CDPH AFL 26-33 updates hospital respiratory-virus surge guidance for 2026-2027 and supersedes AFL 23-30
Published November 8, 2026 · Coverage November 1–7, 2026, Pacific · Medium priority
CDPH issued All Facilities Letter (AFL) 26-33 on November 4, 2026 to general acute care hospitals and acute psychiatric hospitals, superseding AFL 23-30. The letter gives planning and response guidance for an anticipated adult and pediatric surge in respiratory illness and updates surge measures and clinical resources for the 2026-2027 season. It says facilities that anticipate needing flexibility to prepare for surges should submit a program flexibility request through the Risk and Safety Solutions (RSS) website and obtain approval for any alternative use of space or bed classification. It restates that, where already applicable, facilities must continue to adhere to the Aerosol Transmissible Diseases (ATD) standard of Cal/OSHA (the California Division of Occupational Safety and Health), and it asks hospitals to prepare for a surge of at least 20 percent over licensed capacity.
Background
AFL 26-33 supersedes AFL 23-30. The letter explains that CDPH has the authority to grant program flexibility from regulatory requirements if the facility requesting it demonstrates its ability to meet statutory or regulatory requirements in an alternate manner, and that a request must include justification and adequate supporting documentation that the proposed alternative does not compromise patient care. It says seasonal activity for influenza and respiratory syncytial virus (RSV) is expected to increase in the coming weeks and months.
Who this affects
General acute care hospitals and acute psychiatric hospitals (the letter's addressees)
Why it matters
Inference: emergency management, nursing and infection prevention should compare current surge plans, staffing backfill plans and source-control policies against the AFL's list, and identify any space or bed-classification changes that would need a CDPH program flexibility approval before the season peaks. The ATD reference is a reminder of an existing duty, not a new one.
Required actions
- Where already applicable, continue to adhere to Cal/OSHA's Aerosol Transmissible Diseases standard (an existing duty the letter restates).
Recommended action
- Review hospital surge plans against the AFL 26-33 surge measures, including the 20 percent over licensed capacity planning figure.
- Prepare program flexibility requests in advance for anticipated alternative space use.
- Update healthcare-worker vaccination messaging and return-to-work and source-control practices to the AFL's current recommendations.
- Facilities that anticipate needing flexibility to prepare for surges: submit a program flexibility request and obtain CDPH approval for any alternative use of space or bed classification. The letter says such facilities should do this; it is guidance, not a new legal duty.
Scope and timing
- Authority status
- Guidance
- Responsible owner
- Emergency Management; Nursing; Infection Prevention; Compliance (licensing)
- Publication date
- 2026-11-04
- Other dates
- Supersedes AFL 23-30
Not established
The AFL's linked California Health Advisory for Respiratory Virus Season 2026-2027 was not retrieved.
Sources
Complete edition and supplemental material
This article in the complete report →
Executive triage, source-coverage limitations, context and forward horizons remain in the complete report.
Read the entire Compliance Sweep report →