As California continues to make progress in the fight against COVID-19, the state health department is recommending more parts of the economy can begin re-opening as long as counties show they are prepared to deal with a possible surge of cases.

The California Department of Public Health announced Monday that more counties can move through the two phases of Stage 2 of the California Pandemic Resilience Roadmap and start re-opening additional sectors of their economy at their own pace, if the data warrants such a move. To qualify, counties must attest that hospitalization and test positivity rates are stable or declining; that they have a significant level of preparedness with testing, contact tracing, PPE and hospital surge; and that they have adequate plans related to county-wide containment.

Stanislaus County sent a letter to the state on Friday requesting a variance and permission to move into the next stage of re-opening, but was denied because the criteria of no new deaths and less than 56 new cases in a 14-day period was not met.

On Tuesday, the Stanislaus County Board of Supervisors unanimously voted to send a new letter requesting to move into the next phase of re-opening and under the new criteria from the state, it's expected the county will get approval within the next day or two.

"They have designed new metrics that we do meet," Stanislaus County Public Health Director Dr. Julie Vaishampayan said of the state's criteria.

California began its regional variance process on May 7, which gave the state and counties time to see the early impact of these modifications to the statewide Stay-at-Home order.

The state outlined a new process that will be similar to the first variance process allowing for prepared counties to advance at their own pace through Stage 2. To qualify, a county must attest to certain criteria that has been met. Stage 2 is divided into two phases - A and B - and Stanislaus County is currently in the A phase. This expands the essential services and allows for things like curbside retail and manufacturing and logistics for those retail enterprises.

The primary criteria for moving into phase B is that of case metrics. Counties must show a stable or down trending in hospitalizations, cases per population count and test positivity rate. This includes stable hospitalizations on a 7-day average of daily percent change of less than 5%; or no more than 20 hospitalizations on any single day over the past 14 days. Stanislaus County had a hospitalization rate of 2.79 percent for the week of May 11 to May 17, Dr. Vaishampayan said.

The counties also need to show a 14-day cumulative positive incidence of less than 25 cases per 100,000 residents or testing positivity over the past seven days of less than 8%. Stanislaus County recorded a positive rate of 3.39 percent last week.

Counties also have to show that they have a plan in place to deal with any surges. In particular that they are prepared with testing, contact tracing, PPE and hospital surge, and planning for long-term care facility disease outbreak prevention and containment. This includes a minimum daily testing capacity to test 1.5 per 1,000 residents and that testing availability is at least 75% of residents.

Counties must have at least 15 staff per 100,000 county population trained and available for contact tracing and a hospital capacity to accommodate a minimum surge of 35% of their baseline average daily census.

Counties will also need to show that they have a plan to prevent and mitigate infections in skilled nursing facilities. SNFs must have more than 14-day supply of PPE on hand for staff, with an established process for ongoing procurement. It was an outbreak at the Turlock Nursing and Rehabilitation Center that significantly increased the number of cases and deaths in Stanislaus County over the last few weeks. Currently, TNRC is reporting 100 residents and 52 staff members have tested positive for COVID-19. The center has had 17 deaths among current and former residents from COVID-19. As of Tuesday, 25 residents and 15 staff members have recovered from the virus and have been cleared by the local health department, according to TNRC.

Finally, counties must produce plans related to county-wide containment, including testing, contact tracing, vulnerable populations, congregate settings, acute care surge and essential workforce.

The state health department also announced that some sectors of the economy statewide can begin reopening with modifications, including office spaces and counseling services in places of worship, curbside libraries and drive-in movie theaters.

“Californians have done incredible work flattening the curve and slowing the spread of COVID-19,” said Gov. Gavin Newsom. “As we seek an effective therapeutic or vaccine, we are moving into a new chapter in the fight against the disease – focusing on protecting public health by lowering the risk of transmission and aggressively moving to protect vulnerable communities. The virus will still be present in our communities, and it’s as important as ever for Californians to take steps to protect themselves and their families. Wash your hands. Keep physical distance. If you have an underlying health condition that makes you more vulnerable to COVID-19, you should still stay home.”

When Stanislaus County is allowed to move into phase B of Stage 2, it would allow for dine-in restaurant service with modifications like only operating at half or less capacity. It also would allow for the relaxation of retail guidelines so that people could go into the stores and let shopping malls and swap meets open. Other office-based businesses could re-open, though telecommuting would still be encouraged to help with social distancing. Schools and childcare could resume. Services like pet grooming, car washes, landscaping, and tanning facilities also could open, as well as outdoor museums.

What would not be included in either phase of Stage 2 are personal services like hair and nail salons, barbers, tattoo parlors, gyms and fitness studios; hospitality services like bars, lounges, nightclubs and game rooms; entertainment venues like movie theaters, arenas, concert venues, arcades, casinos; community centers like libraries, indoor museums, galleries, public pools, playgrounds and picnic areas; religious and cultural services; festivals and theme parks; and hotels for leisure and tourism. Most of those businesses will not be allowed to re-open until Stage 3 and in some cases like arenas and concert venues, Stage 4.

As of Tuesday, Stanislaus County has had 593 positive cases and 26 deaths. Of the 593 cases, 127 are presumed active and 440 recovered. In the last 24 hours there have been six new cases and zero new deaths.

Of the 127 presumed active cases, 38 are currently hospitalized, with one of those in ICU. A total of 107 people have been hospitalized with COVID-19 locally. The Stanislaus County Health Services Agency is reporting 53 percent of the hospital beds, 46 percent of the ICU beds and 83 percent of the ventilators are available.

Of the county's 593 cases, 428 people caught the virus through direct contact with an exposed individual. Another 146 people got it through community transmission and the remaining 18 were exposed during travel to an area where the virus is present.

While Latinos make up 47 percent of the county's population, they account for 59 percent of the infections. On the flip side, whites make up 41 percent of the population and only account for 29 percent of the cases. Asian Americans make up 5 percent of the county's total population and account for 6 percent of the cases. African Americans represent 3 percent of the total population in the county and 3 percent of the cases. Pacific Islanders represent 1 percent of the county and 1 percent of the infections. American Indian represents 1 percent of the county population and zero of the cases. The classification of other accounts for 3 percent of the population in the county and 2 percent of the cases.

Of those who have been diagnosed with COVID-19, 54 percent are females and 46 percent are males.

People 20 years and younger make up 8 percent of the cases. Those between 21 to 30 years account for 15 percent of the cases. Individuals 31 to 40 years represent 15 percent of the cases, while those 41 to 50 years account for 17 percent. Those between 51 to 60 years make up 16 percent of the cases, followed by those 61 to 70 years, which make up 10 percent of the cases. People in the ages of 71 to 80 years account for 8 percent of the cases, as do those from 81 to 90 years. Those 91 and over account for 3 percent of the cases in the county.

Turlock has the most cases in the county at 181. Modesto has 153 reported cases, followed by 73 in Ceres and 47 in Patterson. Stanislaus County District 5 has 32 cases, District 3 has 25 and District 2 has 21. Riverbank has 14 cases and Newman has 12 cases. Waterford has 11 cases, while Oakdale has eight and Hughson and District 1 each have seven cases. District 4 has two cases.

In Merced County's neighboring communities to Turlock, Delhi has 21 cases and Hilmar has six. All total, Merced County has had 222 cases, with 81 presumed active and six deaths.

Before any businesses do re-open, county officials are encouraging them to check out Good 2 Go Stanislaus online for information and state guidelines on the best practices to put in place to protect guests and employees. Good 2 Go Stanislaus can be found at http://schsa.org/publichealth/pages/corona-virus/.

A total of 9,821 people have been tested for COVID-19 in Stanislaus County. The county has partnered with OptumServe to operate testing sites in Keyes and Patterson and Verily's Baseline COVID-19 Program in Salida. Testing will be by appointment only. If you have COVID-19 symptoms, visit https://lhi.care/covidtestingto sign up for COVID-19 test.