Another day, another reopening plan. After finally acknowledging that the summer push to get the economy going again amid the spread of the pandemic was a literal disaster and with cases across California finally starting to show consistent signs of retreat, the California governor released a new four-tiered system for assessing the risk level by county and standardizing what public spaces can be opened based on infection rate. The four new tiers are color coded from purple ( Tier 1 – widespread transmission) to yellow (Tier 4 – minimal transmission) and most of Southern California was promptly classified as Tier 1. As this new state-wide system is independent of and layered atop the existing color-coded but ill-defined Los Angeles County risk levels, we are now in the somewhat odd position of being told that our risk of contracting COVID-19 where we live is both “purple” and “orange”. That is definitely going to confuse people without a push to get the information distributed clearly and broadly.
There are some things about the new state tiers that are good. Counties previously had about six different metrics that could be used to certify “readiness” to reopen including hospital and ICU admissions, ventilator capacity, and the one that ended up being most problematic of all, a commitment to deploy certain numbers of contact tracers after reopening. Now the ability for counties to continually switch between metrics and put forward the most favorable and the “I’ll gladly pay you Tuesday for a hamburger today” strategy have been swept away. The new tier assignments are based on only two things: the daily new case rate per 100,000 people and the test positivity rate (of the total number of tests recorded in a day, how many of them were positive). Anything over 7 new cases per 100,000 per day and 8% test positivity places a county in the top tier.
A deliberate effort was also made to keep reopenings to a much more measured pace than the every-three-days of early summer. To move down a tier, a county must wait 21 days and must have maintained the new tier’s metric for 14 continuous days. For restaurants, the purple tier allows only outdoor dining, the red tier allows indoor dining at 25% capacity, orange allows 50% capacity, and yellow allows indoor operations at full capacity. Similarly, schools must operate only by distance learning in the purple tier and can begin to offer limited in-person instruction in the red tier and expand in-person instruction at the lower tiers, although how this will be implemented remains to be seen.
More problematic is that while the new system says that in the top tier, “most nonessential indoor business operations are closed”, the state is allowing the opening of all indoor hair salons (but not nail salons, and I’m not even going to try to figure out the state policy on waxing!) and all retail, including indoor shopping malls, at 25% capacity. This policy strongly suggests shopping is now considered “essential business” and I’m left wondering if one of the state advisors was the notorious Teen Talk Barbie of “Math is hard. Let’s go shopping!” fame.
While I am quite happy to support local retail and particularly local small business, there is one thing that is very, very conspicuously absent from this plan. Right now, cases are on a downward trend and this is a very good thing, but if California has finally moved out of its first wave, we cannot overlook the fact that public health officials are scrambling to prepare the state and the country for a horrific second wave this fall. Newsom’s new system is placing counties with decreasing case loads in the top tier and acknowledging that the risk is of catching COVID-19 is high in much of the state, but the plan has absolutely no provisions for any future lockdown measures to mitigate a sudden increase in cases. If there is another surge upward from this point, there is nowhere to go. It seems very much that when the second wave hits (and it will) that we could be in the strange situation of being told “shelter in place unless you really, really need to touch up those summer beach highlights or pick up some new seasonal throw pillows at Pottery Barn”.
And while we are pondering what happens when the second wave arrives, let’s stop for a minute to consider how we’re managing to beat COVID-19 back right now. The governor’s office hasn’t thrown around the words “science-led” as much recently, but good public health policy is grounded in a robust understanding of what factors increase or decrease transmission and we are still learning an incredible amount about this virus. We need to have a very good understanding of what is working so that we can do everything in our power to make sure it keeps working.
There is still a state-wide mask mandate for absolutely everywhere that is not inside your house. Wear a mask to Pottery Barn. Wear a mask to the grocery store. Wear a mask at the park. Wear a mask grabbing your newspaper from your driveway and giving a wave to your neighbor, Ed, who is watering his lawn. Masks reduce the transmission. We know they work. In the places that they are in widespread use, we are seeing them work and seeing cases fall.
There is also another unusual condition here in Southern California likely having a huge impact on COVID-19 transmission that we are only beginning to understand. I mentioned a couple weeks ago that this summer has been unusually humid here in Los Angeles, making outside activity in the heat fairly miserable for everyone who has built up a tolerance to years of dry heat. Now a growing body of research seems to point to a lower humidity significantly increasing the community spread of COVID-19. The latest published study from Australia estimates that a 10% drop in relative humidity can double transmission rates (and, math being what it is, that a 10% increase in relative humidity could then halve transmission rates).
The current theory is that when humidity is low, droplets containing virus particles evaporate quickly into smaller aerosols that are able to flow further through air movement instead of quickly dropping to the ground as the larger, wetter droplets do in more humid air. “How airborne is COVID-19?” is a debate that has been raging across the scientific community and the answers appear to be complex, but the effect of humidity on transmission could explain why countries in tropical regions such as Thailand and Vietnam have been able to more easily contain outbreaks. It also may be a very significant reason that Southern California has recorded consistently decreasing case numbers over a month of unusually high humidity with minimal other recent changes to our efforts to slow community spread.
While we are not likely to get the cold, rainy weather that forces people in other parts of the country indoors here in California for some months, September and October in this state are historically both the hottest and the driest months. This year that not only will bring higher wildfire risks to land that has already been burning for weeks, but as the humidity drops we need to be prepared for COVID-19 spread to swing back up again. While shopping might arguably be a personal choice, once we start reopening schools, as some districts are already pushing to do, we need to be very clear on what happens next should the disease surge again. Switching between distance learning and in-person instructions every one to three weeks will be more disastrous than even long-term distance learning and will completely hinder students’ efforts to effectively absorb any of the material they are taught.
We also need to recognize that, as much as businesses want to stay open, another major surge will put employees at serious risk and could force businesses to close due to a lack of staffing even if state regulations allow them to remain open. If we want to preserve our economy, we need to set aside funding to keep businesses afloat while they are closed, possibly for weeks at a time and to offer support to hourly-wage workers. Low-income employees both need a way to sustain themselves when they cannot unable to work and they need to know that their jobs will still be there for them once the disease recedes again.
As the weather shifts and as we move into autumn, not only is it important that we continue to diligently wear masks and wash hands, but it is important that we continue to strictly limit our time in public spaces to avoid spreading the virus and to give ample space to those people who MUST be out in public to do the work they need to. Those season throw pillows can wait. If you just desperately need to change something around you, see if your local business takes orders by internet or phone, offers curbside pickup or if they will mail your needed widget to your home. They probably do and they will be thrilled to help you with your order. When your widget ships, you can thank your mail carrier by setting out a bottle of water by the mailbox.
It’s going to be hot and dry and dangerous outside soon. I suspect we’ll be trapped in a purple haze for a long time.