCY MEDICAL SERVICES PERSONNEL IN HIGHER-RISK SETTINGS
Date of Order: February 9, 2022
Date of Updated and Amended Order: April 14, 2022
Please read this Order carefully. Violation of or failure to comply with this Order is a misdemeanor punishable by fine, imprisonment, or both. (California Health and Safety Code § 120295, et seq.; Cal. Penal Code §§ 69, 148(a)(1); Marin Municipal Code Chapter 7.99 et seq.)
UNDER THE AUTHORITY OF CALIFORNIA HEALTH AND SAFETY CODE SECTIONS 101040, 101085, AND 120175, THE HEALTH OFFICER OF THE COUNTY OF MARIN (“HEALTH OFFICER”) ORDERS:
1. Background and Purpose.
a. This Order updates and amends the February 9, 2022 Order of the Health Officer (“February 9th Order”), which was made in light of the ongoing threat posed by SARS-CoV-2, the virus that causes COVID-19. The February 9th Order was issued in light of the rapid surge in COVID-19 cases due to the Omicron variant in the County of Marin (“County”), and the imminent threat that it posed to the health of vulnerable residents and the capacity of the healthcare system, as well as the risk of future variants. Specifically, at the time the February 9th Order was issued, Marin County Public Health was managing multiple, preventable COVID-19 outbreaks in vulnerable, higher-risk settings, including skilled nursing facilities (9 outbreaks), residential care facilities for the elderly (9 outbreaks), other group living facilities (19 outbreaks), and in the Marin County Jail. These outbreaks were amplified by contact with staff who were not up to date with their vaccines, an inadequate testing cadence, and a highly contagious variant.
b. This Order updates and amends the February 9th Order based on the fact that the surge in COVID-19 cases and outbreaks in higher-risk settings, which were the impetus for that order, have significantly abated. COVID-19 case rates are returning to levels less likely to pose a substantial threat to (1) the capacity and stability of hospitals in the County, and (2) those at greatest risk of serious illness and death from COVID-19.
c. Evidence shows that individuals who have received a booster shot increase their immunity to a level that confers more protection from all circulating SARS-CoV-2 variants, including the Omicron variant. The U.S. Centers for Disease Control and Prevention (“CDC”) and the California Department of Public Health (“CDPH”) now strongly recommend that all eligible persons receive a booster shot because immunity wanes several months after completion of the initial vaccine series.
d. Vaccination remains a safe and effective means of preventing COVID-19 and its associated harms. Individuals who have not received an initial vaccine series and any booster shots for which they are eligible are more likely to become infected and spread infection to others and are more likely to become seriously ill and die. Individuals who have recovered from COVID-19 develop natural immunity that wanes over time; research indicates the strongest immune response results when an individual has been vaccinated, boosted, and recovered from a COVID-19 infection. Community members, regardless of whether they have previously been infected with COVID-19, must receive vaccinations and booster shots when eligible to maintain the protective effect of the high community-wide vaccination rates in the County.
e. Ensuring that Law Enforcement, Fire, and EMS personnel working in higher-risk settings are both vaccinated and boosted when eligible is critical given the ongoing presence of SARS-CoV-2 and its highly infectious variants, the risk that health systems will be overwhelmed, and other ongoing risks associated with COVID-19 infection. Individuals working in higher-risk settings (1) can expose highly vulnerable individuals who are at increased risk of severe illness and death, (2) must be protected from COVID-19 to the maximum extent possible to ensure adequate staffing in these critical settings, and (3) in the case of jails, shelters, and skilled nursing facilities, can cause large outbreaks if infected.
f. Additionally, Law Enforcement, Fire, and EMS personnel who routinely interact with the public must also be protected from COVID-19 to the maximum extent possible. Law Enforcement, Fire, and EMS personnel interact with the public in a variety of high-risk and often vulnerable situations, including providing medical care, intervening in high-conflict situations, and managing crowds or other large groups of people. In these situations, members of the public may not be wearing face coverings and may not be vaccinated. Moreover, in these situations, Law Enforcement, Fire, and EMS personnel may interact with members of the public who will subsequently enter a higher-risk setting, such as a hospital or jail. To best protect the public and these higher-risk settings, Law Enforcement, Fire, and EMS personnel should be fully protected against COVID-19. In considering options to stem the surge in COVID-19 cases fueled by the Omicron variant, and future variants, and the associated demands on our public safety and healthcare delivery systems, ensuring that Law Enforcement, Fire, and EMS personnel who work in higher-risk settings or routinely interact with the public are all vaccinated and boosted when eligible is critically important.
g. This Order is also issued in light of the Order of the Marin County Public Health Officer Requiring the Verification of Vaccination Status and Requiring Weekly COVID-19 Testing for Certain Unvaccinated Workers (“Testing Order”). This Order initially took effect on September 1, 2021, and requires unvaccinated Law Enforcement, Fire, and EMS personnel to undergo weekly COVID-19 testing. This Order was re-issued on January 6, 2022, and requires all Law Enforcement, Fire, and EMS personnel who are not Up-to-Date (i.e., received a booster when eligible) to undergo weekly COVID-19 testing.
h. This Order continues to require all Law Enforcement, Fire, and EMS personnel who work in Higher-Risk Settings or routinely interact with the public to be Fully Vaccinated. This Order strongly recommends all Law Enforcement, Fire, and EMS personnel become boosted as soon as they are eligible. Any Law Enforcement, Fire, or EMS personnel covered by this Order who are not Up-to-Date (i.e., are booster eligible but have not received a booster) must comply with the requirements set forth in the Testing Order.
For purposes of this Order, the following terms have the meanings given below.
a. COVID-19 Vaccine. “COVID-19 Vaccine” means a vaccine to prevent COVID-19 that is (1) administered under an emergency use authorization from the FDA; (2) approved by the FDA; or (3) listed for emergency use by the World Health Organization.
b. Fully Vaccinated. “Fully Vaccinated” means a person’s status two weeks following the person’s receipt of a single-dose COVID-19 Vaccine or the second dose of a two-dose COVID-19 Vaccine.
c. Up-To-Date. “Up-to-Date” means that an individual is not only “Fully Vaccinated” but has also obtained at least one booster dose of a COVID-19 vaccination for which they are eligible as authorized by the FDA. For example, as of the date of this Order, individuals who received their second dose of the Pfizer or Moderna COVID-19 vaccine more than five months ago are eligible for and must obtain a booster shot to be Up-to-Date, while individuals who received one dose of the Johnson & Johnson COVID-19 vaccine more than two months ago are eligible for and must obtain a booster shot of any of the available vaccines to be Up-to-Date.
d. Law Enforcement. “Law Enforcement” means all law enforcement officers working in (1) the Marin County Sheriff’s Office; (2) Marin County Probation Office; (3) any police department of a city or town within Marin County; (4) the Central Marin Police Authority; and (5) the College of Marin Police Department.
e. Fire. “Fire” means all firefighters, including part-time, stipend, and volunteer in Marin County, including any fire department of a city or town within Marin County.
f. Emergency Medical Services or EMS. “Emergency Medical Services” or “EMS” means all prehospital emergency medical personnel, including but not limited to: authorized registered nurse or mobile intensive care nurse, emergency medical technician, advanced emergency medical technician, paramedic, or a physician and surgeon who provides prehospital emergency medical care or rescue services.
g. Employer. “Employer” means an employer of Law Enforcement, Fire, or Emergency Medical Services, including local governmental entities.
h. Personnel. “Personnel” means employees and volunteers of an Employer.
i. Business. “Business” means 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, having a place of business within Marin County.
j. Higher-Risk Settings. “Higher-Risk Settings” are settings that involve working in shared air space or proximity to people who are at higher risk of severe illness, hospitalization, or death from COVID-19 because of age or underlying medical condition, as well as congregate settings where outbreaks are likely to occur. For the purposes of this Order, Higher-Risk Settings are those portions of the following facilities where there is shared air space or proximity to patients, clients, or vulnerable populations:
i. Skilled nursing facilities, long-term care facilities, adult day care facilities, and memory care facilities;
ii. Healthcare delivery facilities (such as hospitals, clinics, medical offices, dialysis centers, etc.) where patient care is provided, as well as medical first response;
iii. Jails and other correctional facilities, including juvenile detention facilities; and
iv. Congregate shelters.
For purposes of this Order, all Law Enforcement, Fire, and EMS Personnel who are not permanently stationed or regularly assigned to a Higher-Risk Setting but who in the course of their duties may enter or work in Higher-Risk Settings, even on an intermittent or occasional basis for short periods of time, are considered to work onsite in Higher-Risk Settings.
3. COVID-19 Vaccination Requirements for Law Enforcement, Fire, and EMS Personnel in Higher-Risk Settings or who Routinely Interact with the Public.
a. Requirement for All Law Enforcement, Fire, and EMS Personnel to be Up-to-Date.
As soon as possible, but by no later than by March 1, 2022, all Law Enforcement, Fire, and EMS Employers must ensure that any personnel who are not already Fully Vaccinated as of the effective date of this Order and who work in Higher-Risk Settings or who routinely interact with the public have received their first dose of a COVID-19 vaccine. Effective April 15, 2022, all personnel subject to this subsection must be Fully Vaccinated.
Effective April 15, 2022, all Law Enforcement, Fire, and EMS Personnel who are not Fully Vaccinated, except as provided in Section 3.c, shall be prohibited from entering Higher-Risk Settings or interacting with the public in the course of their work.
b. Requirements Regarding Personnel with Approved Exemptions. Law Enforcement, Fire, or EMS Personnel in Higher-Risk Settings may be exempt from the vaccination requirement based on a medical or religious exemption. Employers should undertake a good faith, individualized exemption process. Nothing in this Order is intended to limit a Law Enforcement, Fire, or EMS employer’s ability under applicable law to determine whether to grant an employee’s request for such an exemption, consistent with all applicable laws, and to offer an appropriate reasonable accommodation. All Law Enforcement, Fire, and EMS Personnel who are granted such an exemption must comply with the following requirements:
i. Use a fit-tested, non-vented N95 (or greater) respirator at all times when at work and in shared airspace with others, including any work-related events or gatherings, regardless of their location, except when eating, drinking, bathing, or sleeping;
ii. Obtain twice-weekly molecular or antigen COVID-19 testing; and,
iii. When practicable, avoid using indoor breakrooms or cafeterias and avoid eating indoors or sleeping indoors when others are present in the same airspace.
c. Recommendation to Remain Up-to-Date. Public Health strongly recommends that all Law Enforcement, Fire, and EMS Personnel who work in Higher-Risk Settings or routinely interact with the public remain Up-to-Date with their COVID-19 vaccinations (i.e., receive a booster shot within fifteen days of becoming eligible for a booster). All Law Enforcement, Fire, and EMS Personnel who are not Up-to-Date must comply with the provisions set forth in the Testing Order.
4. Record Keeping Requirements.
An Employer must keep and maintain a record of the following information for the purpose of inspection by an authorized representative of the Health Officer:
a. For Personnel who provide the Employer with documentation of Fully Vaccinated or Up-to-Date status: (1) Full name and date of birth; (2) COVID-19 Vaccine manufacturer; and (3) date of COVID-19 Vaccine administration (first dose, second dose and booster doses).
5. Obligation to Follow Stricter Order.
Where a conflict exists between this Order and any order issued by the State Health Officer, the Governor, or a State agency (such as the California Division of Occupational Safety and Health (“Cal/OSHA”) or CDPH) related to the COVID-19 pandemic, the most restrictive provision controls.
6. Effective Date.
This Order shall become effective at 12:01am on April 15, 2022. This Order shall continue to be in effect until it is rescinded, superseded, or amended in writing by the Health Officer.
If any provision of this Order or its application to any person or circumstance is held to be invalid, the remainder 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.
Copies of this Order shall promptly be: (1) made available at the Bulletin Board adjacent to the entrance to the Chambers of the Board of Supervisors, Room 330, Administration Building, and in the display case in the center arch of the Hall of Justice, Marin County Civic Center, San Rafael, California; (2) posted on the County of Marin website (www.marincounty.org) as well as the County of Marin Department of Health and Human Services website (www.marinhhs.org); and (3) provided to any member of the public requesting a copy of this Order.
IT IS SO ORDERED:
Matt Willis, MD, MPH
Health Officer of the County of Marin
Dated: April 14, 2022