Governor Gavin Newsom unveiled the Blueprint for a Safer Economy, a statewide, stringent and slow plan for living with COVID-19 for the long haul. The plan imposes risk-based criteria on tightening and loosening COVID-19 allowable activities and expands the length of time between changes to assess how any movement affects the trajectory of the disease.

The Blueprint builds on lessons learned from the first six months of the disease – and the new scientific understanding that has been collected – to create a new system for regulating movement and COVID-19 transmissions. It includes:

– At least 21 days to expand activities beyond the initial tier to ensure California better limits the spread of the virus;

– Mandatory metrics – case rates and test positivity – to measure how widespread COVID-19 is in each county and guide what is allowed;

– A uniform state framework, with four categories instead of 58 different sets of rules;

– A more nuanced way of allowing activity: Instead of open vs. closed, sectors can be partially opened and progressively add to their operations as disease transmission decreases; and

– A new process for tightening back up again quickly when conditions worsen.

In an effort to reduce COVID-19 transmission across all of California’s communities, from October 6, 2020, the more populous counties will need to meet a health equity metric in order to further open their economies.

To advance to the next less restrictive tier in the state’s COVID-19 Tier Framework, a county, depending on its size, will need to meet an equity metric and/or show plans for targeted investments to eliminate neighborhood disparities in levels of COVID-19 transmission. Those investments can include spending on augmenting testing, disease investigation, contact tracing, isolation/quarantine support, and education and outreach efforts for workers.

The health equity metric will apply to the 35 counties with populations greater than 106,000. The remaining 23 counties are excluded from meeting the equity metric, but must demonstrate the targeted investments.

The plan also emphasizes that no matter what restrictions the state puts in place, COVID-19 will get the upper hand if Californians don’t adapt their behaviors for the duration of the pandemic.

That means, until an effective vaccine is distributed, Californians must wear a mask every time they’re with people outside their household. Residents must take activities outside and maintain distance even with loved ones who do not live with them. Californians must realize that the safest place to be is still at home. And the elderly and those with medical conditions should still stay away from others as much as possible.

Focus on Equity

According to information gathered by public health officials, the pandemic has had a disproportionate impact on certain communities—such as low-income, Black, Latino, Pacific Islander, and essential workers—reflected in higher rates of COVID-19 infection, hospitalizations, and deaths. These disparities, the California Department of Public Health (CDPH) states, create a public health imperative to address exposure in all communities, including especially those disproportionately affected, as a means to protect all communities.

The Blueprint for a Safer Economy relies on two measures—case rate and test positivity—to determine when a county can move to a less restrictive tier with more sector openings and resultant increased interaction among residents. In order to avoid a surge of infections, the level of baseline infection in a community should be progressively lower as there is more movement and mixing.

Beginning October 6, the health equity metric will be an additional factor in determining the tiers of the more populous counties to ensure test positivity rates in disadvantaged neighborhoods don’t fall significantly behind the overall county test positivity rate.

According to the CDPH, most counties have significant differences in test positivity among more and less advantaged neighborhoods, with these differences often also overlapping with race and likelihood of employment as essential workers.

Especially as counties move into less restrictive tiers with more movement, the importance of this differential prevalence of infection grows because mixing and opportunities for transmission increase. Therefore, it is imperative to reduce disease transmission in all communities to ensure California reopens its economy safely.