California announced on Thursday a based on capacity at hospital intensive care units. While no regions currently meet the criteria to trigger the order, Gov. Gavin Newsom said some could fall under the restrictions in the coming days or weeks.
With more Californians currently hospitalized for coronavirus than at any other time during the pandemic, Newsom said the new orders were designed to try and slow the spread of COVID-19 and limit the load on health care workers.
"The bottom line is, if we don鈥檛 act now, our hospital system will be overwhelmed," Newsom said. "If we don鈥檛 act now, we鈥檒l continue to see a death rate climb, more lives lost."
While the order limits what businesses and activities can remain open, similar to the March stay-at-home order, state Health and Human Services Secretary Dr. Mark Ghaly said the virus is more widespread than it was early on.
"Today's message is not about how we mix safely," Ghaly said. "It's about how we reduce our mixing altogether."
Here's a look at what the order covers, how a region or county can trigger or leave it, and why state officials say they are doing this now to slow the current COVID-19 surge.
When does the order take effect?
The takes effect at 12:59 p.m. on Saturday, Dec. 5. Starting then, if a region's ICU capacity falls below 15%, it will have 24 hours to implement the stay-at-home order.
How do I find out what region I'm in?
Each of California鈥檚 58 counties is in one of five regions.
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
What triggers new restrictions for a region?
A region falls under the stay-at-home order when its ICU capacity drops below 15%. Once that happens, a region has 24 hours before the order goes into effect. None of the five regions designated by the state currently meet that criteria, but some are expected to as early as this week.
How does the county get out of the restrictions?
Regions will have to remain under the stay-at-home order for at least three weeks before being considered to reopen. In order to get out of the restrictions, a county鈥檚 projected ICU capacity for the following four weeks must be at or above 15%.
Once a county is no longer under those restrictions, they will return to the , based on its case and test positivity rates.
What does 'ICU capacity' mean?
ICU capacity refers to the percentage of beds that are staffed, licensed and available in a hospital鈥檚 intensive care unit. In a hospital that has 15% of its capacity remaining, 85% of ICU beds are occupied.
In order for an ICU bed to be considered when measuring capacity, the hospital must have enough staff to treat a patient in that bed, according to the California Department of Public Health. The capacity determination is also based on the number of coronavirus and non-coronavirus patients expected to enter the hospital鈥檚 ICU.
Hospitals can always set up more beds, but California Hospital Association spokesperson Jan Emerson-Shea says they need appropriately trained staff to treat the patients in them.
鈥淚f you don鈥檛 have the staff to staff the bed, having the mattress and the pillow doesn鈥檛 do you a lot of good,鈥� she said. 鈥淭he staffing is what really is keeping us awake at night. If we get the surge that the state is projecting, we will be really stretched from a staffing perspective.鈥�
California requires in intensive care units. The California Hospital Association has been pushing for more flexibility on those ratios.
How can I find out the ICU capacity for my region?
The state has a map showing . According to officials with the state鈥檚 health and human services department, ICU capacity for the five regions as of Dec. 3 are:
Bay Area: 25.4%
Greater Sacramento: 22%
Northern California: 18.6%
San Joaquin Valley: 19.7%
Southern California: 20.6%
Keep in mind, those numbers fluctuate daily as ICUs admit and release patients. Updated numbers will be released daily by the California Department of Public Health.
What businesses will close? What will stay open?
Residents in counties affected by the order can still go to the doctor, buy groceries, go on a hike or worship outdoors. K-12 schools that are already open can continue operating indoors as no more than 20% capacity.
Retail stores and shopping centers are permitted to remain open indoors at 20% capacity, and restaurants can stay open for takeout only. Outdoor recreation facilities can also stay open with modifications, and entertainment production, including professional sports, can operate without a live audience.
The order ends all operations at the following businesses:
- Indoor and Outdoor Playgrounds
- Indoor Recreational Facilities
- Hair Salons and Barbershops
- Personal Care Services
- Museums, Zoos, and Aquariums
- Movie Theaters
- Wineries
- Bars, Breweries, and Distilleries
- Family Entertainment Centers
- Cardrooms and Satellite Wagering
- Casinos
- Limited Services
- Live Audience Sports
- Amusement Parks
Will this be enforced?
Like other COVID-19 restrictions, the state is leaning heavily on local police and sheriffs鈥� departments to enforce the stay-at-home order. That means enforcement will vary depending on city, county and region.
Newsom said his administration has worked with its county partners in order to not 鈥渂e punitive, but firm鈥� in enforcing COVID-19 restrictions. For those who don鈥檛 enforce, he said federal coronavirus dollars the state received and sent to various counties could be reallocated.
鈥淚f you鈥檙e unwilling to enforce the rules, if you鈥檙e unwilling to adopt the protocols to support the mitigation and the reduction of the spread of this disease, we鈥檙e happy to redirect those dollars to counties that feel differently,鈥� Newsom said.
In Sacramento County, Sheriff Scott Jones, who recently announced that he , has repeatedly said that his deputies would not enforce restrictions, but instead educate people not obeying the orders. Other local police sheriffs鈥� departments have largely echoed those sentiments.
Earlier this year, that violated public health restrictions when his department sought over $100 million from the county in federal coronavirus relief funds.
The county awarded the money to cover the office鈥檚 payroll. In turn, the same amount of money was made available in the county鈥檚 general relief fund, which could be spent more freely.
Why does this plan divide California up into regions?
California鈥檚 top health official Dr. Mark Ghaly says the state is taking a regional approach because that鈥檚 how hospital systems work.
"When capacity can鈥檛 be met within a specific county, we lean on neighboring counties and their hospital delivery systems to care for a number of individuals," Ghaly said.
When does the stay-at-home order end?
The order will remain in effect for at least three weeks, but the state could determine at any time whether it will be longer. When announcing the order, Newsom said people will have to 鈥渁bide by these new regional stay-at-home orders to get us through the next month, maybe month and a half, or two months鈥� when vaccines are readily available.
Do stay-at-home orders work to stop the spread of COVID-19?
The order cannot stop the spread of COVID-19, but it can help slow the spread of the virus.
Marta Induni, the senior director of research for Public Health Institute, an Oakland-based nonprofit focused on health equity, said 鈥渃urtailing access to public spaces is going to be very helpful to curtailing COVID-19.鈥�
鈥淓arlier in the year in March and April, adherence to the home guidelines was really essential in keeping the spread of the virus down,鈥� Induni said of California鈥檚 first stay-at-home order.
According to a review by the Centers for Disease Control and Prevention of state and U.S. territory stay-at-home orders in March, those that initially implemented restrictions at the start of the pandemic mitigated the spread of the virus.
Other experts, like George Rutherford, an epidemiologist and biostatistician at University of California, San Francisco, say the effect of these types of orders is dependent on how many people actually avoid mixing with people outside their household.
鈥淚t can be more nuanced, it doesn鈥檛 have to be quite as draconian," Rutherford said. "But people have to abide by it. If they鈥檙e in one of these regions, they鈥檙e gonna have to stay home, they're gonna have to limit their social interaction and really hunker down.鈥�
Why was this plan announced now?
Currently, California hospitals are admitting more COVID-19 positive patients than at any other time during the pandemic. Newsom said the new orders were designed to try and slow the spread of COVID-19 and limit the load on health care workers as the country awaits a vaccine.
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