‘Unprecedented’: California Health Workers Face Fine or Imprisonment for Going Maskless

Bay Area counties issue seasonal mask mandates for health care workers citing increased risk for respiratory viruses

Nurses and doctors at Regional Medical Center on May 21, 2020 in San Jose, California. (Photo by Justin Sullivan/Getty Images)
September 25, 2023

Some of California’s most populous counties have made seasonal mask mandates the new normal for health care workers due to the increased risk of respiratory viruses during the winter months, a move that critics say is an overreach unsupported by science.

San Mateo, Contra Costa, and Sonoma counties in California’s San Francisco Bay Area last week issued orders that workers in hospitals, doctors’ offices, and other clinical sites must mask up from November to April. They followed the lead of nearby Santa Clara County, which last March wrote its own flu season mandate that applies to everyone in medical settings. Of these health agencies, only Sonoma County set an end date of April 2024. The others said they will enforce their orders every year from November to April until further notice.

A health care worker's refusal to wear a mask could mean a fine, imprisonment, or both, with exceptions granted to some—including those working with deaf patients, or who have a disability or health condition that can be worsened by masks. The requirements also vary. San Mateo's states that masks should be worn anywhere a patient may go, such as elevators and lobbies, but not in cafeterias or gift shops. Contra Costa's says they should be worn in spaces where patients are present.

The Bay Area orders come months after the nation’s most comprehensive study of general population mask mandates showed they do little to no good in terms of stopping the spread of respiratory viruses, and critics say they are a sign that the nation’s most progressive regions are still politicizing the pandemic.

"This is the last vestige of a political response to Covid," said Monica Gandhi, a physician and professor at the University of California, San Francisco. "But it is not backed up by data. And if we don’t back up our mandates with data, we will risk even more erosion in trust in public health."

The health agencies argue the mandates are justified given that the risk of flu, COVID-19, and other respiratory viruses is largely seasonal. They cite as their legal basis California Health and Safety Code section 120175, which gives county health offices authority to "take measures as may be necessary" to prevent the spread of infectious disease.

However, interpreting this law to give such broad powers to public health officials is "unprecedented," said Laura Powell, a Bay Area attorney who has advocated against state mask and vaccine mandates.

"Under our form of government, state and local laws are supposed to be made by elected representatives through a public process, not announced as edicts from unelected officials," Powell said.

Matt Brown, a spokesman for the Sonoma health agency, acknowledged that the departments "had some coordination about these orders," but said each county "made its own decision and drafted its own version."

San Mateo, Contra Costa, and Santa Clara health departments did not respond to a request for comment.