California’s new COVID-19 reopening plan

Governor Newsom announced California’s second COVID-19 Reopening plan on Friday. It replaces the County Monitoring List ,which had intricate metrics and county variations, with a new 4-tier system. The Governor described the new system as a uniform framework that is “statewide, simple, slow, and stringent.” The rules calibrate allowed activities with how prevalent the virus is in each county. The higher the new case and positive test rates, the tighter the restrictions.

The four tiers are labeled by risk level and color coded. Here’s the starting lineup.

PURPLE = WIDESPREAD

Counties with more than seven new cases daily for every 100,000 residents and more than 8% of tests positive. Thirty-eight counties start out in here, representing 87% of California’s population. In this tier, most non-essential indoor business operations are closed.

RED = SUBSTANTIAL

4-7 new cases daily per 100,000 people and between 5-8% of tests positive. Nine counties, including Nevada County, start in this tier, accounting for 12% of the state’s population. Some non-essential indoor business operations are closed, but others can open with modifications.

ORANGE = MODERATE

1-3.9 new cases daily per 100,000 and a testing positivity rate between 2-4.9%. There are eight counties with just 1% of the state’s population in this tier. More business operations can be open with less stringent modifications.

YELLOW = MINIMAL

Less than one new case per 100,000 and less than 2% of tests positive. Three small rural counties with only 0.1% of California’s population start in this tier. Most business operations can be open with modifications.

There is no Green, the Governor noted, as there is no place with zero risk where things can go back to pre-COVID “normal”.

To ensure that the effects of different restrictions can be accurately assessed, counties must stay in a tier for 21 days before becoming eligible to move to the next one. If a county has met the metrics for the next tier for two straight weeks at the end of those 21 days, it can advance to the next tier.

Nevada County is in the Substantial (Red) tier, but almost qualifies for the less restrictive Orange tier. Our 4.1 cases per 100,000 people barely makes it into the Red zone, and our test positivity rate of 2.2% is at the lower end of the Orange.

How do we move our county into that less restrictive tier, especially with Labor Day holiday weekend around the corner? New cases and deaths increased substantially in our county and the state after the Memorial Day and Fourth of July holidays.

Part of the reason we saw a surge in cases in June and July is that California loosened restrictions in May. Many people locally and across the country seemed to think the protective measures were all or none: if some of the restrictions were lifted, everything was back to normal. Social distancing, masks in public, sticking to household cohorts and avoiding large gatherings often went by the wayside. But loosening some restrictions doesn’t mean we can forget about all of them.

For example, many people, including me, think it is very important to reopen our schools and is glad that is happening. However, the fact that your child is seeing friends at school doesn’t mean they all should hang out together after school at someone’s home. In fact, it’s the opposite. Being at school with people outside of one’s household group is a risk. Because your child takes that risk, it doesn’t mean that he or she should take lots of other COVID-related risks. It doesn’t mean we can be less careful elsewhere in our lives. To me, it’s like a diet. Let’s say our goal is to keep our weight stable, but end up eating ice cream, thus increasing our risk of gaining weight. We need to decrease that risk by eliminating something else — those cookies or that glass of wine — or by doing an extra hour of exercise. It’s similar with COVI — there is cumulative risk, and all our behaviors add up.

Wearing a face covering in public is another action that will help improve our tier ranking. The latest studies have shown that wearing a face covering in public protects both the wearer and those around from COVID and helps stop the spread of the infection. The more people who wear one, the better off we all are. The same is true of vaccines for COVID or any other infectious disease — the more people that get vaccinated, the better our community immunity will be.

Importantly, increased testing will also help us because the state will adjust our new case rate number down if we have more tests done than the state average. In addition, when fewer people are tested, it usually means that those who are tested are sick and more likely to be positive, thus driving up our test positivity rate. Our testing situation has improved in the past few weeks, with shorter turnaround times and more availability. Testing is available at the state-sponsored OptumServe sites in Grass Valley and Truckee. It is also available at Yubadocs Urgent Care, Western Sierra Medical Clinic, Chapa De, and some doctor’s offices.

Let’s all do our part to help our schools and businesses. Cover your face, keep your space, stay in your household group whenever possible and get tested. Dr. Roger Hicks is the Medical Director for Yubadocs Urgent Care in Grass Valley and the founding president and current Director of the California Urgent Care Association.