Is your county orange? Or purple? Why California chose color tiers for COVID-19 reopening
From air quality alerts to stoplights, governments use color-coded systems to keep people safe in many different settings. Last month, California added another color-based system to communicate about a public health threat: the COVID-19 pandemic.
Gov. Gavin Newsom said his administration designed a new color-coded reopening structure to be easier to understand than the previous system, which included reopening phases and a county monitoring list. Under the new system, counties are sorted into four tiers based on the severity of the outbreak in their communities, with purple being the most widespread and yellow the least.
The state updates the rankings weekly, and posts them in an interactive map.
“We believe this is much more simple, much more transparent, easily monitored by individuals, not just by business representatives, but also by county and state health officers,” Newsom said at a late August press conference. “
Several weeks into the new color-coded system, many are praising it as easier to understand than the previous one, even as businesses say its restrictions on their operations threaten their ability to stay afloat and some evidence indicates it may be contributing to disease spread.
Meanwhile, many businesses see the new tiers as simply “a rebranding of the previous policy,” said Rob Lapsley, president of the California Business Roundtable.
Overall, the new color-coded system is an improvement because it is more straightforward, said state Sen. Steve Glazer, D-Orinda, who has been outspoken about how he thinks Newsom should revise his coronavirus policies.
“The old system lacked clarity and understanding,” Glazer said. “The color codes are an improvement.”
What do the colors mean?
The new system uses the number of new cases and the percentage of tests that come back positive to determine which tier a county falls into:
Purple: Coronavirus infections in purple counties are considered “widespread.” In those counties, more than 8% of tests come back positive or more than 7 new cases per 100,000 residents are found each day. Schools must operate remotely in those counties unless they receive a waiver, while gyms and restaurants can only operate outside. Bars are closed.
Red: Disease spread is considered “substantial” in red counties. At least 5% of coronavirus tests came back positive in the last week. For every 100,000 residents, at least 4 test positive for coronavirus each day. Gyms can operate indoors at 10% capacity, restaurants at 25% capacity, while bars remain closed. After a county spends two weeks in the red tier, schools can resume in-person classes.
Orange: Counties in the orange tier have “moderate” coronavirus spread. The weekly test positivity rate is between 2 and 5 percent. For every 100,000 residents, at least one person tests positive for coronavirus each day. Gyms can operate indoors at 25% capacity, restaurants at half capacity. Bars can operate outside only.
Yellow: Counties with “minimal” outbreaks fall in the yellow tier. The test positivity rate is less than 2%. The daily new case rate is less than 1 per 100,000. Gyms, restaurants and bars can operate indoors at half capacity.
Newsom said the colors were chosen to designate severity, and purposely don’t include green, which people associate with “go.”
“We don’t put a green because we don’t believe that there is a green light that says go back to the way things were or back to the pre-pandemic mindset,” Newsom said.
Color-coded systems can be effective at communicating safety information to the public if the information is measurable and actionable, said James Carafano, a national security expert at the Heritage Foundation, a conservative think tank. The terror-alert system the federal government adopted after 9/11, for example, failed at both criteria. The information conveyed wasn’t possible to measure and there was no clear action people were supposed to take based on the threat level, Carafano said.
A pandemic-related alert system makes more sense, he said, because much of the information is quantifiable. But to be effective, alert systems also have to be very simple.
If it’s more complicated than a stoplight, it’s unlikely to be effective without a massive education campaign, he said. It’s also helpful if the colors used are intuitive – for example a fire danger system that uses red for the most dangerous, because people associate that with hotter temperatures.
“People aren’t that sophisticated,” Carafano said said. “What typically works best for the public are things that are very, very clear.”
That’s a potential issue for a system like California’s, which aims to inform a wide range of people from regular residents to health officials, he said.
“To try to combine all that into one alert system, I think you’re just asking for trouble,” he said.
New COVID tiers
On the day Newsom unveiled the new system, 5.5% of coronavirus tests had come back positive in the past week, what’s known as the state’s test positivity rate. Now, the state’s seven-day test positivity rate is about 2.9%.
Dr. Mark Ghaly, Newsom’s Health and Human Services Secretary, said the state’s improvement since the new system took effect and more businesses were allowed to reopen was a good sign. But on Friday, he said state officials were beginning to see a concerning uptick in coronavirus cases and hospitalizations.
The numbers coincide with an expected increase two-and-a-half weeks after Labor Day, when people may have been tempted to gather with others outside their household. Ghaly said it wasn’t possible to say how much of the increase may be connected to Labor Day gatherings and how much to the new system.
Ghaly has also said it’s been simpler to communicate with local officials under the new approach.
“Those conversations are becoming easier,” he said during a Tuesday press conference. “People understand it in a clearer way than our first framework.”
The new system is an improvement over the old one, where counties with concerning metrics were placed on a monitoring list, and faced a more complicated process before they could reduce restrictions, said Kat DeBurgh, executive director of the Health Officers Association of California.
The old system used a wide range of metrics and criteria, including hospitalization rates, ability to contact trace outbreaks, and testing availability.
“It’s much more straightforward to have these tiers,” DeBurgh said.
Lapsley of the Business Roundtable criticized the tiers for not accounting for data from contact tracing, the process of determining who an infected person may have exposed to the virus and where they may have caught it.
Instead of imposing county-wide restrictions, Lapsley argued there should be more targeted restrictions on specific businesses or neighborhoods where contact tracing has shown the virus is spreading.
In the meantime, the restrictions are inflicting “enormous costs to people’s lives.”
“It’s devastating… Restaurants have opened and closed twice – how do you sustain that, even mentally, if not financially,” he said. “We need to have a more surgical approach.”
Glazer also said the system should account for counties’ ability contact trace and consider the information gleaned from those efforts. Unlike Lapsley, Glazer advocates for applying restrictions more broadly, arguing county reopening decisions should also account for spread in neighboring jurisdictions because people cross county lines frequently.
He said he still sees the tiers as better, but added that this new system could run into the same problem the old one did: reopening too quickly.
When Newsom allowed many counties to reopen over the summer, many critics argued he moved too fast under political pressure. Although Newsom has rejected the idea that he was influenced by politics, he has said the new system will move more slowly to avoid another spike in infections.
“It’s an improvement over the previous regimen,” Glazer said. “The test is whether he sticks to it.”
This story was originally published October 1, 2020 at 5:00 AM with the headline "Is your county orange? Or purple? Why California chose color tiers for COVID-19 reopening."