OAKLAND, Calif. — California has launched the nation’s first mandate on reopening that requires local officials to control the coronavirus in their most impoverished communities before easing business restrictions across their entire county.
The approach is aimed at tackling a persistent inequity in California, where low-income people of color have disproportionately struggled to avoid contracting the disease.
"If you believe in growth and you don’t believe in inclusion, then we’re going to leave a lot of people behind," Gov. Gavin Newsom said this week. "And one of the things we value as a state is inclusion, and we believe that we’re all better off when we’re all better off."
The Covid-19 pandemic has laid stark the health disparities that have long existed, with poor, Black, Latino, Pacific Islander and Native communities being hardest hit by the pandemic. Latinos, for example, make up about 40 percent of the state’s population, but account for more than 60 percent of coronavirus cases and half the deaths.
California’s "equity metric" attempts to tackle that disparity by requiring that the 35 largest counties invest more in testing and ensure that positive rates of infection in the most disadvantaged neighborhoods come close to meeting the county’s overall positivity rate. The rule ensures that restaurants in Beverly Hills can’t resume indoor dining unless the most impoverished census tracts also show low rates of infection.
The change adds a third metric to the state’s newest reopening structure, which Newsom unveiled in late August and billed as an improvement to the previous approach that has been blamed for the state’s summer infection surge. Before now, the new structure has relied only on a county’s overall positivity mark and the rate of new infections.
The equity move could prompt counties to expand testing in low-income neighborhoods and provide tests to anyone who fears they have been exposed, not just those who show symptoms. That may allow such communities to more quickly isolate patients, especially those who are asymptomatic.
The metric uses the California Healthy Places Index to identify the lowest, most disadvantaged quartile in the larger counties’ census tracts. The smallest 23 counties are exempt — with populations of 106,000 or below — but still have to provide the state with an equity plan for their most vulnerable populations.
Orange County Supervisor Don Wagner, a former Republican state lawmaker who has been critical of Newsom’s restrictions, called the new measure “virtue signaling” on the part of the Democratic governor. He also described it as another example of “moving the goal posts,” potentially delaying further business reopenings.
“Even if you meet others but don’t meet the equity one, you’re stuck,” Wagner said.
Tuesday marked the first state update to county tiers since the equity metric was quietly rolled out last week. There remained plenty of confusion and mystery around how it might impact county status, but its debut mostly had no effect in the first go-around.
The state has used four colors to indicate levels of closures in counties. From most restrictive to least, they are purple, red, orange and yellow — mirroring the colors used for air quality. There is no green tier.
Measured only on the equity front, three counties — Fresno, Sonoma and San Bernardino — fell in the purple tier, 13 in red, 15 in orange and four in yellow.
Los Angeles County Public Health Officer Barbara Ferrer said that the new metric may actually help advance the state’s largest county, which has stubbornly remained in the purple tier due to high case counts.
That’s because the equity rule has a wrinkle that rewards counties that dramatically lower their positive test rates overall and in low socioeconomic neighborhoods. If a county can drive down those positivity rates to levels two tiers below, it can move forward one tier. The caveat is that case rates still have to be going down, not up.
Ferrer called it a "complicated algorithm," but said it could make the difference for a county like Los Angeles. The county’s high rate of testing and focus on poorer communities has given it an overall positivity rate of 2.8 percent, below most heavily populated counties in the state. Los Angeles also has a 4.4 percent positivity rate in tracts in the lowest quartile. Both rates are two tiers below the county’s current purple status.
“All of the work that everyone is doing so hard to really focus on the disproportionality and eliminate it, I think is helping us both to reduce transmission but, in this case, also offers us the ability to move to another tier,” Ferrer said during a press briefing Monday.
Los Angeles, however, still needs to reduce its case rate, which stands at 7.4 per 100,000 residents.
Humboldt County was the first county allowed to advance on the basis of low positivity rates both overall and in their lowest quartile communities. It moved to the yellow tier Tuesday despite a case rate hovering just outside the yellow threshold.
The potential benefit of the new metric is no surprise to Kiran Savage-Sangwan, executive director of the California Pan-Ethnic Health Network. She said the metric is designed to encourage more testing.
“I don’t think anyone will be hurt by this metric. Really it’s going to help us better control the spread of the virus,” she said. “By putting the focus of the resources and investments where they needed to be, it is benefiting the counties.”
Some counties could be held back due to significant disparities between their underprivileged communities and their overall rates, based on the first round of underlying data released Tuesday.
The state’s second largest county, San Diego, has an overall positivity rate of 3.5 percent — good enough for the less restrictive orange tier — but a 6.2 percent positivity rate in its lowest quartile of census tracts. The county’s overall case rate isn’t good enough to move to orange, but if it were, the county could be restricted from moving forward. Other large counties with similar disparities include Contra Costa, Fresno, Orange and Santa Barbara.
The new rule has drawn a backlash from Assemblymember Kevin Kiley (R-Rocklin), who labeled it as "a phony notion of ‘equity’ invented by the government." In response, Kiley and Sen. Brian Dahle (R-Bieber), along with two local leaders, proposed a different rule change Tuesday that would allow businesses to reopen if their ZIP code has low infection rates. They singled out the affluent Sacramento County city of Folsom as one that should reopen ahead of the county at large and pointed out that a neighboring upper-income community across the county border has long enjoyed fewer restrictions.
In effect, their proposal would seemingly move in the opposite direction from Newsom’s equity metric by enabling neighborhoods to advance if they have few infections, regardless of how the disease is spreading elsewhere in the county.
San Diego County Supervisor Jim Desmond, who has been critical of Newsom’s reopening plans, said he’s still unclear about details of the equity metric, but had been assured by his county health officials that it was unlikely to negatively affect the county. “If this helps the community get better and healthier, that’s the right thing to do,” he said.
In Santa Clara County, which is poised to move from red to orange as soon as next week, Deputy County Executive David Campos thinks the measure isn’t going to make or break the county. The county has a lowest quartile positivity rate of 3.7 percent, while its overall positivity rate is an even lower 1.8 percent, according to new state data.
Campos commended the state for trying to address these inequities.
“It’s not going to keep us from moving because we have made a lot of progress. For us, the rates are commensurate with where we are in orange, but it hasn’t been easy to get to that point,” he said. “It really reaffirms what we were doing to begin with, and to see the state seeing this is a priority … it’s the right thing to do.”