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Where California’s counties stand in the state’s four-tiered, color-coded coronavirus monitoring system as of Nov. 24. Graphic: California Department of Public Health

By Zach Cavanagh

As Orange County’s daily case rate and testing positivity continued their sharp rise, the county remained in California’s purple “widespread” tier—the highest risk level of the state’s four-tiered, color-coded coronavirus monitoring system—in the state’s latest update on Tuesday, Nov. 24.

The system is the main component of the state’s Blueprint for a Safer Economy for determining in what capacity different sectors, businesses and activities can reopen safely as the COVID-19 pandemic continues.

As case rates and hospitalizations surged in November, the state pulled an “emergency brake” on the system on Nov. 16, which sent several counties to a higher tier and reduced time needed to move back in the tiers from two weeks to one week.

Nationally, the United States pushed over 12 million coronavirus over the weekend, with cases rising in 31 states and well over 100,000 new cases reported each of the last 21 days. There have been 259,256 deaths in the United States, and the national seven-day average testing positivity is at 9.8%.

California’s case rate and positivity rate continued to shoot up as the state reached 24.9 daily new case per 100,000 and the 14-day testing positivity average rose up to 6.2% from the 4.6% of last Monday, nearly double Nov. 2’s rate of 3.2%.

The state saw new records in total cases over the last week, breaking the previous mid-July highs. The 14-day rolling average of daily new cases rose up to 10,605.8 on Tuesday, Nov. 23, with the previous high average being 9,504 on July 24. The previous single-day high for cases of 12,807 on July 21 was broken four of the last five days with Friday, Nov. 20 being the highest at 15,442 and Tuesday coming close behind at 15,329.

Hospitalizations continued their sharp rise with a 75% increase in the last 14 days to 6,641 in the state on Tuesday with 387 new patients and a 5.8% increase in just the last day. The state has also seen a 55% increase of ICU admissions in the last 14 days.

Newsom reported that COVID-19 hospitalizations now take up 7% of the state healthcare system’s total capacity and the COVID-19 ICU cases occupy 17% of the state capacity, both up from 5% and 11%, respectively.

Nearly all of Southern California is now in the purple tier with 45 of the state’s 58 counties at the highest risk level, and the state’s only two yellow “minimal” tier counties dropped back to orange “moderate” tier. Just four weeks ago, only nine California counties were purple.

Orange County’s sharp rise in daily new cases per 100,000 continued this week. The metric jumped to an adjusted 17.2 daily new cases per 100,000 up from the 10.8 new cases that caused the fall back to purple last week. The metric was in the red level at 5.6 two weeks ago. The state uses an adjusted number based on volume of testing, and Orange County’s unadjusted number is 20.2 daily new cases per 100,000.

The county also saw a continued rise in its testing positivity as the countywide number jumped up to the red level at 6.8% from last week’s orange level of 4.6%. The metric was at 3.3% two weeks ago. The countywide testing positivity had been at an orange level since Sept. 8.

The county’s health equity positivity rate was listed as not available this week. The health equity rate was 5.5% each of the previous two weeks.

Since being introduced on Oct. 6, the health equity rate has been at a red level. The health equity rate measures the testing positivity in county’s low-income and more racially diverse neighborhoods.

To move back down to the red tier, Orange County would need to have its metrics at red levels for two consecutive weeks. If the county’s daily case rate is stable or declining but not at the next level, there would be the possibility of moving down if the testing positivity and health equity metrics meet the level for two tiers lower, i.e. orange tier levels while in the purple tier.

The red tier requires the case rate to sit between 4.0-7.0, the testing positivity between 5.0-8.0% and the health equity rate between 5.3.-8.0%. The orange tier requires the case rate to sit between 1.0-3.9, the testing positivity between 2.0-4.9% and the health equity rate between 2.2.-5.2%. The yellow “minimal” tier, the lowest of the four tiers, requires a case rate lower than 1.0, testing positivity below 2.0% and health equity rate lower than 2.2%.

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