With Nevada County, along with the rest of California, anxious to reopen businesses and return to some semblance of normality, one metric more than others will determine how long and how safe the road to recovery will be — testing.

In April, Gov. Gavin Newsom announced a four-stage plan for gradually reopening the state that would progress as determined by measures of six key indicators, including the state’s ability to stabilize hospitalization rates; stabilize intensive care unit rates; secure personal protective equipment; prepare for potential surge in cases; increase testing; and increase contact tracing capacity.

On Monday, Newsom announced that due to recent success in all those areas, the state would be able to move into Stage Two of the recovery plan — where some retailers, manufacturers, offices and public spaces can begin reopening — by next week, with some returning as early as Friday. Businesses eligible to open Friday, including book, clothing and sporting goods stores, can expect more guidance on modifications they’ll be required to make before opening.

During Stage Two counties will be allowed more autonomy in imposing regulations less restrictive than the state’s, with Newsom also announcing a plan for some counties to fast track into Stage Three, when higher risk environments like salons, gyms and religious services can reopen. Full criteria for fast-tracking is set to be released later this week, though Newsom said counties would need to demonstrate a low prevalence of the disease, preparedness for a sudden rise in cases, and the ability to meet testing and contact tracing demands.

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With testing capacity as a barometer, those calling for the county to reopen amid growing unrest can see some light at the end of the tunnel with the addition of a Grass Valley site this week capable of testing up to 130 people a day.

The testing site, located at the Grass Valley Veterans Memorial Building, is one of 86 Newsom announced across the state that would increase the state’s testing capacity and allow expanded testing criteria. An additional site at the North Tahoe Event Center in Placer County will serve the eastern part of Nevada County.

The county to date has tested just under 1,500 people, or 1.5% of the county population, compared to nearly 750,000, or 1.8% of people in the state.

However, until now the county has been focused on testing people with symptoms severe enough to seek medical treatment or people suspected to be in contact with confirmed cases, as people with mild symptoms were advised to stay at home due to a shortage of testing supplies.

Expanded testing

According to Nevada County Public Health Officer Dr. Ken Cutler, testing limitations in the past meant focusing on the number of confirmed cases could be misleading and underestimate the extent of community transmission.

“Given that testing was limited, certain groups necessarily were prioritized for those tests such as hospitalized patients, health care workers, and those in congregate living facilities where outbreaks can be devastating,” Cutler said in an email. “Expanded testing will be important to pick up those with milder symptoms so that they can be isolated and their close contacts traced so they can, in turn, be quarantined. And expanded testing will start to allow for testing of some asymptomatic individuals who are at higher risk of exposure.”

Cutler said increased testing capacity will not only be crucial for the reopening timeline, but for the safety of the county and understanding the disease as a whole.

“Essentially, expanded testing will help us limit transmission and is necessary as we move forward with reopening stages,” he said.

While the state increased testing capacity from 15,000 to 25,000 people tested per day over the last several weeks, Newsom said the state would need to test between 60,000 to 80,000 people a day to fully recover.

Proportionally, that would mean Nevada County would need about 150 to 200 tests per day to meet the state’s goal, though researchers say the need in counties with low density is likely to be even lower.

“This effort moves us closer to our goal of expanding testing opportunities until all those who are symptomatic, regardless of socioeconomic status, have access to testing, and it moves us closer to the overall statewide goals that need to be met in order to reopen the economy,” Health and Human Services Agency Director Ryan Gruver said of the testing site in an email. “Such broad testing will enable us to better understand how many people within our community have been exposed to this disease, and what our risk for additional infections might be.”

Gruver said the site may start below capacity, as others have, averaging about 90 tests a day in the beginning.

According to Cutler, the county’s testing rate has been consistent the past two months, suggesting even with the new site running at limited capacity more than 100 tests per day could be administered.

Gearing up

After an initial shortage of tests at the outbreak of the pandemic, health care providers have since struggled finding specimen collection supplies and with the slow pace of test results.

Since then, wait times have decreased as more labs and testing supplies became available. Newsom said Monday the 86 sites would be fully supplied with the state expecting millions of cases of equipment per day.

The Grass Valley testing site, run by federal government health care business OptumServe, will provide end-to-end testing, collecting specimens and reporting results to individuals on-site, according to its website.

According to Sierra Nevada Memorial Hospital CEO Brian Evans, the hospital decreased testing result wait time with a rapid testing machine that takes just 30 minutes, although it’s used for priority patients like those in emergency care.

As testing and associated supplies increase, county public health nurses in charge of contact tracing — the process of investigating, tracking and limiting possible transmission paths — are gearing up as well.

“We have asked all of our nurses, no matter which program they usually work in, to participate in case investigations and contact tracing,” said Cindy Wilson, director of public health nursing, in an email. “We have pulled other staff members who aren’t nurses but have transferrable skills to ask them (and their supervisors) about availability.”

Wilson said the department is also training student nurses and medical professional volunteers to do contact tracing, and could get more help from the state.

“We are anticipating assistance from the state, which may include more staff, a statewide database, and training,” she said. “All of these efforts will greatly increase our capacity.”

While this week’s announcement brought a more concrete timeline and guidelines for reopening, some counties did not wait. Yuba and Sutter counties saw some businesses open Monday, provided people social distance and wear masks.

With testing capacity increases coming at the same time the state is easing stay-at-home restrictions, the number of positive COVID-19 is bound to increase.

Newsom said that as the state moves into Stages Two and Three of reopening, more onus will be local health and government officials in how they interpret and act on that additional data.

To contact Staff Writer John Orona, email jorona@theunion.com or call 530-477-4229.