California COVID-19 tier update: Yuba among 8 counties promoted; El Dorado is warned
The California Department of Public Health moved eight counties into less restrictive tiers within the state’s reopening framework Tuesday as it works to move through a more gradual resumption of economic activity months after a spike in coronavirus activity halted its previous effort.
But the state also demoted two counties in Northern California, and put three others across the state— including one in the Sacramento area — on notice that they’ll also move backwards in the process if their COVID-19 metrics don’t improve in next week’s assessment.
The tier list changes and COVID-19 data at the statewide level signal overall progress, but also highlight the regional differences that continue to emerge in California’s battle with the coronavirus.
More than 828,000 Californians have tested positive for the respiratory disease to date, and 16,177 have died. Rates of infection and death, along with hospitalizations and intensive care admissions, are much lower than they were in late July, but some of those metrics have shown recent signs of plateauing rather than continuing steady decline.
The weekly update from the state examines counties’ rates of daily new COVID-19 cases and percentage of tests returning positive as its main two criteria.
In the system, which continues to undergo both minor tweaks and larger adjustments to its rules and calculations, CDPH assigns each of the state’s 58 counties to one of four color-coded tiers: purple, red, orange and yellow.
The purple tier is the tightest and requires that a number of activities and businesses — including but not limited to restaurant dining, church worship, gyms and shopping malls — stay closed for indoor operations.
The red tier lets each of those reopen with a hard 25% capacity limit and other modifications. The orange and yellow tiers further reduce those capacity limits while also allowing other, mainly entertainment-centered businesses to open, such as bowling alleys.
The data is assessed on a one-week lag time to account for data discrepancies, meaning this week’s tier assignments reflect data for the week of Sept. 20-26.
County power rankings: Who moved up? Who moved down?
This week, Merced, Ventura and Yuba counties moved from purple to red; Inyo County moved from red to orange; and Humboldt, Plumas, Siskiyou and Trinity counties all improved to the least-restrictive yellow tier.
On the other hand, Shasta County moved from the orange tier to the red tier due to a spike in new cases, and neighboring Tehama County moved from the red tier to the purple tier for the same reason.
Orange-tier El Dorado County, along with red-tier Fresno and Riverside counties, also did not meet the requirements for their current tiers this week. If they fail to do so again in next Tuesday’s report, they will also be demoted by a tier. The state refers to this as a “supportive engagement period with CDPH,” meaning state health officials plan to reach out to these counties for guidance and assistance in lowering viral activity.
It’s the first time in the new system, now in its fifth full week, that any counties have been demoted. Shasta and Tehama counties will have until Friday to close or modify the affected businesses to meet the state standards, according to CDPH.
Yuba-Sutter area split into two different tiers
In a notable development for the greater Sacramento area, CDPH allowed Yuba County to move from purple to red tier.
However, Sutter County, which shares a bi-county health office with Yuba, remains in the purple tier, though it did notch its first week meeting both red-tier criteria.
Both counties’ metrics improved considerably with this week’s update. Yuba departed purple territory with 4.2% test positivity (orange) and 5.6 new cases per 100,000 (red). And despite still being in the purple, Sutter met both orange-tier classifications for the week of Sept. 20-26, with positivity of 3.3% and 3.5 new cases per 100,000.
Yuba-Sutter public health officer Dr. Phuong Luu indicated as recently as last week that she’d asked the state not to advance the two counties through the tier system separately. A Yuba County spokesperson told The Bee in a statement that this recommendation was based on the “intertwined” nature of the neighboring counties.
State health officials declined this request, Luu recently told the Appeal-Democrat newspaper, though she pointed out that with Sutter’s recent rates of coronavirus activity, it appears likely the county will just be one week behind its sister county.
As Luu explained to The Bee at the time in an emailed statement, the disparity in COVID-19 metrics can be largely attributed, in general, to the fact that Sutter has more congregate care facilities than Yuba does.
Congregate facilities include skilled nursing and assisted living homes, which throughout the pandemic have been host to some of the most severe coronavirus outbreaks across the U.S.
A consequence of this for a relatively small county like Sutter is that if its infections are largely concentrated in senior living centers, and then those localized outbreaks begin to subside, a county’s COVID-19 figures could begin rapid improvement shortly thereafter.
Where does four-county Sacramento region stand?
None of Sacramento, El Dorado, Placer or Yolo counties entered this week eligible for a tier change. Sacramento and Yolo only moved into the red stage last week, and El Dorado had only been in the orange for two weeks; all counties need to spend three weeks in any given tier before CDPH considers promotion to the next one.
Counties must also have two straight weeks meeting the next tier’s required metrics before advancing. Placer County couldn’t be promoted this week because it didn’t meet both orange criteria last week.
Likewise, if a county fails to maintain the criteria for its current tier in back-to-back weeks, it will be demoted to a more restrictive stage.
That’s the danger for El Dorado, which in the Sept. 20-26 assessment period saw a test positivity rate of 3.3%, staying well below the orange-tier cutoff of 5%, but a rate of 4.5 daily new cases per 100,000 residents. That latter figure must fall below 4.0 next Tuesday — which will look at data from Sept. 27 to Oct. 3 — to maintain orange status. Otherwise, the bowling alleys will close, and numerous other businesses currently allowed open will have their max capacity limits slashed in half.
Yolo County met both orange criteria in this week’s assessment, with its 2.2% test positivity and 3.3 daily new cases per 100,000 clearing the bar. If the county does so again next week, it’ll move into the orange.
Placer County fared even better, with 1.9% test positivity ranking all the way in the yellow tier, and 2.5 new cases per 100,000 also well below the 4.0 orange-tier ceiling. Placer is in good shape to improve to the orange tier next week if its recent trends hold.
In Sacramento County, the status quo didn’t change much. Its positivity of 3.4% would be good enough for the orange tier, but it’s 5.3 new cases per 100,000 remained right about in the middle of the red-tier range. The very earliest Sacramento could reach orange tier would be Oct. 20, if it meets all orange criteria for the next two weeks.
Health equity adjustment
CDPH introduced a third tier list criteria taking effect this week: health equity.
Before advancing through tiers, counties with more than 106,000 residents must meet a number of requirements centered around keeping test positivity rates low in disadvantaged neighborhoods, and they must demonstrate that they have plans that commit resources to “interrupt disease transmission” among disproportionately impacted populations.
The metrics come from the California Health Places Index (HPI), which is made up of “25 individual indicators across economic, social, education, transportation, housing, environmental and neighborhood sectors,” CDPH explains on its website.
“Each county’s census tracts will be divided into quartiles based on HPI,” and the state will then look at the lowest quartile for each county. CDPH now will permit advancement to a less restrictive tier only if this lowest quartile meets (for the red tier) or comes within a few percentage points of reaching (for orange and yellow) each tier level’s overall test percentage positivity criteria for two straight weeks. These cutoffs for the bottom quartile are: 8% positivity or better to move to the red tier, 5.2% or better to move to the orange tier and 2.1% to advance to the yellow tier.
In the first week working this new criteria, which applies to California’s 35 most populous counties, 23 met the health equity requirement and 12 did not. Those falling short: Contra Costa, Fresno, Orange, Riverside, San Bernardino, San Diego, San Francisco, San Joaquin, San Mateo, Santa Barbara, Shasta and Sonoma counties.
For months, data have made clear that COVID-19 disproportionately impacts communities of color in the United States.
For California’s Latino population in particular, there have been huge disparities in terms of COVID-19 infections and fatalities — accounting for over 61% of the state’s cases and nearly 49% of its more than 16,000 deaths despite making up just under 39% of its population, according to CDPH data.
“While the state’s lowest quartile HPI census tracts are home to 24% of Californians, they account for 40% of COVID-19 cases,” the state health department writes.
Sacramento region creeps toward 600 deaths
Sacramento, Yolo, Placer, El Dorado, Sutter and Yuba counties have combined for 570 COVID-19 deaths and just over 34,000 infections since the pandemic began nearly seven months ago.
Sacramento County health officials have now reported 23,363 all-time infections and 437 deaths, with 118 new cases added Tuesday.
Sacramento County had 96 patients in hospital beds and 29 in intensive care units as of Tuesday, according to state data. The hospitalization total recently dipped below 100 for the first time since late June.
The numbers are down from peaks of about 280 hospitalized and 90 in the ICU as of late July; the recent ICU total matches the county’s lowest since July 3.
Yolo County health officials have reported a total of 56 COVID-19 deaths among 2,903 infections, reporting 10 new cases Tuesday. The county reported 14 new cases Monday and another 14 Sunday. There was just one infected patient in Yolo County hospitals, and none in ICUs, according to state data updated Tuesday morning. The county currently has seven ICU beds available.
Yolo has seen outbreaks at several long-term care facilities, which account for 151 of the total cases and 27 of its deaths.
Placer County has reported a total of 3,694 cases and 51 deaths after reporting 10 new cases and two new deaths Tuesday afternoon. The county reported 56 new cases total for Friday, Saturday and Sunday. It disclosed four deaths last week.
There were 16 people hospitalized specifically for COVID-19 countywide as of Tuesday, up from a total of 13 on Friday, but the ICU count is all the way down to one patient after being as high as 11 earlier last week, the county says. The hospitalized total had plateaued at around 65 in early-to-mid August before declining sharply; the ICU total peaked at 16 on Aug. 25.
El Dorado County has reported a total of 1,216 COVID-19 cases and four deaths. The county reported nine new cases Tuesday after adding 27 new cases to its total on Monday, which included cases reported Saturday and Sunday. The county reported one death in July, one in August and two in September. El Dorado has one patient hospitalized and in an ICU, according to state data updated Tuesday morning.
Sutter County has reported a total of 1,767 COVID-19 cases and 12 deaths after reporting four new cases Tuesday afternoon. The county reported five new cases and one additional death on Monday. There was one infected patient hospitalized in the county, with none in intensive care Tuesday, the county said.
In neighboring Yuba County, a total of 1,211 residents have been infected with COVID-19 and 10 have died, with one death reported Monday. The county reported four new cases Tuesday afternoon. There were three infected people in Yuba County hospitals Tuesday, with two of them in intensive care, the county said.
This story was originally published October 6, 2020 at 1:39 PM.
