Confusion and questions continue to swirl around California’s new tiered coronavirus monitoring system, just as concerns about the actual case rate in Orange County also mount. 

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Over the weekend, OC Health Care Agency officials had to walk back an advisement to schools that they could reopen by Sept. 8.

New guidelines, released Friday, allow for malls and barbers to resume indoor operations, but still prohibit indoor operations at movie theaters, restaurants, bowling alleys, convention halls and theme parks. Most business reopenings will have to limit the number of people inside and most retailers remain open. 

The state’s new guidelines also halt schools from reopening classrooms for counties in Tier One, except for elementary schools that go through the state’s waiver process. 

OC is in Tier One, despite the state’s own metrics showing the county is below the thresholds and is eligible to move to Tier Two. 

Tier One basically means OC is back on the old state virus watchlist. 

The county’s Health Care Agency seems unclear if all schools can begin reopening soon. 

Under the old guidelines, all of OC schools could begin reopening by Sept. 8, after the county was off the old watchlist for two weeks. 

“I confirmed with the State that has not changed for OC except for the update in the new blueprint usually occurs on Monday and the State posts on Tuesday, so the school reopening would be Tuesday, September 8, right after Labor Day weekend.” county health officer Dr. Clayton Chau Tweeted Friday, through the Health Care Agency’s account

But state guidelines seem to indicate otherwise. 

“Schools are eligible for reopening fully for in-person instruction following California School Sector Specific Guidelines once the county is off Tier 1 for 14 days, which is similar to being off the County Data Monitoring List for at least 14 days,” reads the guidelines. 

Now school reopenings are unclear.  

“We’ve requested additional clarification from State re: schools as there are several counties, including #OC, who are in limbo as we were part way thru prior 14 day cycle to re-open. State indicated we would get credit for those days. More to come,” Chau said in a Saturday Tweet. 

State public health officials didn’t answer questions about the issue before publication Monday. 

The issue doesn’t affect elementary schools applying for a classroom reopening waiver, which state health officials ultimately grant. 

So far, 70 elementary schools have been granted the waiver. The majority are private schools, except for Los Alamitos School District, which can open six of its elementary schools. 

Meanwhile, questions surrounding the new metrics are being raised. 

State guidelines note that public health officials will examine case rates and the number of infected people per 100,000 residents in a week-long timeframe, using a seven-day lag to account for delays in test reporting. 

For example, if health officials were to calculate the rates for Monday, the week-long window would start last Sunday, Aug. 23.  

One local college chemistry professor contacted Voice of OC over the weekend and found over 40 percent of the confirmed virus cases reported last week fell outside the two-week window. 

The professor, who spoke anonymously because they feared retaliation, said the percentage of reported tests that are older than two weeks fluctuates daily and that’s why they analyzed the week instead. 

UC Irvine epidemiologist and public health expert, Andrew Noymer, said using the seven-day lag makes sense to account for testing delays. 

“The lag should be calibrated sort of realistically based upon what the real testing lag is. To the extent which I have any concern is that we may be missing cases because the lags are still beyond 14-days,” Noymer said in a Monday phone interview. 

But, he said, the lag means nothing if the test reporting delays are too long. 

“Anything that comes in older than 14 days will just be forever missed in this calculus and I’m just not sure where the rubber meets the road — if all the tests are making it into the database,” Noymer said. “We need to get these test results as rapidly as possible so people can act on them and the state can act on them.” 

The new guidelines don’t give a specific formula on how to calculate the testing positivity rates, either.

The old guidelines did. 

The new guidelines also have a provision that will lower case rates if a county tests over the state’s required 150 people per 100,000 residents. 

It’s unknown how much — or if — state health officials will lower rates, which could potentially move OC from Tier One to Tier Two, allowing for some more business reopenings. The county had been averaging about 180 tests per 100,000 people. 

“Case rate will be determined using confirmed (by PCR) cases, and will not include state and federal inmate cases. Case rates include an adjustment factor for counties that are testing above the state average. The incidence is adjusted downwards in a graduated fashion, with a maximum adjustment at twice the State average testing rate,” state the guidelines. 

State officials are expected to update the new system every Tuesday, beginning Sept. 8. 

If OC does move into Tier 2, churches, gyms, restaurants and movie theaters can resume indoor operations. The guidelines call for limiting the number of people indoors by putting capacity limits on certain business sectors. 

Since the pandemic began in March, the virus has killed 980 OC residents out of 48,538 confirmed cases, according to the county Health Care Agency.

OC coronavirus death rates continued to climb this month, reaching their highest levels yet of the pandemic. The two weeks leading up to Aug. 27 were the deadliest so far, with 178 deaths in that two-week period. 

Public health officials often use a two-week death total or average because it can take two weeks for deaths to be entered into official data systems. They have also noted that rises and falls in deaths lag behind trends in cases and hospitalizations.

For context, Orange County has averaged around 20,000 deaths a year since 2016, according to state health data. According to those same statistics, the flu kills about 543 OC residents annually.   

As of Monday, 317 people were hospitalized for the virus, including 98 in intensive care units. 

Nearly 651,000 tests have been conducted throughout OC, which is home to roughly 3.2 million people. 

Noymer said the new tiered system is better, despite some initial concerns. 

“I think the four-tiered, color-coded system is a step in the right direction of clarity and risk communication,” I think there was a lot of discussion about Orange County being on or off the watchlist and some people interrupted that to mean everything was hunky dory,” Noymer said. 

“There’s a bit of confusion this week, but in the long run it will become a lot clearer exactly how the statistics are calculated. It’s a step in the right direction and unfortunately we find ourselves purple at the moment.” 

Spencer Custodio is a Voice of OC staff reporter. You can reach him at Follow him on Twitter @SpencerCustodio

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