In practice, it is a vaccine mandate that covers vast numbers of workers, and it is likely to be expanded to cover everyone. The opinion was decided in OSHA's favor, 2 to 1. 

The decision has been appealed to the Supreme Court which will likely make the final judgement. As this case grinds through the court system, workers around the country are being fired, mandates are going into effect, and cities are segregating their populations based on their willingness to acquiesce to government's mandated medicine. 

The majority begins its decision with a chilling announcement that smacks of ideological bias. 

Recognizing that the "old normal" is not going to return, employers and employees have sought new models for a workplace that will protect the safety and health of employees who earn their living there. In need of guidance on how to protect their employees from COVID-19 transmission while reopening business, employers turned to the Occupational Safety and Health Administration (OSHA or the Agency), the federal agency tasked with assuring a safe and healthful workplace….

We are unaware of a single business in America that "turned to" OSHA with that question: what should we do?

The court majority continues with an announcement not of law but of panic: in the face of this disease, just let the bureaucracy rule! 

The record establishes that COVID-19 has continued to spread, mutate, kill, and block the safe return of American workers to their jobs. To protect workers, OSHA can and must be able to respond to dangers as they evolve. …

On multiple occasions, this tone is repeated, along with highly questionable claims: "The number of deaths in America has now topped 800,000 and healthcare systems across the nation have reached the breaking point."

Given this situation, says the court, "it is not appropriate to second-guess that agency determination considering the substantial evidence, including many peer-reviewed scientific studies, on which it relied."