On Sunday, June 28, Gov. Gavin Newsom and California Department of Public Health officials announced that several counties should close bars in response to rising COVID-19 positive case numbers in the state, but on Wednesday, July 1, Gov. Newsom expanded on the state’s response with guidance directing counties that have been on the County Monitoring List for three consecutive days or more to close indoor operations for certain sectors.
The new orders take effect immediately.
“Today’s action is necessary to help slow the spread of this virus,” said Dr. Sonia Angell, State Public Health Officer and Director of the California Department of Public Health said in a released statement. “We put ourselves and our community at greatest risk for COVID 19 when we mix with people who don’t live with us. And if you go out, wear a face covering, keep your distance, wash your hands frequently and limit unnecessary indoor activities that increase the risk of exposure.”
All bars, brewpubs, breweries and pubs must close.
New guidance announced on Wednesday targeted additional sectors that include:
Indoor dine-in restaurants
Indoor wineries and tasting rooms
Indoor family entertainment centers
Indoor movie theaters
Indoor zoos and museums
These sectors are allowed to continue staying open for business but must modify operations to provide services outside or by pick-up.
The new set of guidelines will apply for three weeks and is subject to an extension.
The new order applies to 19 counties that have been on the monitoring list for three or more consecutive days. These 19 counties represent 72 percent of California’s population. Those counties as of July 1 are:
“California is seeing the virus spreading at alarming rates in many parts of the state, and we are taking immediate action to slow the spread of the virus in those areas,” said Governor Newsom. “We bent the curve in the state of California once, and we will bend the curve again. But we’re going to have to be tougher, and that’s why we are taking this action today.”
Newsom said the state would use the authority of bureaus and regulatory agencies to help enforce these orders. Newsom stated that education is the first measure the state will take in order to gain compliance.
“I’m not coming out with a fist. We want to come out with an open heart, recognizing the magnitude of some of these modifications in this dimmer switch, and what it means to small businessmen and women, what it means to communities, what it means to the economic vibrancy, and health of our state and in turn our nation. So again, we want to educate. We want to encourage. We want to give people time to come into compliance. That’s the spirit that we bring to our enforcement efforts,” Newsom said during a press conference on Wednesday.
Should a business or county not comply with the new orders, then Newsom shared the state will take more drastic measures such as using bureaus and regulatory agencies.
Newsom stated that withholding $2.5 billion in funding in counties that do not implement the orders or openly refuse to comply in response to rising concerns surrounding the COVID-19 pandemic is another measure the state would consider.
Criteria used to classify a county on the watch list
Counties are asked to show less than 25 cases per 100,00 residents over the last 14 days, or a maximum of eight percent of total testing is positive over the last 14 days.
A county is considered to meet hospitalization criteria if there is a more than a 10 percent change in three day average of COVID-19 hospitalized patients or 150 positive tests per day per 100,000 residents over the last seven days.
Hospital capacity is also a concern for state officials. Counties that have less than 20 percent of total Intensive Care Unit (ICU) beds available and less than 25 percent of total ventilators available will land them on the watch list.
“If the county has insufficient progress, on containing their disease transmission and hospitalization rates, a county should consider reinstituting sector limitations or more general stay-at-home provisions. If the county makes insufficient or no progress, the State Public Health Officer may take action,” reads state guidance material on county data monitoring.
Overall the state saw a rise of 6,367 new positive cases on June 29. California has experienced a 45 percent increase in positive cases in the last seven days. The positivity rate is currently at 5.5 percent in the last 14 days, a rise from 4.4 percent on June 15. The increase in the positivity rate raised concerns with state officials leading to this decision.
“California is using data and science to guide our response to COVID-19. We are actively monitoring COVID-19 across the state and working closely with counties where there are increased rates and concerning patterns of transmission,” said Dr. Sonia Angell, State Public Health Officer and Director of the California Department of Public Health in a released statement on June 28. “We all have our part in the fight against community spread of COVID 19. If you go out, then remember, wear a face covering, keep your distance, and wash your hands frequently.”
Stanislaus County flagged
Stanislaus County was flagged to be on the monitoring list due to an increased number of hospitalizations. The county has seen a rise from 44 hospitalizations on June 14 to 113 patients hospitalized on June 30. This has led to Stanislaus County having a hospitalization rate of 19.2 COVID-19 patients per 100,000 residents.
The county monitoring list identified drivers of the increase in hospitalizations in Stanislaus to include:
Increase in outbreaks and clusters related to family gatherings, business (in and out of county) and healthcare facilities.
The hospital being a regional hospital accepting patients that are residents outside the county.
Decreased attention to personal protection measures such as face coverings and social distancing.
The state recommended that the county take action to address concerns, including:
Prioritizing rapid contact tracing, isolation, and quarantine by public health staff for new positive cases.
Continual monitoring of tests being conducted in the county and relocating sites, when necessary, to more densely populated and higher incidence areas.
Continually offering businesses resources and technical assistance to comply with local requirements.
Closely monitoring healthcare facilities and continuing to provide infection preventionist expertise to assist SNFs with planning and response.
Retaining trained employees from other county departments to continue to assist in contact tracing.
Partnering with community-based organizations serving minorities for outreach, education, and mobile testing.
Increased messaging, including a public media campaign to promote face covering and social distancing.
Sectors targeted because of their high-risk environment
The sectors included in the new guidance released on July 1 are all considered to be high-risk areas of transmission by state officials.
“These sectors, foundationally, are settings where groups convene and may mix with others for prolonged periods of time often without a face covering. Additionally, physical movement within the establishment, duration of time spent in the establishment, and the degree of social mixing among individuals and groups outside one’s household are all significant in these sectors, which substantially elevates the risk of transmission even where face coverings can be worn. Furthermore, in some of these sectors centered on eating and drinking, compliance with face coverings is not possible for the full duration of time someone spends in these establishments,” stated a press release on Wednesday.
During a press conference on Monday, Gov. Newsom stated that local health officials have referenced bars as a potential hotspot for transmission of the coronavirus.
“Bars are social environments where groups of people mix. In these environments, alcohol consumption reduces inhibition and impairs judgment, leading to reduced compliance with recommended core personal protective measures, such as the mandatory use of face coverings and the practice of social and physical distancing. Bars are generally louder environments requiring raised voices leading to the greater projection of droplets,” stated a press release on Sunday. “These factors present a higher likelihood of transmission of COVID-19 within groups, between groups, and among the workforce. Public health professionals within California and throughout the nation have identified bars as the highest risk sector of non-essential businesses currently open. Beyond the higher risk of transmission in bar settings, contract tracing, a key measure needed to control spread, is also more challenging in bars because of the constant mixing among patrons and a lack of record-keeping of those in attendance.”
The state will continue to update and issue guidance as public health officials monitor COVID-19 data across California.