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Indoor mega-events will require up-to-date vaccinations, including boosters,  

starting February 1, 2022 

San Francisco, CA – Mayor London Breed N. Breed and San Francisco Health Director Dr. Grant Colfax announced today updates to the Safer Return Together Health Order in response to the sharp increase of COVID-19 cases driven by the rapidly-spreading Omicron variant. Major changes include (1) the City’s alignment with the State to require boosters among workers in healthcare and high-risk settings – as well as some additional higher-risk settings not covered by the State requirements – by February 1, 2022, (2) a temporary suspension of the indoor universal mask exemption that allowed removal of masks for stable groups of 100% fully vaccinated individuals in certain settings, and (3) a requirement that attendees and staff of indoor mega-events are up-to-date on COVID-19 vaccinations, including boosters if eligible, starting February 1, 2022.  

In addition, San Francisco Department of Public Health (SFDPH) plans to align its guidance on Isolation & Quarantine with the recently announced modifications recommended by the Centers for Disease Control and Prevention (CDC) and the California Department of Public Health (CDPH), which include shortening the isolation time for people who are COVID-positive. 

“Our residents how shown time and time again that they understand the importance of protecting public health,” said Mayor London Breed. “Thanks to our high vaccination rates we are in a much better place than last winter, but there is real danger out there for those who are unvaccinated. We will continue to focus on taking the steps necessary to deal with this latest surge of cases, while also keeping our businesses open and keeping our kids in school, which is so important for our young people and their families. Do your part and get yourself and your family boosted so we can all continue to protect each other in the weeks and months ahead.” 

San Francisco’s COVID-19 7-day average case rate as of December 21, 2021 was 398, surpassing the peak average during the Delta surge, and more recent data show the rate has continued to increase in the past week. Cases are rising three times faster than during the summer Delta-fueled surge and further rapid increases are expected. While the hospitals currently still have ample capacity, the rate of hospitalizations has also started to increase but so far remains low compared to last Winter. 

“We know that our focus in this Omicron surge must be on reducing hospitalizations and maintaining our capacity to care for San Franciscans, and these measures will help ensure this,” said Dr. Susan Philip, San Francisco Health Officer.  “We do not want to wait until it’s too late to implement these measures to better protect our community.” 

San Francisco is taking precautionary measures to keep schools and businesses open, and limit severe illness, hospitalizations and deaths.  

“As COVID-19 becomes endemic, we need to ensure everyone eligible gets vaccinated and boosted, we sustain our hospital capacity, and protect the most vulnerable – these updates to the Health Order help us achieve that,” said Dr. Grant Colfax, San Francisco Director of Public Health.   

Several changes to the Health Order are temporary as the City continues to monitor impacts of the Omicron variant. 

“While it is difficult to move backward after all the progress the City has made, the Omicron variant has shown that responsible steps, including introducing a short-term mask mandate, should be taken to bridge the gap until all residents have the opportunity to benefit from the protection of a booster shot,” said the San Francisco Independent Fitness Studio Coalition. “We know fitness plays a crucial role in helping people stay both mentally and physically safe as we battle this pandemic, and our employees and clients are ready to meet the moment and do their part to protect the residents of San Francisco.” 

In addition to the Health Order update, SFDPH will be updating local guidance on isolation and quarantine. The CDC announced that people who test positive for COVID-19 but are asymptomatic are recommended to isolate for 5 days instead of the previously recommended 10 days, with masking for an additional 5 days.  

The CDC also announced that for people who are unvaccinated or are more than six months out from their second mRNA dose (or more than 2 months after the J&J vaccine) and not yet boosted, individuals are recommended to quarantine for 5 days followed by strict mask use for an additional 5 days. Alternatively, if a 5-day quarantine is not feasible, CDC considers it imperative that an exposed person wear a well-fitted mask at all times when around others for 10 days after exposure.  

For individuals who have received their booster shot, the CDC states these individuals do not need to quarantine following an exposure, but should wear a mask for 10 days after the exposure. 

SFDPH will formally adopt these policies once written guidance is adopted by the CDC and CDPH.  SFDPH will provide updates to local Isolation & Quarantine guidance here:  

Summary of Key Changes to the Health Order

Booster Requirements for Workers in Healthcare and High-Risk Settings 

The State of California recently announced that workers in healthcare and certain other high-risk settings must receive a booster by February 1, 2022. San Francisco’s revised Order conforms to the updated State Health Order and extends the booster requirement to other designated higher-risk settings that are already covered by San Francisco’s previous requirements for personnel in those settings to receive their full initial series of the COVID-19 vaccine.     

Personnel working in high-risk settings who are eligible for a booster and have not yet received one must be tested once or twice a week for COVID-19 (depending on the setting) and provide proof of a negative test until one week after they receive a booster. Due to the threat Omicron poses to hospital capacity, eligible personnel in high-risk settings are strongly urged to receive their booster as soon as possible before the deadline. 

Temporary Suspension of Indoor Universal Masking Exemption 

The Order suspends the indoor universal masking exemption for stable cohorts of 100% fully vaccinated people in select settings including workspaces, gyms, religious gatherings starting at 12:01 a.m. on December 30, 2021 until January 31, 2022. 

CDPH imposed a universal indoor masking requirement for the state on December 14, 2021, but granted exemptions to San Francisco and other counties that already had local indoor masking policies in place.  This update to the Order brings San Francisco in alignment with the State.  Universal masking means the requirements apply to everyone, regardless of their vaccination status. 

Additionally, participants in indoor youth sports are required to wear masks through January 31, 2022.  

Up-to-Date Vaccinations 

The Order adds the concept of being “up-to-date on vaccination” which includes having received a COVID-19 booster when eligible, similar to other types of vaccines that are recommended for regular upkeep. For information on booster eligibility, visit:  

Beginning February 1, 2022, operators and hosts of indoor mega-events (1,000 people or more under state and local guidelines) are required to verify proof of up-to-date vaccinations, which includes a booster received at least one week prior to an event, for eligible patrons and staff.  Patrons between 5 and 11 years old (or their parents or guardians) must show proof of full vaccination or a negative COVID-19 test taken within one day (for antigen tests) or two days (for PCR tests) prior to entry into the event venue, and children between 2 and 4 years old need a negative test. 

Operators and hosts of large outdoor events (with between 5,000 and 9,999 people) and outdoor mega-events (10,000 people or more under state guidelines) are encouraged to consider the same up-to-date vaccination verification as indoor mega-events. 

The Order strongly urges that certain indoor facilities that currently must check for proof of full vaccination, such as restaurants, bars, clubs, and gyms and other fitness centers, require patrons and staff to show proof that they are up-to-date on vaccination, including boosters if those individuals are eligible, and to implement that requirement as soon as possible.   


The updated Health Order clarifies, in relation to schools, that based on the demonstrated effectiveness of measures that reduce the risk of transmission in school settings, including the requirement for universal masking indoors, the use of rapid testing, and vaccinations for children age five and older, the Health Officer strongly believes that schools can and should remain open for in-person classes for all grades.  The Order strongly recommends that teachers, staff, and administrators in TK-12 schools be up-to-date on vaccination, including boosters, and the Health Officer will be updating school and youth-related directives to require masks for participants in indoor youth sports, through January 31, 2022.    

Skilled Nursing Facilities 

The Health Officer will also be issuing a temporary requirement later this week regarding visitors, requiring on-site testing of visitors at the time of the visit and limiting the number of visitors per day through the end of January 2022 in order to further protect residents at those facilities.   

Updates to the Health Order will be available at:  

Additional COVID-19 resources are available at: