As summarized in a previous GT blog post, California’s Blueprint for a Safer Economy established criteria for easing and tightening restrictions on the activities of California residents and businesses based on counties’ Coronavirus Disease 2019 (COVID-19) infection rates. When the system took effect initially on Aug. 31, the state assigned each county one of four color-coded tiers – Widespread (purple), Substantial (red), Moderate (orange), or Minimal (yellow) – based on two factors: average daily case rate and test positivity rate. To move into a less restrictive tier, a county must meet the criteria for the less restrictive tier for the previous two weeks.

Effective Oct. 6, a third criterion took effect. The California Health Equity Metric is intended to reduce disparities of COVID-19 transmission in disadvantaged communities hardest-hit by the virus and is reportedly the first of its kind at the state level in the nation. The metric has two components.

First, a county’s test positivity rate for its most disadvantaged neighborhoods, identified by numerous social, economic, and health factors from census data, must not lag significantly behind the county’s overall test positivity rate for the previous two weeks. Second, counties must submit by Oct. 13 a targeted investment plan that identifies its disproportionately impacted populations, provides the percentage of the county’s COVID-19 cases in those populations, and describes how it plans to use federal grant funds at equal to or greater than the percentage of COVID-19 cases in its disproportionately impacted populations to reduce virus transmission in those populations. (Given data limitations in smaller counties, the first component does not apply to counties with fewer 106,000 residents; such counties still must submit a targeted investment plan.)

The Health Equity Metric also allows for accelerated progression into a less restrictive tier.  Counties in purple or red tiers whose case rates are declining but that have not yet met the threshold for the less restrictive tier can nonetheless advance to the less restrictive tier if the test positivity rates both countywide and in the county’s disadvantaged neighborhoods meet the threshold for the tier that is two tiers less restrictive than the current tier for the previous two weeks. Counties in the orange tier can advance to yellow if, countywide and in disadvantaged neighborhoods, the test positivity and case rates meet specified thresholds. Notably, the Health Equity Metric is not factored into whether a county will move to a more restrictive tier.

The Health Equity Metric encourages counties to devote more resources to underserved communities hardest hit by the virus – an imperative that will become increasingly critical across communities as more counties move into less restrictive tiers and more activities resume. The metric, however, adds another hurdle for counties to cross and carries the potential to slow the state’s economic recovery should counties fail to take appropriate action. Employers should continue to stay abreast of where the counties in which they operate stand on the state’s tier system and consult applicable local public health orders before resuming normal business activities.