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By Zach Cavanagh

As the coronavirus pandemic rages on, the state of California continues to look ahead.

On Monday, Dec. 28, Gov. Gavin Newsom outlined Phase 1B recipients of the state’s vaccine distribution plan, and on Tuesday, Health and Human Services secretary Dr. Mark Ghaly confirmed that the stay-at-home order would remain in place in the Southern California region because the projected four-week available ICU capacity and other pandemic metrics are not improving.

California is still in Phase 1A of its COVID-19 vaccine distribution plans, with the state’s health care workers, first responders and nursing home facility staff and residents continuing to receive their first doses.

For Phase 1B, which could start in the next month, Newsom said the state has outlined a group of recipients that includes people 75 and older, teachers, child care workers, emergency services workers, and food and agriculture workers. Incarcerated individuals are also expected to be in this group.

Newsom estimated that 262,000 doses had been administered in California as of Monday, with 1.8 million doses in supply. The state expects to receive 297,375 more Pfizer-manufactured vaccines and 232,000 more Moderna-manufactured vaccines by the end of the week.

The vaccine distribution plans are another step forward, while the state’s regional stay-at-home orders—the first of which for Southern California and the San Joaquin Valley regions ended their initial three weeks on Sunday, Dec. 27—will be extended.

Where California’s regions stand with the state’s stay-at-home order as of Dec. 29. Graphic: California Department of Public Health

As originally outlined, after the initial three-week period of the stay-at-home orders passed, the state will now make a daily review of each region’s projected four-week available ICU capacity, and if that projection remains under 15%, the order shall remain in place. Once the region’s four-week projection shows 15% availability or greater, the region will be released from the order.

The projections are based on the region’s current ICU capacity, seven-day average case rate per 100,000 residents, transmission rate and rate of ICU admission. Dr. Ghaly noted the case rate may be chief among these metrics for projection, as the state has found about 12% of new cases are in the hospital within 10-12 days of a positive test and that 10% or more of those newly hospitalized cases will eventually enter the ICU.

The Southern California region and Orange County were again both listed at 0.0% adjusted ICU availability on Tuesday, Dec. 29.

According to the county, the adjusted ICU availability is being used “to preserve the capacity of the ICU to also treat non-COVID-19 conditions. … If a disproportionate number of ICU beds are being utilized to treat COVID-19 patients, then patients with non-COVID medical issues may not be receiving or be able to receive the level of care they need.”

If a region is using more than 30% of its ICU beds for COVID-19 patients, an extra 0.5% is removed in the adjusted capacity for every 1% over that 30% threshold to preserve those necessary resources and beds.

As of Tuesday, Southern California had an unadjusted available ICU capacity of 10.9%, and Orange County was at 8.9%. Southern California is down from 12.3% last week, and Orange County is up from 7.5%.

The San Joaquin Valley (0.0%), the Bay Area (10.4%) and Greater Sacramento (19.1%) regions are the other three of the state’s five regions under the stay-at-home order. Currently, the San Joaquin Valley is the only other region to go through its initial three weeks and will also receive the daily four-week projections. Northern California is at 27.9%.

State hospitalizations have risen 36.5% in the past 14 days, and state ICU patients have gone up 35.1% in 14 days. As of Tuesday, Orange County hospitalizations had risen 53.6% in the past 14 days, with ICU patients increasing by 59.8%. Both the state and county are at a record number of COVID-19 hospitalizations at 21,240 and 2,106, respectively. Orange County is at a record number of ICU patients with 473.

Nationally, the United States now tops 19.3 million coronavirus cases. There have been 334,836 deaths in the United States, and the national seven-day average testing positivity is at 10.6%.

Where California’s counties stand in the state’s four-tiered, color-coded coronavirus monitoring system as of Dec. 29. Graphic: California Department of Public Health

As of the state’s tier update on Tuesday, Dec. 22, California’s case rate and positivity rate had continued to rise as the state reached 93.1 daily new cases per 100,000 and the 14-day testing positivity average dropped to 12.6% from the 13.4% of last Tuesday and still up from the 10.7% of the week before that. Dr. Ghaly noted that, with the slight drop in the 14-day rate and 12.0% seven-day rate, the rates are beginning to stabilize.

Despite that start, the state has continued to see its record-high total of new cases and case averages climb higher. The 14-day rolling average of daily new cases rose to 40,703.6 on Monday, Dec. 28, up from 38,235.7 on Monday, Dec. 21.

Nearly all of California is now in the purple tier in the state’s four-tiered, color-coded coronavirus monitoring system, with 54 of the state’s 58 counties at the highest-risk level. There are only three counties at the red “substantial” risk level, one county at the orange “moderate” risk level and none at the yellow “minimal” risk level. Nine weeks ago, only nine California counties were in the purple tier.

The four-tiered 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.

Orange County’s coronavirus monitoring metrics continued to climb higher in the purple tier this week. Daily new cases per 100,000 residents continued to trend sharply upward this week as the metric jumped to an adjusted 53.5 daily new cases per 100,000, up from the 51.8 new cases last week and the 42.7 of two weeks ago. The metric jumped to the purple level at 10.8 six weeks ago.

The state reports an adjusted case rate, which is adjusted for the volume of testing. The unadjusted rate is 98.5 daily new cases per 100,000, up from 78.1 last week.

The county also saw a marked rise in its testing positivity, as the countywide number climbed into the purple level to 16.9% from last week’s 15.2%. The metric was at 13.2% two weeks ago. The threshold for the purple tier is 8%.

The county’s health equity positivity rate was reported at 24.2%, up from last week’s 22.7% and the 18.8% of two weeks ago. The threshold for the purple tier is 8%. The health equity rate measures the testing positivity in a 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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