LOW HOSPITALIZATIONS KEY TO STATUS
State: Spike in county cases not enough to cause return to red tier
California Department of Public Health amended its reopening blueprint Thursday, adding local hospitalization rates to the calculus that determines whether or not a county will drop out of its current tier if its case rate spikes.
It is a tacit acknowledgment that cases, in and of themselves, just do not mean what they used to before a large percentage of the state’s most atrisk individuals were vaccinated. Studies have increasingly shown that severe illness and hospitalization are much less likely among the vaccinated.
The change has particular resonance in San Diego County, which barely made the cut to join the orange tier this week with 5.8 cases per 100,000 residents, a score just 0.1 cases under the orange tier limit. PreThe viously, two scores over 5.9 would have put San Diego back in the red tier even as the entire system is itself on borrowed time. Gov. Gavin Newsom said Tuesday that he believes the blueprint can be scrapped by June 15 because, by then, the vast majority of Californians will have had an opportunity to become fully vaccinated.
Nathan Fletcher, chair of the county Board of Supervisors, applauded the move Thursday afternoon and said he had been lobbying the governor and others in state government for just such a change for roughly the past two weeks.
Though they are now able to use more of their indoor spaces, businesses have been uncertain about investing the time and money necessary to exit tier-induced hibernation for fear that, as occurred twice in 2020, rising case rates could suddenly shut everything down again.
That latest change, Fletcher said, should make an abrupt about-face less likely, at least as long as currently stable pandemic trends hold.
“It provides some certainty that, barring some unforeseen fundamental change in COVID, we’re going to continue to advance in a positive direction through the June 15 end of the tier system,” Fletcher said.
The state’s blueprint addendum notes that “unless there are extenuating circumstances, such as low rate of vaccine uptake, a county will only move to a more restrictive tier if hospitalizations are increasing significantly among vulnerable individuals, especially among vaccinated individuals, and both test positivity and adjusted case rates show a concerning increase in transmission.”
In cases where counties have out-of-bounds scores in two consecutive weekly reports, the state “will review the most recent 10 days of data, including hospitalization data, and if CDPH determines there are objective signs of stability or improvement the county may remain in the tier. If the county’s most recent 10 days (of ) data does not show objective signs of stability or improvement, the county must revert to the more restrictive tier.”
It’s a more subjective standard than the by-thenumbers rubric that has so far set the pace of reopening because the exact definitions
of what constitutes sufficient hospital stability have not been precisely defined.
Fletcher faced immediate pushback Thursday afternoon after touting the change on Twitter. Dr. Kristian Andersen, a heavy-hitting immunologist at San Diego’s Scripps Research, tweeted that the move was “short sighted” indicating that “the plan always should have been to drive community transmission of SARSCoV-2 down close to zero.”
He expressed a concern cited by many top experts in recent weeks that the public health effort should never get into a mode where some level of coronavirus transmission is OK because vaccination of the most vulnerable populations has made hospitalization less likely.
The more the virus replicates in the human body, experts such as Andersen note, the more chances there are for additional mutations to arise, increasing the speed at which the pathogen becomes able to evade the current crop of vaccines.
“With variants,” Andersen said, “we can’t manage the pandemic at the level of hospitalizations.”
Asked about the variant variable, Fletcher said no one should think that this change to the tier system is acceptance of more cases. Overall, he said, the goal is still eradication but, in the meantime, minor fluctuations in case rates should not be the sole reason why businesses and organizations, already hurting after more than a year of disruption, should again find their situation changing dramatically.
“That is a concern; we want our case rates to go down and to remain low,” Fletcher said.
He noted that the public health effort continues to ask the public to do the things that help most to control transmission even as the orange tier arrives.
The majority, he guessed, will comply.
“They’ll use the face coverings, avoid the high-risk settings and allow us to work our way out of this,” Fletcher said. “We may have some little bumps along the way, but I think we’re headed in the right direction.”
Thursday’s COVID-19 tracking report from the county health department listed an additional 300 cases and four deaths. Daily total hospital census fell from 181 Tuesday to 173 Wednesday, continuing a flat trajectory that has persisted for two weeks. As hospitalizations tend to lag infections, and the median incubation period for coronavirus is about six days, it’s still a bit soon to know for sure whether the region will experience an increase in activity linked to Easter weekend.