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By Zach Cavanagh

As the winter surge in the coronavirus pandemic begins to plateau – either as a realistic trend or due to holiday-lagged testing and reporting – the state of California continues forming further phases of its COVID-19 vaccine distribution plan.

The state’s first step in the here and now is to administer more of the doses currently in the state supply to its Phase 1A recipients.

As of Monday, Jan. 4, Gov. Gavin Newsom reported that 454,306 first doses had been administered of the 1,297,000 total doses the state has received. Newsom said that 611,500 are still to be shipped with the second doses arriving this week.

Newsom said the state is aggressively working to accelerate the pace of vaccine administration by engaging with the health system more directly by having dentists administering the vaccine along with pharmacy techs, the national guard and clinic and doctor partnerships. The state is also working with pharmacy programs from CVS and Walgreens to administer the vaccine to skilled nursing facilities.

Phase 1A is currently providing the vaccine to healthcare workers and long-term care residents.

Newsom provided more details on Phase 1B which is split into two tiers and should begin later this month. In Tier One, individuals 75-years-old and older and workers in education, childcare, emergency services, food and agriculture are eligible to receive the vaccine.

Phase 1B Tier Two will include individuals 65-years-old or older and workers in transportation and logistics; industrial, commercial residential and sheltering facilities and services; and critical manufacturing. Tier Two will also include incarcerated and homeless individuals in congregate settings.

Newsom also introduced Phase 1C, which will include individuals 50-years-old and older or people over age 16 with underlying health conditions or disabilities that increase COVID-19 risk. Phase IC will also include workers in water and wastewater; defense; energy; chemical and hazardous materials; communications and IT; financial services; government operations and community-based essential functions.

These guidelines and distribution plans are discussed by the state’s Community Vaccine Advisory Committee, whose meetings can be viewed weekly online at

Where California’s regions stand with the state’s stay-at-home order as of Jan. 5. Graphic: California Department of Public Health

As of Tuesday, Jan. 5, the Southern California region remains under the state’s regional stay-at-home order, as the state’s four-week ICU projection for the region still does not meet the 15% available criteria to exit the order.

After the initial three-week period of the stay-at-home orders passed on Dec. 27, 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.

The Southern California region and Orange County were again both listed at 0.0% adjusted ICU availability on Tuesday, Jan. 5.

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 9.2%, and Orange County was at 4.9%. Southern California is down from 10.9% last week, and Orange County is down from 8.9%.

The San Joaquin Valley (0.0%), the Bay Area (5.9%) and Greater Sacramento (11.7%) regions are the other three of the state’s five regions under the stay-at-home order. Currently, the San Joaquin Valley and Greater Sacramento are the other two regions to go through its initial three weeks and will also receive the daily four-week projections. Northern California is at 29.8%.

State hospitalizations have risen 18% in the past 14 days, and state ICU patients have gone up 14% in 14 days. As of Tuesday, Orange County hospitalizations had risen 23.8% in the past 14 days, with ICU patients increasing by 29.2%. Both the state and county are at a record number of COVID-19 hospitalizations at 22,485 and 2,236, respectively. Orange County is at 504 ICU patients, just under record number of Jan. 1 with 506.

Where California’s counties stand in the state’s four-tiered, color-coded coronavirus monitoring system as of Jan. 5. Graphic: California Department of Public Health

Nationally, the United States now tops 20.9 million coronavirus cases. There have been 353,483 deaths in the United States, and the national seven-day average testing positivity is at 13.55%.

As of the state’s tier update on Tuesday, Jan. 5, California’s case rate and positivity rate dipped for the first time in nearly two months as the state dropped to 74.1 daily new cases per 100,000 from 93.1 last week and the 14-day testing positivity average dropped to 12.4% from the 12.6% of last Tuesday and from the 13.4% of the week before that.

The state also finally saw a drop from its record-high total of new cases and case averages. The 14-day rolling average of daily new cases dropped to 37,666.2 on Monday, Jan. 4, up from 40,703.6 on Monday, Dec. 28.

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.

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 67.8 daily new cases per 100,000, up from the 53.5 new cases last week and the 51.8 of two weeks ago. The threshold for the purple tier is 7.0.

The state reports an adjusted case rate, which is adjusted for the volume of testing. The unadjusted rate is 74.8 daily new cases per 100,000, down from 98.5 last week.

The county also saw a small rise in its testing positivity, as the countywide number climbed to 17.1% from last week’s 16.9%. The metric was at 15.2% two weeks ago. The threshold for the purple tier is 8%.

The county’s health equity positivity rate was reported at 23.4%, down from last week’s 24.2% and the 22.7% 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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