SAN DIEGO COUNTY REMAINS IN THE RED TIER

New ‘health equity’ score would prevent easing restrictions

It is another week in the red for San Diego County with continued high testing rates nudging the region away from the precipice once again in the state’s weekly tier assessment.

Released midday Tuesday, the report keeps San Diego in its current spot in the red tier, one from the bottom of the state’s four-level ranking system.

But it also includes a new measure that will prevent further advancement to less-restrictive rungs of the reopening ladder until significant progress is made in reducing the number of positive tests in the region’s most disadvantaged neighborhoods.

The state’s new “health equity” score calculates a separate positive test rate for census tracts in each county that score lowest on the California Healthy Places Index, a classification system that uses a range of socioeconomic statistics to pinpoint the location of the most and least disadvantaged neighborhoods.

Starting this week, the state is calculating a cumulative test positivity rate for the 25 percent of local census tracts deemed most disadvantaged by the index, and counties cannot advance in the tier system unless they meet limits for the county as a whole and also for the areas deemed most disadvantaged.

At the moment, that’s not happening.

San Diego’s overall positivity rate was 3.5 percent in the state’s latest report, qualifying the region for the next highest and less restrictive tier — colorcoded orange. But the positivity rate for the roughly 150 census tracts in San Diego in the lowest quartile of the quality index, according to the state, have a composite positivity rate of 6.2 percent. Positivity rates must be below 5 percent for two consecutive weeks in order for a region to move up a tier. The stark

assessment that some locations see a positive testing rate nearly twice as high as the region’s average surprised no one. Rates in some South Bay and East County ZIP codes have long exceeded those of the region as a whole.

But seeing the number still so high, said Roberto Alcantar, chief strategy officer for the Chicano Federation of San Diego, provides fresh motivation for the coronavirus outreach and education work that many local organizations are currently doing in the communities they serve.

Many are surely wondering how San Diego County will collectively reduce the test positivity rate in those areas highlighted by the state. Alcantar said Tuesday evening that the work is already under way.

“For sure, the work to bring those numbers down has started,” he said. “There is a clear strategy between 10 nonprofit organizations that have contracted with the county to work together and address the systemic barriers that have made the rates higher in some communities throughout this pandemic.”

In August, the county signed outreach contracts with the federation, which leads a coalition of 10 different Latino-serving community organizations, as well as with Mental Health America to work with local Black communities and Somali Family Service of San Diego to work with refugee communities.

The idea was to tap the local knowledge and connections that nonprofits have already built in the communities they serve and use those relationships to advocate for testing and diseasecontrol strategies that range from staying in county-provided hotel rooms after testing positive to providing accurate and timely information to the contact tracers and and case investigators responsible for containing outbreaks.

Some work is already underway, Alcantar said, with COVID-19 information centers already online and testing centers in some cases already in place on the premises of trusted community organizations. Public service announcement campaigns, he added, will soon launch to reach more people in their native languages.

“We’re going to have more aggressive outreach with PSAs in Spanish, more speaking directly to the community through community forums,” he said. “We’re ready to take this on.”

At the moment, though, it is clear that the new positivity rate is not by itself holding the region back.

Counties can only climb out of their current tier if both of the numbers the state tracks weekly meet the requirements for the next level.

While San Diego’s positivity rate has consistently landed in the orange tier since the state’s ranking system was announced, its case rate, defined as the average number of cases per 100,000 residents, has consistently headed in the opposite direction, threatening to plunge the region into the lowest and most-restrictive purple tier. Such a fall would require many businesses and organizations, including restaurants, places of worship and gyms, to move their operations fully outdoors again.

As predicted, San Diego was once again skirting the border between red and purple Tuesday with a raw score of 7, which is the limit beyond which the tier assignment changes from red to purple.

However, the county once again benefited from an adjustment system built into the state’s ranking system. The raw rate was adjusted downward to 6.5 because the number of tests performed locally per 100,000 residents was 260, greater than the state’s median rate of 216. A similar testing-based adjustment kept San Diego out of the purple tier last week, reducing a raw purple score of 7.2 to 6.7, a number that is within bounds for the red tier.

Though countywide progress on the overall case rate will have to happen before the state’s equity rate is immediately relevant, it is clear that making it to the orange tier should be the long-range goal of anyone who wants to help their local businesses and organizations.

Moving up one notch would allow restaurants to double the amount of indoor capacity they are able to use, jumping from their current limit of 25 percent to 50 percent. Places of worship, movie theaters and museums, zoos and aquariums would experience the same increases for their indoor spaces. Gyms would be able to increase indoor usage from their current limit of 10 percent to 25 percent.

No county health leaders were available to discuss the new equity index rate Tuesday. The county will, however, hold its weekly COVID news conference this afternoon and is expected to provide further insights into its thinking on the issue then.

It is clear, though, that the government intends to do more.

On Monday, Chula Vista Mayor Mary Casillas Salas and county Supervisor Greg Cox opened a new drive-up testing site at the South Chula Vista Library.

Salas and Cox said this new service is part of an ongoing effort to expand testing options to address the continuing high number of cases in the South Bay. Chula Vista is using CARES Act funding to staff the site with emergency medical technicians and municipal staff to help support the medical experts.

Samples are collected using nasal swabs and transported to a local highthroughput lab run by Helix, a local testing juggernaut under contract to perform up to 4,000 tests per day for the county health department.

As is now the case for county-run, drive-up testing sites across the region, appointments are preferred but not required.

County officials encouraged people with and without symptoms who are at high risk for COVID-19 to be tested. Health care and essential workers should also be tested, as well as people who had close contact with individuals who have tested positive.