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By Zach Cavanagh

In a state update on Monday, Nov. 30, Gov. Gavin Newsom addressed the state’s continually rising coronavirus case rates, the potential overcrowding of hospitals and ICU units, as well as the forthcoming first steps of vaccine distribution as 52 California counties, including Orange County, slid further into the purple “widespread” risk tier in the state’s latest update on Tuesday.

The state’s four-tiered, color-coded coronavirus monitoring 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.

Nationally, the United States has more than 13.5 million coronavirus cases, with well over 100,000 new cases reported each of the past 28 days. There have been 268,045 deaths in the U.S., and the national seven-day average testing positivity rate is at 9.71%.

As of the state’s most recent tier update on Tuesday, Dec. 1, California’s case rate and positivity rate continued to rise, as the state reached 30.2 daily new cases per 100,000 residents and the 14-day testing positivity average rose to 6.4% from the 6.2% as of early last week, and the 4.6% of the week before that.

Where California’s counties stand in the state’s four-tiered, color-coded coronavirus monitoring system as of Dec. 1. Graphic: California Department of Public Health

The state has sailed far past the previous mid-July highs in new cases and case averages that were passed last week. The 14-day rolling average of daily new cases rose to 13,123.8 on Sunday, Nov. 29 from the 10,605.8 on Nov. 23, with the previous high average being 9,504 on July 24. Nov. 24 posted the largest single-day number of the pandemic with 18,350 cases. The single-day high for cases in July was 12,807 on July 21.

However, Newsom put California’s rising case totals into perspective. As the most populous state in the nation, California’s raw totals will always be high, but Newsom pointed to the national numbers for seven-day average case rate per 100,000 residents.

California comes in 39th of the 50 states at 34.5 cases per 100,000, while North Dakota (112.3), Wyoming (111.7), South Dakota (111.5) and Minnesota (104.6) top the list.

Newsom also reported that the state expects that roughly 12% of those daily COVID-19 cases will lead to hospitalizations within two weeks of reporting, which, with those rises in case rates and the 89% increase in hospitalizations over the past 14 days, causes concern by state officials.

Newsom warned that hospitalizations could increase two or three times the current total in one month if there was no change in behaviors. Currently, 59% of California’s hospital beds are in use, with 11% of those being COVID-19 cases, and 75% of all ICU beds are occupied, with 23% of those being COVID-19 cases.

Based on current rates, the state projects that by Dec. 24, 79% of the state’s hospital beds could be in use and 112% of the state’s ICU beds could be occupied, including 107% of Southern California’s ICU beds.

Newsom mentioned that there is the potential for another stay-at-home order for purple tier counties if the hospitalization and ICU capacities continue toward those levels.

Nearly all of California is now in the purple tier, with 52 of the state’s 58 counties at the highest risk level. There are only six counties at the red “substantial” risk level, one county at the orange “moderate” risk level and none at the yellow “minimal” risk level. Just five weeks ago, only nine California counties were purple.

Newsom remained confident that California would be ready to handle the surge and touted the state’s personal protective equipment (PPE) stockpile. Newsom reported California’s PPE stockpile is the largest in the country, even larger than the federal stockpile, with 40 million more N95 masks in the state inventory than in the national stockpile.

With regard to the forthcoming vaccine, Newsom said the state anticipates getting 327,000 doses from Pfizer in mid-December with Moderna’s vaccine to follow. These would be the first doses of the vaccine, with the second doses following within three weeks.

Newsom said the plan for Phase 1A distribution will be out this week, as a state workgroup is drafting guidelines and recommendations for the distribution plan. The plan will then be reviewed by the Community Advisory Vaccine Committee before being announced.

Orange County’s coronavirus monitoring metrics continued to rise this week. Daily new cases per 100,000 continued to trend upward this week. The daily new cases per 100,000 jumped to an adjusted 22.2 daily new cases per 100,000, up from the 17.2 new cases last week.

The metric jumped to the purple level at 10.8 two weeks ago. The state uses an adjusted number based on volume of testing, and Orange County’s unadjusted number is 29.8 daily new cases per 100,000.

The county also saw a continued rise in its testing positivity, as the countywide number climbed into the purple level to 8.8% from last week’s 6.8%. The metric was at 4.6% two weeks ago. The threshold for the purple tier is 8%.

The county’s health equity positivity rate was listed as a local estimate of 13% this week, well into the purple level. The health equity rate was 5.5% when last reported by the California Department of Public Health on Nov. 10. 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—that is, orange tier levels while in the purple tier.

The red tier requires the case rate to sit between 4.0 and 7.0, the testing positivity between 5.0% and 8.0% and the health equity rate between 5.3% and 8.0%. The orange tier requires the case rate to sit between 1.0 and 3.9, the testing positivity between 2.0% and 4.9% and the health equity rate between 2.2% and 5.2%. The yellow “minimal” risk 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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