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California counties struggle with coronavirus case rate



It’s a metric that often comes up in conversations about reopen the economy in California, a passport to a more normal life in the midst of the COVID-19 pandemic.

The fate of companies depends on it. In many counties, that’s all that keeps people from dining indoors at restaurants, watching movies on the big screen, and sweating during spin classes at the gym.

The number: 7.0.

Under California’s latest reopening plan, state officials require counties to meet certain parameters before allowing more companies to open their doors and welcome customers. Counties from Los Angeles to Butte and Sonoma to San Bernardino have blocked attempts to register seven or fewer new coronavirus cases per 1

00,000 residents every day.

The bite of a metric, known as the correct case rate, represents how many people get sick each day in a county.

The standard is part of the state’s attempt to find a delicate balance that avoids an increase in cases as restrictions are relaxed. Ideally, if transmission is low enough, small increases in prevalence due to the opening of multiple businesses do not overwhelm the health system.

“All of these concepts and approaches stem from this notion of slow and rigorous … so we don’t end up having to go back later,” California Health and Human Services Secretary Dr. Mark Ghaly said in a recent briefing.

But what exactly the threshold should be is a bit of a guess, experts say, as no one really knows what constitutes a safe level of transmission for reopening.

In late August, Governor Gavin Newsom unveiled a new reopening system that assigns each county a tier based on how broadcast the broadcast is. The level corresponds to what is allowed to reopen. Counties can move to a less restrictive level by meeting benchmarks that show the spread has been tightened for two weeks in a row.

Sacramento County, for example, has long been stuck in the purple level – the most restrictive – where most businesses deemed non-essential are closed or allowed to operate outdoors only.

But last week, the state announced that for the first time the county reduced the number of new cases per day to fewer than seven for every 100,000 residents. If Sacramento continues to progress, it could move into the red band this week, allowing it to immediately restart (restricted) indoor operations at gyms, restaurants, museums, churches and other facilities, said Dr. Olivia Kasirye, Public Health county official.

“We hope and anticipate to officially switch to the red band,” Kasirye said in an interview.

The current state system is largely based on just two metrics: the case rate and the positive rate, which is the percentage of tests for the virus that come back positive.

These metrics were chosen, as opposed to the number of hospitalizations or deaths, because they should reveal relatively soon whether cases are increasing in a region, Ghaly said. It could be several weeks before a wave results in hospitalizations or deaths, he noted.

To go from purple to red, a county’s positivity rate must be 8% or less, while the daily rate of cases is seven or less per 100,000 residents. These numbers are partly estimates, said UC San Francisco epidemiologist Dr. George Rutherford.

“It’s all arbitrary,” Rutherford said. “There is no page in an epidemiology textbook that you could point to and say, ‘This is how you do it.’ … We are learning as we go. “

The state has chosen to change the case number to take into account the number of tests each county is doing – it doesn’t want to penalize counties for catching more cases. If counties run more tests than the state average, their case rate will be slightly reduced; conversely, counties lagging behind the state average in testing will see their case rate adjusted to the upside.

In the last week for which the data was released, Kern County recorded 6.3 cases per 100,000 residents every day. Yet the state has recalculated the Kern rate to account for the number of tests below the county average. This increased the case rate to 7.2, above the threshold for moving down.

In contrast, Los Angeles County’s case rate dropped from 7.7 to 7.0 due to extensive testing.

Based on these adjusted rates, 11 counties, including Ventura, Kern, and Monterey, are stuck in the purple level with a case rate greater than 7.0, although their positivity rate is less than 8%. San Diego County, in the red range, was recently close to returning to purple as its case rate had started to rise above 7.0.

Despite its recent drop to 7.0, L.A. continues to struggle with its case rate. Los Angeles County Director of Public Health Barbara Ferrer said she anticipated an increase in the case rate will disqualify the county from proceeding with the reopening when new data is released Tuesday. The positivity rate was less than 3 percent, but the case rate probably won’t stay on track, he said.

“The problem that was most difficult for us … was the daily case rate; we had to reduce the corrected rate to seven new cases per 100,000 people,” Ferrer said Monday.

The fact that counties continue to meet the positivity rate requirements but not the case rate standards is by design, Ghaly said. As counties ramp up testing, their positivity rates will typically begin to decline, he said. Once testing is ramped up, counties are able to use identified cases for contact tracing and isolation, to ultimately reduce transmission.

“Looking at everything that materializes, it’s actually moving as we hoped: that the positivity of the test drops a little earlier than the case rate and that it allows counties to move forward with some degree of confidence to the next level,” he said Ghaly.




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