Image of Tomás J. Aragón, M.D., CDPH director

In a bid to stem a rising tide of COVID-19 cases, California is requiring that all indoor visitors to healthcare facilities — including skilled nursing facilities — show proof of full vaccination or of a negative SARS-CoV-2 test.

It’s a move designed to protect the most vulnerable as the state weathers the fastest rise in COVID-19 cases of the pandemic so far, according to the California Department of Public Health, which issued the order. Most new infections are driven by the highly contagious delta variant, it said.

Facility operators must have a plan in place for ensuring compliance with the order, which went into effect Wednesday, the CDPH said in a public letter

“As we continue to see an increase in cases and hospitalizations due to the delta variant of COVID-19, it’s important that we protect the vulnerable patients in these settings,” said Tomás J. Aragón, M.D., CDPH director and state public health officer. “[V]accination against COVID-19 is the most effective means of preventing further infections, transmission, and outbreaks.”

Valid forms of proof, exemptions

Acceptable proof of vaccination includes a COVID-19 Vaccination Record Card issued by the Centers for Disease Control and Prevention or a World Health Organization Yellow Card; documentation from a healthcare provider; or a digital record including a QR code that can be scanned by a SMART Health Card reader.

Results from federally approved antigen or PCR tests also are acceptable. They must be performed 72 hours before the visit, or facilities can conduct the tests on-site “if practical,” the CDPH noted. The order also requires that indoor visitors be masked and practice social distancing. 

Visitors are exempt from the vaccination and testing portions of the order if they wish to see a resident in critical condition, when death may be imminent. The order does not apply to those seeking an outdoor visit, as long as it does not involve entering indoor property.

The new order builds on the state’s requirement that all long-term care facilities staff members and other healthcare workers show proof of vaccination or get tested weekly. Among California residents aged 12 years and older, 63% are fully vaccinated and an additional 10% are partially vaccinated.

Skilled nursing facilities have accounted for more than 2,000 California COVID-19 outbreaks in the past seven months, CDPH reported. “Recent outbreaks in healthcare settings have frequently been traced to unvaccinated staff members, demonstrating the risk of unvaccinated persons in these settings,” Aragón said.

Vaccine passports to come?

The idea of mandated proof of vaccination has gained traction among hospital systems and other private employers, although California lawmakers have so far been wary of implementing it for all state residents, the East Bay Times reported.

“I think the conversation has shifted to these two words that we didn’t want to use at the beginning, which are vaccine passports and vaccine mandates,” Monica Gandhi, a University of California San Francisco infectious disease expert, told the news outlet.

In related news, the city of San Francisco has begun offering booster shots of the Pfizer or Moderna vaccines to people who have already received the one-dose Johnson & Johnson shot and are seeking additional protection as delta variant infections surge.