SAN DIEGO COUNTY, Calif. — California will begin using a new tier structure and case rate to evaluate the spread of coronavirus in counties this week. Each tier has different rules about what businesses can be open and what restrictions they must abide by.
State health officials calculated San Diego County had a case rate of 5.8 on Friday, which places it in Tier 2, colored red on state maps when the system takes effect on Monday.
Unlike the previous case rate, the new metric is calculated daily and reviewed weekly. It also contains provisions for businesses and schools while the previous case rate was only tied to education.
“This is trying to strike a balance between economic viability and protecting the public's health,” said Wilma Wooten, M.D., M.P.H., the county’s public health officer. “Everyone really is involved in making sure that we are successful."
Under the Tier 2 guidelines, all retail businesses may operate at 50% capacity. Indoor venues at museums, zoos, aquariums, restaurants places of worship and movie theaters may reopen at 25% capacity. Capacity at restaurants, churches, and theaters are also capped at 100 people.
Bars that do not serve food must remain closed until Tier 3 when they will be permitted, with the health officer’s approval, to operate only outdoors.
The new system also adjusts the case rate metric used to measure success against the spread of coronavirus. The previous system was calculated based on the number of new cases for every 100,000 residents over a 14-day period with a three-day lag. Once a county had fewer than 100 cases for every 100,000 residents for 14 consecutive days then schools were permitted to reopen for in-person education, with their district’s approval. Counties with a case rate above 100 were placed on the state’s monitoring list. The list has now been replaced by Tier 1.
San Diego County schools are on track to receive permission to reopen on Tuesday and will not be affected by the new case rate as it will already be in Tier 2.
After Monday, the state will calculate the county’s case rate based on daily new cases per 100,000 residents and reported using a seven-day average with a seven-day lag to allow more time for results to come in and be calculated.
San Diego is the only county in Southern California that will start the system not in Tier 1.
See below for commonly asked COVID-19 questions and answers:
Why is there a new case rate for California?
The state added tiers to reopen businesses in phases. The new case rate helps monitor changes over a shorter period.
How is the new case rate in California calculated?
The California Department of Public Health calculates the case rate daily based on the average number of new cases per 100,000 people over a seven-day period with a seven-day lag. The rate is then adjusted down if a county performs more tests than anticipated based on the state testing average with a maximum adjustment of twice the state average.
CDPH will assess the indicators weekly, beginning on Sept. 8.
How does this affect schools in California?
Schools are permitted to open when a county leaves Tier 1. San Diego County schools will be permitted to resume in-person education after Aug. 31. However, individual districts may have their own metrics to determine when to reopen their classrooms.
Does the number of available hospital or ICU beds affect a county’s tier in California's new system?
No. The previous system flagged counties if they had an increase of 10% or more of patients hospitalized for coronavirus or fewer than 20% of ICU beds available. The current tier system removed this metric. However, the county continues to monitor these metrics and more and considers them triggers for modifying the current health officer’s order.
“We'll continue to look at other metrics. Those in our triggers dashboard, as well as the metrics that have been included in the past monitoring list,” said Wooten.
How could flu season affect the case rate?
The case rate only calculates coronavirus. The flu would be a separate metric. CDPH is working to reduce cases of COVID-19 to avoid burdening the health care system when flu season occurs. In other parts of the state, winter often has more indoor activities, which could further spread COVID-19.
How do we move to a lower tier?
We can move to Tier 3 when our county’s daily case rate is between 1 and 3.9 and remains there for 14 consecutive days. The county must continue to meet metrics for data collection, testing access, contact tracing, supportive isolation and outreach.
Can a county go from Tier 2 to Tier 4?
No. The county must spend at least 21 days in a respective tier before progressing to a lower tier.
Could we move to a more restrictive tier?
Yes. If the daily case rate were to exceed the limit for the current tier for 14 consecutive days, then the county would move into the higher tier. Businesses would be expected to implement further restrictions within three days.
Can the county impose stricter restrictions than what is listed in state guidelines?
Yes. The health officer maintains local discretion to be more restrictive. So far, San Diego has not gone beyond state guidelines and continues to stress education is a preferred method.
“As we see issues, people should also be clear that we will shut down entities if they are not following the guidelines and if there are particularly outbreaks occurring as a result,” said Wooten.
Why do retail stores have to operate at 50% capacity?
“By decreasing the capacity, this will help with increased risk and increased exposure,” said Wooten.
How will the county enforce the new guidelines?
The county continues to emphasize education over penalties.
“It's the owners and the host, the organizers that really have to mandate these requirements. They have to stick to them. They have to enforce them, and we will do the same with respect to our compliance teams we’ll get out there,” said Gary Johnston, Chief Resilience Officer at the County’s Office of Emergency Services. “It is a team effort down from the organization, the entity, the industry, the business, the schools, down to the individual that if we collectively do the right thing, we will stay in the red and hopefully actually move to the right to orange.”
Why is the state and county's case rate different?
The county calculates data through 11:59 p.m., whereas the state may use a different 24-hour window. The county's case rate also includes jail inmates and results from local correctional facilities. The state does not include these facilities in its case rate calculations.