With the lightning-speed spread of the COVID-19 omicron variant, Santa Clara County health officials on Tuesday issued a new order that expands on the state's vaccination requirements for workers in high-risk settings, including health care facilities, jails, shelters and long-term care facilities.

The Dec. 28 county health order mandates up-to-date vaccination for workers in certain health care and long-term care settings by Jan. 24. The workers would be required to be fully vaccinated and have received a booster shot if they work in these high-risk settings:

• Skilled nursing facilities, long-term care facilities, adult day care facilities and memory care facilities.

• Health care delivery facilities (such as hospitals, clinics, medical offices, dialysis centers) where patient care is provided, and those who are medical first responders.

• Jails and other correctional facilities.

• Congregate shelters.

The order also enhances the protection of the state mandate by requiring up-to-date vaccination for all medical first responders, jail staff and shelter workers. It requires unvaccinated or unboosted staff who work in health care, jail, long-term care or shelter settings to be reassigned to lower-risk settings or otherwise be prohibited from working in higher-risk settings. This includes workers with religious or other exemptions, who would be reassigned to jobs that are outside of the higher-risk settings, county Counsel James Williams said.

The order also speeds up mandated up-to-date vaccinations for these workers by Jan. 24 instead of the state's Feb. 1 deadline. County officials said they made that decision based on how quickly the omicron variant is spreading and the widespread availability of vaccination appointments in the county.

"Less than two weeks ago, we noted that the omicron variant was about to bring a deluge of new COVID-19 cases to Santa Clara County. Unfortunately, that deluge is now here," Dr. Sara Cody, the county's health officer and director of public health, said in a statement. "We urge everyone in our community to get boosted as soon as they are eligible and be highly cautious because the omicron variant is so transmissible. It is especially essential that workers who are delivering healthcare and interacting with vulnerable populations are vaccinated and boosted in order to best protect themselves and the people in their care.”

Businesses aren't mandated to require up-to-date vaccination, but the health order recommends that they require their workers to be vaccinated and boosted against COVID-19 now if they have not done so already. In addition, businesses were advised to move operations and activities outdoors where possible, where there is significantly less risk of COVID-19 transmission. If this is not possible, ventilation should be maximized, according to the county.

Businesses that serve the public, especially those with activities that require patrons to remove their face mask to engage in the business (such as restaurants and bars), should require their patrons to be up to date on their vaccination and show proof of up-to-date vaccination prior to entry.

The county also offered additional recommendations for businesses and the community, such as not gathering indoors in groups of more than 10 people from outside their household, unless everyone is wearing face masks at all times.

The Aug. 2 health order that requires universal indoor masking remains in effect throughout Santa Clara County. Cody said while people should continue to support restaurants through takeout orders, delivery and generous tipping, health officials advise against indoor dining. For New Year's Eve celebrations, she doesn't recommend gathering, but if people choose to do so, they should limit their contacts to 10 people or fewer and everyone should wear masks while indoors.

She urged people to take the omicron variant seriously and to do everything they can to protect themselves and others.

"The case rates are going up incredibly fast. They will exceed last winter's," she said. "(Omicron) grows with breathtaking speed."

Although the variant is thought to cause milder cases of illness in people who are fully vaccinated and boosted, the sheer numbers of infected people will mean a large number of hospitalizations. The new order is being instituted in part to help reduce overburdening of hospitals and health workers, Cody said.

Although people are now able to take COVID-19 test at home, Cody noted that many of those cases won't be recorded in the health care system; the number of cases are therefore undercounted. Hospitalization rates recorded on the county's public dashboard also have a lag time and won't reflect the incidents in real time.

The number of people who have gotten their booster shots has been stable, at 54% of all who are eligible; 67% of adults ages 65 and older have received their boosters. County officials urge those who haven't yet been boosted to do so as soon as possible.

"We're in a different place now than we were a year ago," Cody noted, as vaccinations weren't available until late last year. But as health officials learn about the interplay between the vaccine and the variants, they are seeing many breakthrough infections among people who have been vaccinated but who are not yet boosted, she said.

Everyone ages 16 and older who received their Pfizer-BioNTech or Moderna vaccinations more than six months ago or their Janssen/Johnson & Johnson vaccine more than two months ago is eligible for a booster and should get one right away, Cody said.

In addition to vaccinations and boosters, masking, testing, ventilation, and distancing remain the best defenses to COVID-19.

"Our community needs to know that if they call an ambulance, go to the hospital, or are in a long-term care facility, everyone working in those settings will be fully vaccinated and boosted, particularly given how easily and quickly the omicron variant is spreading," Cody said in the statement. "We also need to do everything we can to protect healthcare workers and others in higher-risk settings from infection and serious illness at work. We will meet this challenge as we have met every other challenge throughout this pandemic."

Appointments for vaccinations and boosters are available at sccfreevax.org. Vaccinations through the county are free to the public, insurance is not required and they are available regardless of immigration status.

Detailed information on the new health order and FAQs is available at covid19.sccgov.org.

Watch the public health leaders discuss the new health order: