Dr. James issues masking mandate for healthcare settings April 3-May 11

WHEREAS, the coronavirus disease 2019 (COVID-19) is caused by a virus that spreads easily from person to person which may result in serious illness or death and has been classified by the World Health Organization as a worldwide pandemic;

WHEREAS, COVID-19 has spread throughout Washington State, including San Juan County, significantly threatening the life and health of persons in San Juan County;

WHEREAS, on March 13, 2020, the President of the United States issued a presidential proclamation declaring that the COVID-19 outbreak in the United States is a national emergency;

WHEREAS, COVID-19 can spread from people without symptoms, including persons who are asymptomatic or pre-symptomatic, to others;

WHEREAS, the primary mode of transmission of COVID-19 is respiratory droplets from infected individuals;

WHEREAS, respiratory droplets from infected individuals can be transmitted not only through coughing or sneezing but also through other actions including talking or breathing;

WHEREAS, there are current vaccinations that can be effective in preventing hospitalization and death from COVID-19 in fully vaccinated individuals, however they provide short periods of protection and while effective at preventing severe infection (hospitalization and death) in some they are much less effective at preventing infection and spread of the disease to high risk individuals.;

WHEREAS, non-pharmaceutical interventions, such as wearing medical masks, are an effective measure to control and prevent the spread of COVID-19;

WHEREAS, use of medical masks to cover the mouth and nose are recommended by the Centers for Disease Control (CDC) to help control the spread of COVID-19 by reducing the transmission of respiratory droplets from infected individuals into the environment from asymptomatic or pre-symptomatic individuals;

WHEREAS, the Washington Department of Health maintained a statewide requirement for masking in healthcare facilities effective October 31, 2022, in order to protect vulnerable persons;

WHEREAS, the Washington Department of Health announced on March 3, 2023, that the statewide requirement for masking in healthcare facilities will end effective April 3, 2023, but that the Department will continue to recommend masking in healthcare facilities beyond that date;

WHEREAS, the United States Department of Health and Human Services and other federal agencies have announced an expectation that the federal Public Health Emergency is likely to expire at the end of the day May 11, 2023;

WHEREAS, for children under two years old it is difficult to safely wear a medical mask;

WHEREAS, elderly or immunocompromised individuals are at increased risk for severe illness from COVID-19, and over 35% of San Juan County’s population is comprised of individuals over the age of 65 as compared to 15% of the population in most counties;

WHEREAS, about 10% of high-risk elders in San Juan County, about 20% of eligible 12- to 64-year-olds in San Juan County, and those persons in San Juan County with diseases or medical treatments that render them immune compromised have not received and thus are not protected by vaccination;

WHEREAS, elderly and immunocompromised individuals need to safely access healthcare, and the concentration of these populations is higher in healthcare settings;

WHEREAS, documented cases known as “breakthrough cases” are now occurring among a portion of fully vaccinated individuals;

WHEREAS, RCW 70.05.070 requires and empowers the local health officer to take such action as is necessary to control and prevent the spread of any contagious or infectious diseases within the jurisdiction;

WHEREAS, WAC 246-100-036 requires the local health officer, when necessary, to institute disease control measures deemed necessary based on their professional judgment, current standards of practice, and the best available medical and scientific information; and WHEREAS, in my professional judgment, based on the current standards of practice and the best available medical and scientific information, it is my determination that medical masks remain essential for public safety in healthcare settings where vulnerable persons are likely to be present, specifically in areas where vulnerable patients are likely to be present; NOW, THEREFORE, I, Dr. Frank James, Local Health Officer for San Juan County, under the authority of RCW 70.05.070, RCW 43.20.050, and WAC 246-100-036, and on the basis of the foregoing recitals, make the following ORDER:

1. Use of Medical Masks. Owners and operators of healthcare facilities in San Juan County shall not permit or allow any non-employee to enter or remain inside a building owned or operated by the healthcare facility unless the non-employee is wearing a medical mask or more protective mask over their mouth and nose. Owners and operators of healthcare facilities in San Juan County and home health providers in San Juan County shall ensure that employees, contractors, and volunteers wear a medical mask or more protective mask during times when in a room or common area inside the healthcare facility building that is occupied by one or more patients.

2. Applicability. This order applies only to buildings used for one or more of the following purposes: emergency medical services, hospitals, outpatient clinics, long-term care, skilled nursing, or family group homes. This order does not apply to healthcare facility buildings that serve limited populations where vulnerable populations are unlikely to congregate, including dental offices, optometry offices, physical therapy, massage, or eye care clinics.

3. Exceptions. The following exceptions apply to Section 1 of this Order:

a. No person is required to wear a medical mask in a medical setting at a time when doing so would not be medically appropriate for the wearer or would interfere with medical care.

b. Children under the age of two are not required to wear a medical mask.

c. Patients in their own room in long-term care are not required to wear a medical mask.

d. Owners and operators of healthcare facilities in San Juan County and home health providers in San Juan County are not required to enforce this order as it applies to employees, contractors, or volunteers who are not able to wear a medical mask and are entitled under the Americans With Disabilities Act (ADA), Title VII of the Civil Rights Act of 1964 (Title VII), the Washington Law Against Discrimination (WLAD), or any other applicable law to a disability-related reasonable accommodation or a sincerely held religious belief accommodation to the requirements of this order.

Any violation of this order is a misdemeanor punishable by fine and arrest and imprisonment up to 90 days pursuant to RCW 70.05.120.

This Order becomes effective April 3, 2023, and shall remain in effect until May 11, 2023, at 11:59 p.m. unless sooner rescinded by order of the County Health Officer following a determination that the wearing of medical masks in healthcare settings is no longer necessary.

DATED this 31 day of March, 2023.

FRANK JAMES, M.D. SAN JUAN COUNTY HEALTH OFFICER