Updated Dec. 11
Correction: Some "limited services" businesses listed as "critical infrastructure" by the state can remain open. See a list of what businesses can remain open here.
California announced a new regional stay-at-home order based on capacity at hospital intensive care units starting Dec. 5.
As of Dec. 18, the Greater Sacramento, San Joaquin Valley, Bay Area and Southern California regions are under the order (see a map of regions here).
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’t act now, our hospital system will be overwhelmed," Newsom said. "If we don’t act now, we’ll continue to see a death rate climb, more lives lost."
While the order limits what businesses and activities can remain open (see a full list here), 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 new regional stay-at-home order took 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.
Yolo County and five Bay Area Counties voluntarily implemented new restrictions before the order went into effect.
Residents in counties affected by the order can still go to the doctor, buy groceries, go on a hike or worship outdoors. Outdoor playgrounds are open as of Dec. 9. K-12 schools that are already open can continue operating indoors.
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.
Some businesses called "limited services" by the state can stay open with modifications, including laundromats, dry cleaners, auto repair shops, landscapers, residential and janitorial cleaning services, HVAC services, appliance repair, electricians, plumbers, mechanical tradespersons, Handypersons and general contractors. See a full list here by searching for your county here.
The order ends all operations at the following businesses (except when they are included in the state's list of "critical infrastructure"):
- Indoor playgrounds
- Indoor recreational facilities
- Hair salons and barbershops
- Personal care services such as nail salons, tattoo parlors and body waxing
- Museums, zoos, and aquariums
- Movie theaters
- Bars, breweries, and distilleries
- Family entertainment centers
- Cardrooms and satellite wagering
- Some limited services, such as car washes, door-to-door services and sales, pet grooming and dog walking (see a full list by searching for your county here).
- Live audience sports
- Amusement parks
Each of California’s 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 the 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.
How can I find out the ICU capacity for my region?
The state has a map showing information on ICU capacity by region here. 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.
How does a 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’s 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 state’s tiered system, 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’s 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’s 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.
“If you don’t have the staff to staff the bed, having the mattress and the pillow doesn’t do you a lot of good,” she said. “The 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.”
California requires specific provider-to-patient ratios in intensive care units. The California Hospital Association has been pushing for more flexibility on those ratios.
Will this be enforced?
Like other COVID-19 restrictions, the state is leaning heavily on local police and sheriffs’ 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 “be punitive, but firm” in enforcing COVID-19 restrictions. For those who don’t enforce, he said federal coronavirus dollars the state received and sent to various counties could be reallocated.
“If you’re unwilling to enforce the rules, if you’re unwilling to adopt the protocols to support the mitigation and the reduction of the spread of this disease, we’re happy to redirect those dollars to counties that feel differently,” Newsom said.
In Sacramento County, Sheriff Scott Jones, who recently announced that he tested positive for COVID-19, has repeatedly said that his deputies would not enforce restrictions, but instead educate people not obeying the orders. Other local police sheriffs’ departments have largely echoed those sentiments.
Earlier this year, Jones committed to breaking up social gatherings 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’s payroll. In turn, the same amount of money was made available in the county’s general relief fund, which could be spent more freely.
Why does this plan divide California up into regions?
California’s top health official Dr. Mark Ghaly says the state is taking a regional approach because that’s how hospital systems work.
"When capacity can’t 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 “abide by these new regional stay-at-home orders to get us through the next month, maybe month and a half, or two months” 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 “curtailing access to public spaces is going to be very helpful to curtailing COVID-19.”
“Earlier in the year in March and April, adherence to the home guidelines was really essential in keeping the spread of the virus down,” Induni said of California’s 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.
“It can be more nuanced, it doesn’t have to be quite as draconian," Rutherford said. "But people have to abide by it. If they’re in one of these regions, they’re gonna have to stay home, they're gonna have to limit their social interaction and really hunker down.”
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.
Correction: A previous version of this story incorrectly stated the status of schools under the new order. K-12 schools that are already open can continue operating indoors with no capacity restrictions.
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