OC Health Officer's Orders & Recommendations

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OC Health Care Agency Logo CLAYTON CHAU, MD PhD
DIRECTOR/ COUNTY HEALTH OFFICER

405 W. 5TH STREET, 7TH FLOOR
SANTA ANA, CA 92701
www.ochealthinfo.com

COUNTY OF ORANGE HEALTH OFFICER'S
ORDERS AND STRONG RECOMMENDATIONS
(Revised June 17, 2021)

In light of the Executive Order N-07-21 that ended the Stay Home Order and the Blueprint for a Safer Economy as of June 15, 2021, the new State Public Health Officer Order effective June 15, 2021, and the new face covering guidance by the California Department of Public Health (CDPH) effective June 15, 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 May 18, 2021. The Orders and Strong Recommendations issued on May 18, 2021, are no longer in effect as of June 17, 2021.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:

  1. 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:
    1. 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.
    2. 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.
  2. Unless one of the criteria, above, applies, i.e. 3.a) or 3.b), the individual may not leave his or her place of isolation except to receive necessary medical care.

    A person is considered to be diagnosed with or likely to have COVID-19, if the person has:

    1. Received a positive COVID-19 PCR or rapid antigen laboratory test result; and/or
    2. Been informed by a physician that he or she is likely to have COVID-19 and/or;
    3. Signs and symptoms that are consistent with COVID-19 (i.e., new onset of fever, cough, shortness of breath or trouble breathing).

    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 # 3.

    This self-isolation order DOES NOT in any way restrict access by first responders to an isolation site during an emergency.

  3. 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 shall be deemed exposed to COVID-19 and shall take the following actions:

    Not Fully Vaccinated Persons

    1. 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.
    2. 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:

    1. 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.
    2. Stay at least 6 feet from others through Day 14;
    3. Wear face coverings at all times through Day 14 and adhere to the face covering order # 5, below, after Day 14;
    4. 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:

    1. 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. During critical staffing shortages, the following asymptomatic persons who are not fully vaccinated for COVID-19 are not required to quarantine:
      • Health care providers;
      • Emergency responder; and
      • Social service workers who work face to face with clients in the child welfare system or in assisted living facilities.

    Definitions:

    "Close contact" means being within 6 feet of an infected person for a cumulative total of 15 minutes or more, over a 24-hour period, starting from 2 days before illness onset (or, for asymptomatic persons, 2 days prior to test specimen collection) until the time the infectious person is isolated. A person who is diagnosed with or likely to have COVID-19 is considered infectious from 48 hours before the moment his or her symptoms first appeared until that time when the person is no longer required to be isolated. A person who is diagnosed with COVID-19 but has no symptoms is considered infectious from 48 hours prior to the date the person was tested until 10 days after that date.

    "Emergency responder" includes military or national guard, law enforcement officers, correctional institution personnel, fire fighters, emergency medical services personnel, physicians, nurses, public health personnel, emergency medical technicians, paramedics, emergency management personnel, 911 operators, child welfare workers and service providers, public works personnel, and persons with skills or training in operating specialized equipment or other skills needed to provide aid in a declared emergency, as well as individuals who work for such facilities employing these individuals and whose work is necessary to maintain the operation of the facility.

    "Health care provider" includes physicians; psychiatrists; nurses; nurse practitioners; nurse assistants; medical technicians; any other person who is employed to provide diagnostic services, preventive services, treatment services or other services that are integrated with and necessary to the provision of patient care and, if not provided, would adversely impact patient care; and employees who directly assist or are supervised by a direct provider of diagnostic, preventive, treatment, or other patient care services; and employees who do not provide direct heath care services to a patient but are otherwise integrated into and necessary to the provision those services – for example, a laboratory technician who processes medical test results to aid in the diagnosis and treatment of a health condition. A person is not a health care provider merely because his or her employer provides health care services or because he or she provides a service that affects the provision of health care services. For example, IT professionals, building maintenance staff, human resources personnel, cooks, food services workers, records managers, consultants, and billers are not health care providers, even if they work at a hospital of a similar health care facility.

  4. 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 June 15, 2021. The Guidance can be found at: https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/COVID-19/guidance-for-face-coverings.aspx. The Guidance states:
  5. Guidance for Individuals

    Masks are not required for fully vaccinated individuals, except in the following settings where masks are required for everyone, 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 and other youth settings.
      • Note: This may change as updated K-12 schools guidance is forthcoming, pending updates for K-12 operational guidance form CDC.
    • Healthcare settings (including long term care facilities).
    • State and local correctional facilities and detention centers.
    • Homeless shelters, emergency shelters and cooling centers.

    Additionally, masks are required for not fully vaccinated individuals in indoor public settings and businesses (examples: retail, restaurants, theaters, family entertainment centers, meetings, state and local government offices serving the public).

    For additional information, see Face Covering Q&A at https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/COVID-19/Face-Coverings-QA.aspx.

    Guidance for Businesses, Venue Operators or Hosts

    In settings where masks are required only for not fully vaccinated 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.
  6. 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 order #4 ("Self-Quarantine of Persons Exposed to COVID-19"), above.

STRONG RECOMMENDATIONS

Effective immediately, and continuing until further notice, the following shall be in effect in unincorporated and incorporated territories in Orange County, California:

  1. For Vulnerable Population. In general, the older a person is, the more health conditions a person has, and the more severe the conditions, the more important it is to take preventive measures for COVID-19 such as getting vaccinated, social distancing and wearing a mask when around people who don't live in the same household, and practicing hand hygiene. For more information, see https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html.
  2. COVID-19 Vaccination for County Residents. All Orange County residents should receive COVID-19 vaccination in accordance with the Federal Food and Drug Administration (FDA) and CDC guidance unless a medical contraindication applies. Minors, who are eligible to receive COVID-19 vaccination in accordance with the applicable CDC guidelines, should be vaccinated in the presence of their parent or legal guardian.
  3. Seasonal Flu Vaccination for County Residents. All County residents should obtain the seasonal flu vaccination unless a medical or religious exemption applies.

GENERAL PROVISIONS

  1. The Orders and Strong Recommendations, above, shall not supersede any conflicting or more restrictive orders issued by the State of California or federal government. If any portion of this document or the application thereof to any person or circumstance is held to be invalid, the remainder of the document, 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 the orders and strong recommendations are severable.
  2. The Orders contained in this document may be enforced by the Orange County Sheriff or Chiefs of Police pursuant to California Health and Safety Code section 101029, and California Government Code sections 26602 and 41601. A violation of a health order is subject to fine, imprisonment, or both (California Health and Safety Code section 120295).

REASONS FOR THE ORDERS AND STRONG RECOMMENDATIONS

  1. On February 26, 2020, the County of Orange Health Officer declared a Local Health Emergency based on an imminent and proximate threat to public health from the introduction of a novel coronavirus disease (COVID-19) in Orange County.
  2. On February 26, 2020, the Chairwoman of the Board of Supervisors, acting as the Chair of Emergency Management Council, proclaimed a Local Emergency in that the imminent and proximate threat to public health from the introduction of COVID-19 created conditions of extreme peril to the safety of persons and property within the territorial limits of Orange County.
  3. On March 2, 2020, the Orange County Board of Supervisors adopted Resolutions No. 20-011 and No. 20-012 ratifying the Local Health Emergency and Local Emergency, referenced above.
  4. On March 4, 2020, the Governor of the State of California declared a State of Emergency to exist in California as a result of the threat of COVID-19.
  5. As of June 15, 2021, the County has reported a total of 255,069 recorded confirmed COVID-19 cases and 5,103 of COVID-19 related deaths.
  6. Safe and effective authorized COVID-19 vaccines are recommended by the CDC. According to CDC, anyone infected with COVID-19 can spread it, even if they do NOT have symptoms.  The novel coronavirus is spread in 3 ways:1) Breathing in air when close to an infected person who is exhaling small droplets and particles that contain the virus. 2) Having these small droplets and particles that contain virus land on the eyes, nose, or mouth, especially through splashes and sprays like a cough or sneeze. 3)  Touching eyes, nose, or mouth with hands that have the virus on them. See https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/how-covid-spreads.html.
  7. CDC requires face coverings on planes, buses, trains, and other forms of public transportation traveling into, within, or out of the United States and in U.S. transportation hubs such as airports and stations. See https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/about-face-coverings.html.
  8. The CDPH issued a revised Guidance for the Use of Face Coverings, effective June 15, 2021, available at: https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/COVID-19/guidance-for-face-coverings.aspx.
  9. According to the CDC and CDPH, older adults, individuals with medical conditions, and pregnant and recently pregnant persons are at higher risk of severe illness when they contract COVID-19. See https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/index.html; see also https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/COVID-19/PublicHealthGuidanceSelfIsolationforOlderAdultsandThoseWhoHaveElevatedRisk.aspx.
  10. The Orders and the Strong Recommendations contained in this document are based on the following facts, in addition to the facts stated under the foregoing paragraphs: (i) Safe and effective FDA authorized COVID-19 vaccines have become widely available, but many Orange County residents have not yet had the opportunity to be vaccinated, or have not completed their vaccination series to be fully vaccinated; (ii) there are currently limited therapeutic options proven effective that consistently prevents the severe illness associated with COVID-19; (iii) the current consensus among public health officials for slowing down the transmission of and avoiding contracting COVID-19 is for unvaccinated persons to avoid gathering and practice social distancing, frequently wash hands with soap, wearing face covering and get vaccinated; (iv) some individuals who contract COVID-19 have no symptoms or have only mild symptoms and so are unaware that they carry the virus and are transmitting it to others; (v) current evidence shows that the novel coronavirus can survive on surfaces and can be indirectly transmitted between individuals; (vi) older adults and individuals with medical conditions are at higher risk of severe illness; (vii) sustained COVID-19 community transmission continues to occur; (viii) the age, condition, and health of a significant portion of Orange County's residents place them at risk for serious health complications, including hospitalization and death, from COVID-19; (ix) younger and otherwise healthy people are also at risk for serious negative health outcomes and for transmitting the novel coronavirus to others.
  11. The orders and strong recommendations contained in this document are necessary and lest restrictive preventive measures to control and reduce the spread of COVID-19 in Orange County, help preserve critical and limited healthcare capacity in Orange County, and save the lives of Orange County residents.
  12. The California Health and Safety Code section 120175 requires the County of Orange Health Officer knowing or having reason to believe that any case of a communicable disease exists or has recently existed within the County to take measures as may be necessary to prevent the spread of the disease or occurrence of additional cases.
  13. The California Health and Safety Code sections 101030 and 101470 require the county health officer to enforce and observe in the unincorporated territory of the county and within the city boundaries located with a county all of the following: (a) Orders and ordinances of the board of supervisors, pertaining to the public health and sanitary matters; (b) Orders, including quarantine and other regulations, prescribed by the department; and (c) Statutes relating to public health.
  14. The California Health and Safety Code section 101040 authorizes the County of Orange Health Officer to take any preventive measure that may be necessary to protect and preserve the public health from any public health hazard during any "state of war emergency," "state of emergency," or "local emergency," as defined by Section 8558 of the Government Code, within his or her jurisdiction. "Preventive measure" means abatement, correction, removal or any other protective step that may be taken against any public health hazard that is caused by a disaster and affects the public health.
  15. The California Health and Safety Code section 120130 (d) authorizes the County of Orange Health Officer to require strict or modified isolation, or quarantine, for any case of contagious, infectious, or communicable disease, when such action is necessary for the protection of the public health.

IT IS SO ORDERED:

Date: June 17, 2021                                                     

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Clayton Chau MD, PhD
County Health Officer
County of Orange