Marin County Public Health is urging healthcare and long-term care facilities to require masks for all staff and visitors starting Nov. 1, citing rising COVID-19 levels across the Bay Area.
The county issued a formal advisory on Thursday, Sept. 24, covering vaccination, masking and infection control for the 2026–27 respiratory virus season. The guidance applies to facilities countywide, including San Rafael-area hospitals and nursing homes. The agency rated the current risk to Marin County as moderate, with COVID-19 transmission climbing but hospitalizations still comparatively low.
The masking recommendation runs from Nov. 1 through March 31, 2027. It applies to anyone in close contact with patients or residents, regardless of vaccination status. The county stopped short of issuing a masking order but said it may impose one if transmission or hospital strain worsens.
COVID-19 wastewater levels in Marin have been rising since summer, driven by the XFG variant. A Patch California report published Sept. 1 flagged a Marin County wastewater site among seven statewide with "very high" viral levels. That same metric was in the "very low" range as recently as the week ending June 27.
Dr. Matt Willis, formerly Marin County's public health officer, told KQED in early September that the current wave had not yet peaked. "Based on current patterns, we still have plenty of the current wave ahead of us," Willis said.
Influenza and RSV (respiratory syncytial virus) remain low but are expected to follow their usual seasonal arc, with RSV picking up in October and flu accelerating in December. Last season, combined hospitalizations from all three viruses peaked the week ending Jan. 3, 2026.
Broader vaccine eligibility
The advisory adopts California Department of Public Health (CDPH) and West Coast Health Alliance recommendations that make updated COVID-19 vaccines available to anyone 6 months and older. That is broader than the U.S. Food and Drug Administration's (FDA) label, which limits the four approved XFG-targeted shots largely to adults 65 and older or younger people with qualifying conditions.
Under state law AB 144, California-regulated health plans must cover CDPH-recommended vaccines at no cost to patients, even when the FDA label is narrower.
The county especially recommends COVID-19 vaccination for infants 6–23 months, adults with risk factors, adults 65 and older, pregnant or postpartum people, immunocompromised individuals and anyone in close contact with someone at higher risk. Healthcare workers were added as a specific priority group this season.
New mRNA flu vaccine
The advisory also flags mFLUSIVA, the first mRNA-based influenza vaccine, approved by the FDA on Aug. 5 for adults 50 and older. In clinical trials, the vaccine was about 26.6% more effective than a traditional flu shot at preventing lab-confirmed influenza, according to Johns Hopkins Bloomberg School of Public Health. Its list price is $149.56 per dose.
The county recommends flu shots for everyone 6 months and older, ideally by the end of October.
Outbreak reporting
Facilities must report suspected respiratory outbreaks in long-term care or congregate settings immediately to Marin County Public Health at (415) 473-4163 or after hours at (415) 499-7238. Starting Jan. 1, 2027, all RSV deaths in children under 18 will become nationally notifiable under a new reporting process.
