May 4, 2020

The Governor announced today that the state would be moving into Stage 2 this Friday – for counties that can attest to their readiness to do so.

With the state’s COVID-19 readiness “report card” in good shape – conducting 30,000 tests daily, millions of N-95 masks on the way, more than 2,000 hospital beds available, and 10,000 ventilators at the ready – and significant pressure from local government building by the hour, Governor Newsom released a new Executive Order loosening his statewide stay-at-home order and promised new guidance on Thursday. 

CSAC applauds the Governor for recognizing the role of counties and providing a clear path forward our members that are not only willing, but also ready, to reopen. With clear public health parameters and reliance on data, this new phase balances the safety of the public with the need for the resumption of local economic activity.  

Characterized as a “soft opening” for Stage 2, the new guidance will require counties to develop a self-evaluation, needs assessment, and containment plan before proceeding further into Stage 2. The evaluation must include an attestation of readiness and ability to mitigate the spread of COVID-19 by the local health officer, and be approved by the Board of Supervisors. More detail on how exactly Boards must act will be released with further guidance on Thursday.

Counties with low cases, deaths, and high readiness – all parameters to be determined with guidance on Thursday – may “accelerate” through stage 2 at own pace with:

• An attestation by the county that they are ready to proceed through Stage 2.
• County submits self-evaluation and containment plan to CDPH with attestation that the county has met specified parameters to mitigate the spread of COVID-19.
• Plan must be developed in consultation with local or regional hospitals and health systems and community stakeholders.

The plans address five major elements, including: prevalence of coronavirus, adequate testing (at least 1 test per 1,000 people), health care capacity, how to care for vulnerable populations – especially those in congregate care settings such as elder care homes, shelters, and jails – and a detailed containment plan if COVID-19 cases should spike. Then finalized plans would be submitted to the California Department of Public Health. Here is more detail on the five elements – but please note that all of this information is pending confirmation through state guidance slated for Thursday:
  
ATTESTATIONS

• Must include all five elements: prevalence, testing, health care, vulnerable populations, containment plan.
• Written and signed by Local Health Officer
• “Approved” by the Board of Supervisors (unclear if approve or ratify – seeking more detail)
• Must be posted on public county website
• Submitted to CDPH  (review process is unclear)

PREVALENCE

• County must provide data from the last 14 days on the number of positive cases and hospitalizations; numbers need to be flat or declining
• Testing results need to show a less than 10% rise in cases over the last 14 days

TESTING

• Must show testing capacity of 1 test performed per 1,000 residents and ability to get to 2 tests performed per 1,000 within 2 months (July 1)
• Testing must be accessible: within 30 minutes travel time for urban areas; within 60 minutes travel time for rural areas
• County must prove or request containment capacity with contact tracing resources able to cover three times the number of  positive cases in the preceding 7 days (assumes 10 contacts per positive case)
• Must have plan to isolate positive cases and help special populations such as homeless
• Must have ability to issue and enforce isolation and/or quarantine orders within 24 hours of identified case

HEALTH CARE

• County must work with local or regional hospitals and health systems to ensure they can accommodate a 25% surge of patients and develop surge plans

VULNERABLE POPULATIONS

• County must demonstrate continued protections for vulnerable populations
• County must assess skilled nursing facilities, elder care facilities, jails, and other congregate care sites and ensure they have a 14-day supply of PPE. (PPE can be obtained through OES, MHOAC, by each site independently, or a mix)
• County must demonstrate cluster testing capacity sufficient for outbreaks at congregate care sites and jails, shelters, etc.

CONTAINMENT PLAN   
The county must include within the containment plan:

• Plan to increase testing
• Specimen collection and locations
• Lab readiness (includes all lab capacity)
• Community surveillance capacity and data
• Contact tracing: Does the county have enough workforce? Do they have language and cultural competency?
• How will the county handle an increase in cases?
• How will the county isolate low-income or unhoused cases?
• County must assess congregate care site readiness – can the site test and isolate properly?
• Care surge: can the county accurately track daily capacity? Also need to develop containment plans for workplaces and essential businesses
• Does the county need PPE from state or can county/site secure from other sources (or a mix of both)?
• Assess relationship with surrounding counties, including regional case rates, readiness, ability to accelerate, ability to handle non-residents/tourists.

BUSINESSES

For businesses within counties that demonstrate readiness, the Governor’s new executive order would allow certain retail businesses and associated supply chains with clear safety measures to open again for curbside pickup only. This includes florists, clothing stores, booksellers, home goods stores, sporting equipment stores, etc.
 
Dine-in restaurants, offices, and personal care services are not included in this initial Stage 2 soft opening. The rule of thumb is that only businesses that can limit the amount of interaction time may open.
 
A county may choose to review all business safety plans or simply employ spot enforcement as needed. A county may also continue to enforce a more strict health order as determined by the data and the local public health officer. 
 
Details:

• Not all businesses will open
• Includes expanded retail and associated supply chains and logistics with curbside pickup ONLY (no one allowed in stores)
• Includes drive-in religious services, other religious community services – serving curbside meals, food pantry, etc.
• DOES NOT include dine-in for restaurants (that would be Stage 3, along with personal care services)
• All businesses would need to develop risk assessment and site plan, along with capacity for continuous risk evaluation. Guidance provided by state (possibly a checklist for businesses)
• The business plan is a prerequisite for any business to open
• Plans could be reviewed by local public health, but not required to review. State will not participate in business review process.