San Diego County officially falls into most-restrictive COVID-19 tier

The day many have dreaded for months has now come to pass. San Diego County fell to the most-restrictive level of the state’s COVID-19 reopening system Tuesday, Nov. 10, meaning that restaurants, houses of worship, movie theaters and other organizations must cease or significantly reduce their indoor operations by 12:01 a.m. Saturday, Nov. 14.

In the state’s latest tier report, the region received an adjusted case rate of 8.9 per 100,000 residents, once again over the limit of 7. Taken together with last week’s score of 7.4, San Diego County has now gone two consecutive weeks with out-of-bounds numbers that force it to fall to the lowest of the four levels included in the coronavirus risk-ranking system

San Diego County was not alone. It was among 11 counties statewide to fall a tier in the latest report as a fall surge in cases felt most strongly in the middle of the country begins to show itself in California. Sacramento and Stanislaus counties joined San Diego in its fall to purple Tuesday, Nov. 10.

The pain will be felt most strongly in restaurants, movie theaters and houses of worship which, according to state rules, will be required to move back outdoors just as they did on July 13, one month after local public health officials allowed gyms, hotels, bars and other businesses to reopen. It was a move that, within two weeks, saw the number of daily infections surge past the 700 mark, leading to the current statewide strategy of forcing businesses and other organizations thought to be at the greatest risk of spreading infections to operate outdoors or not at all.

As the region has teetered week after week on the brink of falling into the purple tier, many local business owners have said they will refuse to comply with the state’s orders to move backwards.

It remains to be seen how this apparent impasse will resolve itself.

To date, local law enforcement agencies have been reluctant to cite those who break public health mandates, but Dr. Wilma Wooten, the county’s public health officer, recently sent a letter to every jurisdiction in the area asking each to “step up enforcement efforts around egregious violators.”

The county health department is also sending 40,000 masks to local law enforcement departments for officers to hand out when they see someone with an uncovered face. The county’s enforcement tip line, reminded Supervisor Nathan Fletcher, is (858) 694-2900 and is staffed by officials ready to take down complains about health orders. Those complaints can also be emailed to safereopeningcomplianceteam@sdcounty.ca.gov.

Urging San Diegans to report each other clearly does not sit well with local leaders.

“No one wants to be punitive, no one wants any business or any entity to be closed at all, but the simple reality is, we are now faced with an increase in spread and transmission that threatens our community,” Fletcher said.

Officials warned that turning this particular battleship will not be accomplished in a week. San Diego County will need two consecutive case rates under 7 to return to the red tier and, with the number of new cases arriving at the county health department daily for investigation now consistently over 400, no one, officials said, should expect a rapid reversal.

“It’s gonna take a while, so we are asking everyone to be patient,” Wooten said. “I know that’s a lot to ask, but we have to stay the course.”

Reaction to that plea was immediately mixed.

Churches

Some organizations, such as Skyline Church in La Mesa, have no intention of adhering to the new restrictions.

Other churches won’t be affected at all, really.

In a statement on its website, the church said it will continue to hold indoor, in-person services “for the purpose of good public health.”

The church went on to question why locations like strip clubs and casinos could remain open while churches and schools were being forced to close.

“As a church, we will continue to exercise our rights given to us under the Constitution of the United States of America, therefore Skyline Church will remain open in order to help people,” the statement read. “We are here to serve our community. We hope to see you Sunday.”

The Rock Church, which has five brick-and-mortar locations across the county, hasn’t held indoor services since churches were first ordered to close, and only started hosting outdoor services about six weeks ago.

“We’re taking this (pandemic) seriously,” said Travis Gibson, campus pastor at The Rock. “We want to show our congregation that we care about them physically, that we care about them spiritually -- and we want to make sure that we’re doing everything we can to make sure all of those needs are met.”

Much of the church’s congregation has chosen to watch services online, Gibson said. Between 50,000 and 75,000 people stream the Sunday service each weekend.

But church leaders knew some were hungry for in-person options, so they put together an outdoor service plan that includes mask requirements, temperature checks and reminders to socially distance.

About 900 to 1,000 people attend in-person services each Sunday. Sometimes the weather makes outdoor services a little uncomfortable or airplanes overhead muffle the sermon, but congregants didn’t seem to mind, Gibson said. They come for the people.

“We love our city and we love our church and we’re going to do what we can to make sure people can worship safely outdoors,” Gibson said.

Nursing homes

A majority of the county’s skilled nursing homes had been allowed to resume indoor visitations in recent months. Now, with San Diego County shifted into the purple tier, those visits will be restricted only to specific patient groups.

Indoor visitations will only be allowed for patients who are pediatric; in labor/delivery; living with physical, intellectual or developmental disabilities; those with cognitive impairments; and those nearing end-of-life.

That means family caregivers like Chula Vista resident Norma Cazares will not be able to visit with their loved ones indoors.

Cazares is the primary caregiver for her 86-year-old aunt, Alicia. She has visited her weekly since she was brought to an El Cajon nursing home in May after a COVID-19 diagnosis and hospital stay. (Cazeres asked that her aunt’s last name and nursing home not be published for her privacy).

Since her aunt was released from the hospital and placed in the nursing home, Cazares and her family have not been able to enter the facility at all. At first, visits were only through the window, and later they were able to visit with one another on the patio.

She worries what conditions are like inside and would like to see inside to make sure Alicia is well cared for.

“She does complain about the food, and unfortunately she’s lost at least 20 pounds,” Cazares said. “Of course one of the side effects of COVID-19 can be where they lose the ability to taste and smell.”

Cazares was hoping to arrange a small birthday visit for Alicia later this month — complete with taquitos, her aunt’s favorite food — when she heard the news that San Diego County has shifted to the purple tier.

“She’s fully aware it’s her birthday coming up, plus we’ve been talking about it trying to keep her spirits up,” Cazares said. “She was excited about it, we were all excited about it, and now this.”

She has not yet heard back about the status of her weekly outdoor visits or the birthday celebration, and with San Diego County now in the purple tier, Cazares won’t be able to visit indoors anytime soon.

Schools

Falling to the purple tier prevents any K-12 schools not already reopened for in-person education from doing so until red tier status is regained.

This creates a significant question, most particularly in North County’s Vista Unified School District which sent entire campuses home for two weeks shortly after reopening when a handful of cases popped up, all associated with off-campus exposures.

In an email, the California Department of Public Health confirmed that “if a school opened up as part of a district opening process while in (the) red (tier) but closed as part of the protocol for managing an outbreak, they are considered a district that has opened and therefore, after following that protocol, can resume in-person education.”

Saying that, nearly two weeks after sending entire campuses home, VUSD superintendent Matt Doyle said his office does not have “any evidence at this point of any school-based transmission.” All cases, he said, have been traced back to exposures in homes.

“We will be moving forward with our schools returning to in-person instruction as planned,” Doyle said.

To help detect new cases quickly, the district has partnered with Vista Community Clinic, announcing a new testing clinic Tuesday that will provide free coronavirus tests at the Linda Rhoades Recreation Center seven days per week from 8:30 a.m. to 5:30 p.m.

Overall, it appears that schools are not, in and of themselves, generating many cases. Dr. Eric McDonald, medical director of the county’s epidemiology department, said Tuesday that he is aware of only one case believed to have become infected at a local K-12 school.

— Paul Sisson, Lyndsay Winkley and Lauren J. Mapp are reporters for The San Diego Union-Tribune

— San Diego Union-Tribune staff writers Lori Weisberg and Phillip Molnar contributed to this report.