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Southern California would be back in purple, red tiers if old color-coded system still existed

California has come a long way in the battle against COVID-19. But maybe not as far as many think.

Case rates have risen enough in recent weeks that if the state’s old four-color tier system were still in place, Los Angeles County could have just moved into the most restrictive purple tier, where Southern California spent the darkest days of the pandemic, while Orange, Riverside and San Bernardino counties would likely now be in the second-most restrictive red tier, according to state data updated Wednesday, July 21.

Hospitalizations are on the rise as well, with the number of confirmed COVID-19 patients undergoing hospital treatment statewide doubling in just the past 16 days to more than 2,400 and the number requiring intensive care doubling in the past 17 days to 575. The last time the numbers rose that quickly was in November and December, as the devastating winter surge was building.

Since the state reopened June 15 and the tier-based restrictions were lifted, California has tried to crawl back to something closer to pre-COVID-19 normalcy. Battered by the human and economic toll of the pandemic, Californians suddenly could enjoy unrestricted gatherings on Independence Day while returning to old favorites such as live sports, bars and theme parks.

Delta variant fuels rise

Now, as the delta variant of the virus fuels the new rise in cases, health officials are seeing now-familiar surge patterns that followed past holiday periods. Los Angeles County is once again requiring people to wear masks indoors, regardless of their vaccination status, and about one-third of California’s counties are recommending but not requiring it.

But could the state ever return to more widespread restrictions like those in place under the tier system if the situation continues to get worse?

Marcia Godwin, a professor of public administration at the University of La Verne, doesn’t believe so, especially considering Gov. Gavin Newsom’s fight to avoid recall in a Sept. 14 election in which his handling of the pandemic looms large.

“Politically, while there’s a recall on the horizon, there’s not going to be the same sentiment for statewide action,” Godwin said. “Really, now it’s about nudging, encouraging, begging people to get vaccinated as an alternative to additional mandates.”

Jamie McDonough, RN, left, and Nurses Assistant Vanessa Gutierrez, check on a COVID-19 patient in the COVID ICU at St. Joseph Hospital in Orange, CA on Wednesday, July 21, 2021. COVID-19 cases have risen in recent weeks due, in part, to the delta variant. (Photo by Paul Bersebach, Orange County Register/SCNG)

The vaccinations have been shown to be highly effective at preventing severe disease. In the past two weeks, more than 95% of the COVID-19 patients coming to Providence St. Joseph Hospital in Orange have been unvaccinated, said Dr. Brian Lee, medical director of the emergency care center.

Moreover, while unvaccinated patients are having just as severe symptoms as ever, “The few patients that do come in that are fully vaccinated tend to have a less severe course” of illness, Lee said. He also said has not seen any significant numbers of health problems directly related to people getting the vaccine.

Clearly, with so many Californians vaccinated, the situation is very different now than it was when the tier system was created last August, said Dr. Robert Kim-Farley, of UCLA’s Fielding School of Public Health.

“This pandemic is now a pandemic among the unvaccinated,” Kim-Farley said. “The numbers are relatively small, compared to the numbers back at that time. But we are doing a more nuanced and tailored approach of encouraging everyone to wear masks indoors without curtailing capacity and without resulting in physical distancing. The tier system was extremely useful and provided clear understanding among the population as to what actions needed to be taken based upon the level of transmission of the virus in the community at a time, when no one was vaccinated.”

Veronica Reyes, center, of Anaheim waits to receive a coronavirus test administered by Lisa Chau, left, a physician assistant and Noelia Olivares, right, a medical assistant, at Families Together of Orange County Community Health Center in Tustin on Thursday, July 22, 2021. (Photo by Mark Rightmire, Orange County Register/SCNG)

Back in purple and red

By June 15, when the old tier system — officially the “Blueprint for a Safer Economy” — was retired, Southern California was in the yellow tier, meaning the risk from coronavirus was considered minimal and most businesses could be open with modifications. Counties were seeing fewer than two new cases per day per 100,000 residents, and less than 2% of all coronavirus tests were coming back positive.

Those numbers have all since multiplied. As of Thursday, July 22, state coronavirus data shows Los Angeles County is seeing 11.3 new cases per day per 100,000 residents. That’s over the threshold of 10 new cases that would put it back in the purple tier, where restaurants couldn’t offer indoor dining, bars were closed, retail stores and most other businesses had to limit capacity and places like theme parks and concert venues were shuttered.

The case rates of 6.2 in Orange County, 8.1 in San Bernardino County and 8.2 in Riverside County would put them all in the red tier, where restaurants could be open for indoor dining but most businesses still had to limit capacity.

(Of note, the case-rate data available from the state now is not the exact same data used in the old tier system. That was based on a case rate that was adjusted up or down based on whether a county was testing less or more than other counties. It’s possible that enough L.A. County residents are getting tested now that its case rate could be adjusted down to within the red-tier range. The other counties would not be adjusted downward.)

The test-positivity rates now range from 4.7% in L.A. County to 6.5% in Riverside County.

Highest rates since February

The current case and positivity rates are all the highest they’ve been since February, but are still a fraction of what they were at the height of the pandemic in December and January, when case rates were over 100 and positivity rates were near or over 20%.

Dr. Roger Lewis, professor and chair of Harbor-UCLA Medical Center’s Department of Emergency Medicine, said another significant number to watch is hospitalizations.

“The fact that we are seeing relatively low case counts gives us a little bit of time to respond,” said Lewis, who led the L.A. County Department of Health Services project modeling that measured demand on the county’s hospital system. “But one should not be fooled by the relatively low case counts, given the rise of rapid rate of increase.”

As worrisome as the current increases are, there appears to be consensus among medical experts that they won’t culminate in the kind of catastrophe that Southern California endured last winter, when hospitals and morgues were overrun.

Between the levels of high-risk people who have been vaccinated and the number of people who have already had the disease, “I think enough numbers are there to prevent us going back to a January surge level,” said Lee, the Orange County ER doctor.

He also pointed out that since last summer and fall, “We’ve learned a tremendous amount in terms of treating COVID.” If people come in for treatment early, he said, it can prevent them from reaching the point where they have to be hospitalized.

No push for return to tiers

Andrew Noymer, a professor of public health at UC Irvine who studies disease prevention and population health, noted that the color-coded tiers were established to help keep the hospital system afloat until a vaccine was available. With California no longer in that situation, it would be difficult to revert back to a similar set of restrictions, he said, especially given that vaccination rates might not increase much going forward.

“We can require masks. We can close schools. We can close amusement parks. But ultimately the ‘original sin’ is the lack of vaccinations,” Noymer said. “How long are you going to keep things closed because some people won’t want to vaccinate themselves?”

Still, he would have liked for at least a remnant of the tier system to have stayed in place.

“If we’re all green or yellow, congratulations to us. But (having a system still going) would give you a fallback position if a county had to go back to orange again. Now, we just don’t have tiers. And how are you going to get counties to go back to tiers once they’ve seen their amusement parks open?”

Even if the state doesn’t decide to put any broad restrictions back in place, Godwin said that if case and hospitalization rates continue to rise and vaccination rates don’t, she would expect to see more counties take action.

“I think some kind of targeted indoor mask mandate is possible if the rates continue to go up. There could very well be some restrictions on large gatherings,” she said. “At this point there doesn’t seem to be sentiment for closing entirely.”

Source: Orange County Register

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