Health

How California’s new COVID-19 rules will work


Gov. Gavin Newsom’s new regional stay-at-home order is similar to the original sweeping order issued in March, but is significantly limited in some ways.

All retail stores will be allowed to remain open, as will be outdoor spaces like parks and beaches.

The order prohibits gatherings and requires people to stay home and minimize their interactions with other households as much as possible. The practice of keeping people physically distant from one another interrupts the transmission of the virus.

Nearly 20,000 Californians have died after being infected with the coronavirus, responsible for the worst global pandemic in more than a century. State officials are forecasting that intensive care units will exceed capacity within weeks, which could worsen mortality in hospitals. Unless the current surge in cases is turned around, California’s death toll could double by the end of winter.

Here’s how the new order works.

When the stay-at-home order goes into effect

Where: A stay-at-home order would be implemented by region, triggered when the region’s intensive care unit capacity falls below 15%.

When: The order would go into effect 48 hours after a region hits the ICU capacity threshold.

What are the regions? There are five: Southern California, the San Joaquin Valley, the Bay Area, the Greater Sacramento area and rural Northern California.

Projections: None of these regions have met this threshold, but all are expected to meet it soon.

Four of the regions are expected to have less than 15% of ICU capacity by early December — Southern California, the San Joaquin Valley, the Greater Sacramento area and rural Northern California. The Bay Area is expected to hit that threshold in mid- to late December.

Here’s the current available ICU capacity by region, based on actual numbers, according to the California Health and Human Services Agency:

Bay Area: 25.4%
Greater Sacramento: 22%
Southern California: 20.6%
San Joaquin Valley: 19.7%
Rural Northern California: 18.6%

The percentages change daily as intensive care units admit and release patients, according to the agency.

What closes once a region hits this threshold

  • Outdoor restaurant dining
  • Hair salons, barbershops, nail salons and other personal care services
  • Playgrounds
  • Outdoor cardrooms and satellite wagering and casinos
  • Outdoor museums, zoos and aquariums
  • Outdoor movie theaters
  • Outdoor wineries
  • Overnight stays at campgrounds
  • Food, drink or alcohol sales at outdoor recreational facilities

Retail would stay open, but with more limited capacity

This is a major difference — all retail would be allowed to remain open under this stay-at-home order, although at a reduced capacity. Counties can impose tougher rules than the state’s.

  • Most of California: In much of the state, essential retail, like supermarkets and drug stores, were allowed to open at 50% of capacity; non-essential retail, like other stores and malls, opened at 25% capacity. The new order would lower capacity of all retail to 20%.
  • Los Angeles County: L.A. County on Monday already had tightened capacity limits at retail. When L.A. County falls into the scope of the new order, nonessential retail capacity limits would remain the same at 20%. Essential retail capacity would fall from 25% of capacity to 20%.
  • Santa Clara County: Whenever Santa Clara County falls into the scope of the new order, the home of Silicon Valley would see its own toughened capacity limits for essential stores go from 25% to 20%. Santa Clara County has an even tougher limit for nonessential retail, 10%, that would remain in place.

Shopping centers would also be capped at 20% of capacity. Eating and drinking in stores would be prohibited and someone would need to be stationed at the entrance to ensure the capacity limit is not exceeded. Special hours should be imposed for seniors or those with compromised immune systems.

Travel and use of hotels and lodging for tourism and leisure prohibited

After the first statewide stay-at-home order imposed in the spring, California allowed counties to reopen hotels for tourism and individual travel in June.

The new regional stay-at-home order, when effective, again prohibits hotel use for tourism, leisure and other nonessential reasons, like nonessential travel, whether it be a vacation or a road trip to see family or friends.

Specifically, it allows hotel and lodging for essential reasons only, defined as supporting “critical infrastructure sectors,” which includes a category of designated essential sectors, including workers in healthcare, food, agriculture, energy, utilities, transportation, communications, government operations, manufacturing, financial services and the entertainment industry.

The order would prohibit nonessential travel.

What stays open

  • Entertainment production
  • Professional sports without live audiences, except for Santa Clara County, which has its own order banning contact sports, which has forced the San Francisco 49ers to temporarily relocate to Arizona for its December home games
  • Schools that are already open for in-person learning can remain open
  • Outdoor areas like beaches, parks, and hiking trails
  • Dentist offices
  • Medical offices
  • Childcare and prekindergarten
  • Restaurants for takeout and delivery service
  • Critical infrastructure sectors

How long do regions stay under the order?


Regions stay under the order for at least three weeks.

To be released, the region must have its area’s forecasted ICU capacity for the next four weeks reach 15% or greater.

The counties then return to the existing reopening tier system, determined by the coronavirus case rate and test positivity rate, to determine what industries can reopen.

Officials can make forecasts on ICU capacity because they know that on average, about 12% of people who test positive for the coronavirus will need hospitalization two weeks after they receive their positive test result, a portion of whom will need to be transferred to the intensive care unit about a week or 10 days after admission.

What’s the state’s rationale?

The explosion of cases and hospitalizations in recent weeks could overwhelm the state’s intensive care units. Average daily case rates and hospitalizations have tripled over the last month, and an average of 67 Californians were dying daily from COVID-19 over the last week, a 60% jump from mid-November.

Should ICUs become overwhelmed, mortality is certain to skyrocket, experts say, with nurses and doctors suddenly responsible for more critically ill patients than they can handle. Some critically ill patients would have to be moved to parts of the hospital not designed to handle such patients. And physicians warn that there are only so many doctors, nurses and other providers who are highly trained in providing intensive care.

“We know that by reducing our overall movement and mixing for a short period of time, we can get the gains that we need to bend this curve … and save lives now,” said Dr. Mark Ghaly, the California Health and Human Services secretary.

Ghaly noted that Europe has been successful recently in reimposing stricter stay-at-home orders and driving down the spread of the virus, after incremental approaches, while less economically harmful, proved ineffective.

How will it be enforced?

Realistically, the order will work only if most Californians comply. The order won’t work if Californians collective decide to defy it.

Newsom said he’s seen support for enforcing the order from a number of local officials, although he acknowledged that some officials have said they’re not planning to enforce the rules. Newsom said among counties unwilling to enforce rules or adopt measures to reduce the spread of disease, he plans to withhold funding set aside to address the pandemic.

Newsom said state agencies are also able to enforce the order, such as through the Department of Alcoholic Beverage Control, which regulates alcohol licenses.

What about travel?


California issued a travel advisory last month that urged against nonessential out-of state trips and asked people to quarantine for 14 days after arriving from another state or country.

Now that the regional stay-at-home order is expected to be in place soon, “we’re asking people then to consider canceling their travel plans now,” Ghaly said.

Once the order goes into effect, the state is asking people to stay at home and not mix and move around. Part of the recent surge in California, Ghaly said, was caused by travelers coming to California from other areas.

“All nonessential travel we are ordering to be temporarily restricted,” Newsom said.

The directive to cancel nonessential travel plans is a requirement, not an advisory. The requirement really isn’t enforceable, but Ghaly said he hoped that labeling it a requirement would encourage compliance.

Why use a regional approach?


The regional approach is being used because that’s how hospitals and healthcare delivery systems work when some hospitals reach capacity, Ghaly said. When one county is full, it leans on a nearby county for help.

Rural Northern California: Del Norte, Glenn, Humboldt, Lake, Lassen, Mendocino, Modoc, Shasta, Siskiyou, Tehama, Trinity

Bay Area: Alameda, Contra Costa, Marin, Monterey, Napa, San Francisco, San Mateo, Santa Clara, Santa Cruz, Solano, Sonoma

Greater Sacramento: Alpine, Amador, Butte, Colusa, El Dorado, Nevada, Placer, Plumas, Sacramento, Sierra, Sutter, Yolo, Yuba

San Joaquin Valley: Calaveras, Fresno, Kern, Kings, Madera, Mariposa, Merced, San Benito, San Joaquin, Stanislaus, Tulare, Tuolumne

Southern California: Imperial, Inyo, Los Angeles, Mono, Orange, Riverside, San Bernardino, San Diego, San Luis Obispo, Santa Barbara, Ventura




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