COVID-19 - Dr. Jim Halverson

Ask Dr. Halverson: Understanding state's 4-tier COVID-19 reopening guidelines

web 4 17 Halverson photo
By Dr. Jim Halverson
On Aug. 31, California began reopening guidelines that are statewide, simple, slow and stringent. These guidelines were set forth in response to the state’s unsuccessful first attempt at reopening in early June, which led to an increased incidence of coronavirus cases in the next two months. The state’s coronavirus hospitalizations increased from 3,142 on June 4 to 7,170 on July 21. 
The new system is based on statewide criteria and a uniform framework providing four tiers of reopening rather than differing sets of restrictions and guidance for each county in the state. Movement between tiers is determined by simpler metrics focused on only two metrics — case rate and test positivity. 
Each tier is numbered and color-coded. Tier 1 (purple) represents the highest “widespread” risk level for a county with more than seven new cases per 100,000 residents per day and/or more than an 8% testing positivity rate. Ventura County had been at the purple tier since the guidelines were introduced, but moved to the red tier Oct. 6.
Tier 2 (red) represents substantial risk, tier 3 (orange) moderate risk, and tier 4 (yellow) minimal risk. Counties moving between tiers will need to meet that tier’s criteria for two weeks before being eligible to move to the next level, with a mandatory 21-day wait time between each move. Counties will only be able to move one tier at a time. If a county fails to continue to meet the current tier’s criteria for two straight weeks, it could be moved back to its previous higher-risk category.
“We don’t put up green because we don’t believe that there’s a green light that says just go back to the way things were or back to the pre-pandemic mindset,” Gov. Gavin Newsom explained in announcing the guidelines. “These are the guidelines that we’re putting forward to get us through the flu season and work through the next few months in the state of California.”
Case rate explained
The case rate per county is the number of newly reported cases on average per day for the week prior to the weekly report. This report is put out every Tuesday by the state. Due to reporting delays, there is a one-week lag period in data. For example, the report on Tuesday, Sept. 29, was for Sunday, Sept. 13, through Saturday, Sept. 19. Federal and state prisons are not included in county numbers. For Ventura County to move to Tier 2, we have to average fewer than seven new cases per 100,000 county residents per day for that one-week period for two consecutive weeks. Our county has 850,000 residents, so that equates to fewer than 60 new cases per day. On Sept. 28, our case rate decreased to that level for the first time (seven) since the guidelines went into effect.
Test positivity rate explained
The test positivity rate is the number of positive test results divided by the total number of test results reported in that week. For example, Ventura County currently has a 3.6% positivity rate, which equates to 36 positive tests out of 1,000 tests done. To move to tier 2, a county must average 8% or below.
Encouraging results
At the time of the implementation of the plan on Aug. 31, 38 of California’s 58 counties were in the purple, tier 1 category. Nine counties were in tier 2, eight counties were in tier 3  and only three had qualified for tier 4. The last report on Sept. 28 showed 18 counties in tier 1, 22 counties in tier 2, 15 counties in tier 3, and three counties in tier 4. In addition, statewide hospitalizations for COVID-19 were down to 2,287 people on Oct. 3 from 4,205 people on Aug. 27.
Local relevance
Our move Oct. 6 from tier 1 to tier2 allows many businesses that have been closed, such as movie theaters, to reopen with limited indoor capacity. Restaurants will be allowed 25% indoor capacity. Churches can reopen indoors with a maximum of 25% capacity or 100 people, whichever is fewer. For a complete list of openings allowed at each tier, please see the state’s COVID-19 website,
Very importantly, schools are eligible for reopening for at least some in-person instruction once the county is out of tier 1 for at least 14 consecutive days. For Ojai and Ventura County, this could come as early as Oct. 21. To reopen, schools must also meet all of the other state guidelines for reopening, including having support from teachers, staff, administration and parents.
This four-tiered system has worked well since it began on Aug. 31. Case rates and hospitalizations are significantly down statewide and in our county. Continued compliance with social distancing, wearing of masks and appropriate hygiene measures are giving encouraging results. As we move into the flu season, KEEP IT UP! Get your flu shot. Your efforts are keeping all of us much safer here in our valley. Thank you.
Stay committed, stay properly informed, stay positive, stay safe and stay well.

— Dr. Jim Halverson is a longtime Ojai Valley physician who writes a weekly column on COVID-19 for the Ojai Valley News.