What does California’s new ‘equity’ metric mean?

Health equity metric could create barriers for some counties

There’s a new hurdle for counties in California before they’re permitted to reopen further, but for some in the Bay Area, it could provide a loophole of sorts to an accelerated path forward.

It’s called the health equity metric. Its intent is to lessen the burden of COVID-19 on the Black, Latinx, and Pacific Islander communities that have been disproportionately impacted by the virus while ensuring they aren’t left behind as the state moves to reopen. Combined with a county’s weekly cases per- capita and its positivity rate, those three factors will determine a county’s tier level in the state’s color-coded reopening system.

“Our entire state has come together to redouble our efforts to reduce the devastating toll COVID-19 has had on our Latino, Black and Pacific Islander communities,” Dr. Erica Pan, the state’s acting public health officer, said in a statement.

For counties where that gap is the widest, the measure could act as barrier to reopening. But in the places with the least disparate effects, where there is a widespread low positivity rate, it could allow them to take even further steps to reopen, even if the case rate hasn’t met the next tier’s threshold.

Here’s how it works: disadvantaged communities are identified as the lowest quartile of census tracts in a county, using the Healthy Places Index. The positivity rate in those communities must be within a certain percentage of the county’s overall rate, or else it’s not able to advance to the next tier. But if a county’s overall positivity rate and the one in its lowest quartile meet the threshold for the next tier, it can advance without meeting the per-capita case rate requirement, as long as they are trending downward.

As of Friday, ever y county in the Bay Area had reported a seven- day positivity rate below 5% — one requirement to move from the red to orange tier — but San Francisco was the only one to advance. Every other county reported too many cases to move on.

Because San Francisco has already earned state approval for additional reopening, it’s unlikely the city would feel much effect from the new metric. It only affects a county’s ability to move forward, not back, in the reopening process.

But other counties in the region could benefit from the provision that allows them to advance regardless of case rate.

Alameda County officials responded to Thursday’s announcement with an almost immediate announcement of their own: that even in the lowestquartile of healthy places in the county, the positivity rate over the past seven days was 3.8%, while the countywide rate was 2.3%.

As long as cases in Alameda County were trending down, regardless of how many, that would make it eligible to enter the orange tier. Similarly to San Francisco, it has moved at a slower pace than allowed by the state and continued to with the news Thursday.

County officials laid out a plan that would allow for gyms, libraries and museums to operate indoors at limited capacity starting next Friday and elementary schools the following Monday. Over the next month, middle and high schools could be considered for reopening, as well as indoor dining and movie theaters.

In San Mateo County, however, the positivity rate among its lowest-quartile of healthy places was nearly double what it was for the county as a whole: 7.1% vs. 3.7%. For it to advance from the red to orange tier, the positivity in its least healthy communities would have to be lowered to at least 5.2% — or with 10% of the 5% positivity rate threshold.

7- day positivity rates by county, as of Oct. 1 Alameda — 2.3%

Contra Costa — 3.5% Marin — 2.6% (excludes San Quentin State Prison) Napa — 2.5%

San Francisco — 1.6% San Mateo — 3.7%

Santa Clara — 2.0% Solano — 4.3%

Sonoma — 4.3%

Source: County department data

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