Fresno County stays in red COVID-19 reopening tier. What will it take to keep that status?
Fresno County’s businesses will keep operating under red Tier 2 of California’s coronavirus restrictions for a seventh consecutive week following Tuesday’s update on the risks of COVID-19 spread in each of the state’s 58 counties.
But an increase in cases means the county is in jeopardy of backsliding into the most restrictive set of regulations unless it can get back on track by next week.
Neighboring Kings and Merced counties also maintained their station for one more week in the red tier of the state’s four-tier, color-coded “Blueprint for a Safer Economy.” The blueprint governs the degree to which various business sectors in each county can reopen or expand operations from broad restrictions put in place in the spring to limit the spread of COVID-19.
Tier 2 is color-coded red to represent “substantial” risk of viral spread. Fresno County graduated from purple Tier 1 — the most restrictive level denoting “widespread” risk of viral spread in the community — on Sept. 29. Merced County emerged from the purple tier a week later, on Oct. 6, and Kings County followed on Oct. 13.
All three counties, however, are on tenuous footing for keeping their red-tier status.
The tier assignments are based primarily on two key measures of coronavirus spread for each county: the average number of daily new cases per 100,000 residents in a county, and the percentage of people tested for whom results come back positive for COVID-19 infection.
The California Department of Public Health calculated Fresno County’s new-case rate at 8.3 per day over the seven-day period ending Oct. 31, while the testing positivity rate was reported at 5.5%. The testing measure is well below the ceiling 8% positivity to remain in the red tier. But the case rate, which last week was 6.1 per 100,000, lurched above the orange-tier threshold of 7.0 new daily cases.
”We have multiple different trends that are pointing in the wrong direction,” said Dr. Rais Vohra, Fresno County’s interim health officer, in a video call with reporters on Tuesday afternoon. “If we continue this trend … very unfortunately we will be asked to move back into the purple tier. This is a very concerning development.”
As Fresno, Kings and Merced counties have each advanced from purple to red, some of the most notable limitations have been relaxed for certain business sectors:
- Restaurants that were previously allowed to only offer take-out, delivery or outdoor dining have been able to resume indoor dining service at up to 25% capacity.
- Churches and houses of worship, which had been barred from indoor services, can have services at up to 25% capacity.
- Gyms and health clubs can operate indoors at up to 10% capacity.
But case rates ballooned in each of the three counties, exceeding the 7.0-per-100,000 ceiling for the red tier. Each county faces the prospect of a return to purple-tier restrictions if they remain above that threshold when the state issues its next update on Nov. 17.
If that happens, among the changes confronting residents and businesses are that restaurants would once again be limited to outdoor dining, take-out or delivery; churches could not hold services indoors, and gyms would be limited to outdoor operations.
‘Purple Thanksgiving’
In Fresno County, Vohra said the case trends in recent weeks have been a concern to him even before Tuesday’s tier announcement. Beyond that, he added, hospitalizations of coronavirus patients have been ticking up, and the availability of intensive-care unit beds at hospitals across the county is shrinking – not only to treat COVID-19 patients, but other serious illnesses.
“Hospitals are telling us they have a very small number of ICU beds,” he said. “Admissions are going to create real challenges for our hospital partners” as confirmed coronavirus cases continue to climb.
“Speaking frankly, I think we’re going to have a purple Thanksgiving,” Vohra added, acknowledging the case increases in the period since the Oct. 31 period for which Tuesday’s tier assessments were based.
In Kings County, the new-case rate shot up from last week’s adjusted daily estimate of 5.7 per 100,000 residents to 8.4 in Tuesday’s announcement. Merced County’s rate increased even more, to almost 13 new cases per day per 100,000, up from 5.2 last week.
Two other Valley counties, Madera and Tulare, have been mired in the purple tier since the blueprint system was initiated in late August. Mariposa County started in orange Tier 3, representing “moderate” risk of transmission, and advanced to yellow Tier 4, the least imposing of the levels denoting “minimal” risk, on Sept. 22.
In Mariposa County, the new-case rate ticked up to 1.6 per 100,000 residents, a level at which the state could reassign the county back into orange Tier 3 if it remains above 1.0 next week.
Murky state mathematics
The state’s calculations of new cases per 100,000 residents aren’t as straightforward as simply dividing the number of cases reported each day by the state on its COVID-19 website in a county and dividing that by the county’s population.
For example, using those figures from the California Department of Public Health and the formula outlined in the Blueprint for a Safer Economy, yields a seven-day average of 11.3 new cases per 100,000 in Fresno County for the week ending Oct. 31.
The difference, according to the state, lies not only in cases that are excluded from the calculations – infections in state or federal prisons, for example – but also in how the California Department of Public Health starts the clock on counting a “case” for the purposes of calculating for the tier assignments.
While the state’s daily dashboard reflects when health officials are notified of a confirmed positive test, “our cases (for tier assignments) are calculated on episode date which is the first possible date that a case was known to have an infection,” according to a statement provided to The Bee last week by the Department of Public Health.
So for the week ending Oct. 24, the state used a figure of 454 cases based on when an infection began as the basis for last week’s tier calculation of an unadjusted 6.3 cases per 100,000. By contrast, the public CDPH dashboard reflects a total of 794 cases based on when confirmed test results became known – a difference of 340 cases for that week.
“Cases may still flow to the state after CDPH does its tier assignment data pull,” the department’s statement said. “We pull the data on Monday morning and the cases that are there … are what we use to calculate the unadjusted case rate.”
Then, the state applies an adjustment, either upward or down, depending on testing volume within a county – the rate gets adjusted higher if the county is testing a lower rate of people than the state average, or lower if a county exceeds the state’s average testing volume.
Nowhere on the state’s public-facing dashboards does the health department report the number of cases by infection start date that is used for the tier calculations.
Getting from red to orange
In a process that’s been described by Gov. Gavin Newsom and state Health & Human Services Secretary Dr. Mark Ghaly have described as a “dimmer switch” approach, the blueprint allows the state to gradually advance counties into less restrictive tiers based on the health metrics.
But as a dimmer switch can be used to gradually brighten a light, if a county’s new-case rate or testing positivity rate deteriorates and slides above the tier threshold, state health officials can also lower the switch and reassign the county back into the more restrictive tier.
For several weeks, Fresno County’s new-case rate fluttered back and forth across the purple/red threshold, threatening to send the county back into the more restrictive purple tier if it missed the mark for two consecutive weeks.
To move forward into orange Tier 3, in which more businesses have freedom to reopen and expand indoor operations, Fresno County and other red-tier counties have to reach several goals:
- Reduce the new-case rate to an average of fewer than 4.0 cases per day per 100,000 residents.
- Reduce the countywide testing positivity rate to less than 5.0%.
- Achieve a “health equity” rate for testing positivity of under 5.3% across the county’s most disadvantaged neighborhoods defined as the 25% of census tracts that are the most socioeconomically challenged.
A county must meet all of those thresholds, and maintain each of them for two weeks, before formally being promoted by the state into orange Tier 3.
Once in orange, restaurants, movie theaters and houses of worship would be allowed to increase indoor operations to 50% of their capacity or 200 people, whichever is fewer; gyms can expand indoor offerings to 25% of capacity; museums and zoos can open indoor activities at up to 50% capacity; and wineries . Wineries are allowed to open indoors up to the lesser of 25% capacity or 100 people.
In these and other sectors for which indoor operations are allowed, the blueprint calls for requiring face coverings for staff and patrons, and measures to ensure social distancing.
Businesses that can reopen with outdoor operations under the orange tier include bars, breweries, and distilleries at which meals are not served.
Statewide backsliding
Across California, 10 counties saw either their case rates or testing positivity exceed their tier threshold for a second week, and were demoted Tuesday to more restrictive blueprint tiers:
- Sacramento, San Diego and Stanislaus counties were downgraded from red Tier 2 back into purple Tier 1.
- Amador, Contra Costa, El Dorado and Santa Cruz were demoted from orange Tier 3 into red Tier 2.
- Modoc, Siskiyou and Trinity counties were reassigned from yellow Tier 1 into orange Tier 2.
Additionally, 26 other counties missed one or both measures for one week, which could send them backwards next week if they fall short again in the Nov. 17 assessments:
- Besides Fresno, Kings and Merced counties in the central San Joaquin Valley, other California counties in danger of falling back to purple Tier 1 are Glenn, Kern, Lassen, Placer, San Luis Obispo, Solano, Sutter, Ventura and Yuba counties.
- Butte, Colusa, Del Norte, Mono, Napa, Nevada, Plumas, Santa Clara, and Tuolumne counties could slide back to red Tier 2 from their current orange Tier 3.
- Mariposa, Alpine, Calaveras, Humboldt and San Francisco counties, now in yellow Tier 4, could fall back into orange Tier 3.
This story was originally published November 10, 2020 at 11:55 AM.
