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Nurses at Backus Hospital in Norwich plan to strike Tuesday in protest over contract talks

Nurses at Backus Hospital in Norwich are set to strike Tuesday and Wednesday to protest what they say is the company’s refusal to negotiate a contract.

The hospital and Backus Federation of Nurses, part of AFT Connecticut that represents more than 400 nurses have been in contract talks since June. The two sides differ on compensation, improved distribution of personal protective equipment and recruiting and keeping new nurses, according to the union.

A spokeswoman for parent company Hartford HealthCare did not immediately respond to questions about staffing at Backus Hospital during the walkout. Donna Handley, president of the hospital, said earlier this month Backus will remain open during a strike and will work to reach an agreement.

Union President Sherri Dayton said recent negotiations led to progress on improved protective gear policies, expanded access for breastfeeding by new mothers and accountability for safe patient limits.

But the company has not yielded on calls by the union to improve recruitment and retention of nurses, the union said.

The union has organized a rally Tuesday at the hospital and will be joined by U.S. Rep. Joe Courtney, D-2nd, Randi Weingarten, president of the American Federation of Teachers, and other labor leaders and elected officials.

Nurses at the not-for-profit hospital are seeking higher pay and more staff to relieve nurses who often work hours after the end of their shifts, the union said. They also say they are forced to reuse personal protective equipment kept in paper bags until it’s compromised or soiled and are demanding Hartford Healthcare keep a three-month supply of N95 masks.

Hartford HealthCare insists personal protective equipment is always available to patients and staff.

Stephen Singer can be reached at [email protected]

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Massachusetts unveils plan for tenants, owners

BOSTON — Massachusetts Gov. Charlie Baker has unveiled a new $171 million initiative that he said will help tenants and landlords cope with the fiscal challenges of the ongoing coronavirus pandemic.

The Republican governor said in a statement Monday that the goal of the initiative is to keep tenants in their homes and ease the ongoing expenses of landlords once the state’s pause on evictions and foreclosures expires on Saturday.

About $100 million will go to expand the capacity of the Residential Assistance for Families in Transition program to provide relief to renters and landlords struggling because of the pandemic. Another $49 million will go to rapid rehousing programs for tenants who are evicted and at risk of homelessness.


Other funds will help provide tenants and landlords with legal services during the eviction process and support mediation programs to help tenants and landlords resolve cases outside of court.

Landlords have called the pandemic eviction ban unconstitutional, arguing that it restricted their free speech and their ability to acquire compensation for unlawful land taking. Meanwhile, housing advocates have called for passage of a comprehensive eviction prevention measure intended to help stabilize renters, homeowners and small landlords for a year.

When the state moratorium expires Saturday, a moratorium established by the federal Centers for Disease Control and Prevention will take effect in Massachusetts and prevent evictions through December for qualified tenants.

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HERE’S WHAT YOU NEED TO KNOW ABOUT THE VIRUS OUTBREAK:

— Supreme Court nominee Amy Coney Barrett faces Senate despite virus

— Trump insists he’s free of virus, ready for campaign trail

— Britain expected to tighten restrictions on hard-hit northern cities like Liverpool

— EU nations gear up to adopt traffic-light system to identify outbreaks

— Four Swiss guards who protect 83-year-old Pope Francis have the virus

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— Follow AP’s pandemic coverage at http://apnews.com/VirusOutbreak and https://apnews.com/UnderstandingtheOutbreak

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HERE’S WHAT ELSE IS HAPPENING:

CARSON CITY, Nev. — Nevada COVID-19 response director Caleb Cage said Monday that he had tested positive for the virus on October 6 after developing symptoms over the prior weekend.

Staff working in the governor’s office began working from home following his diagnosis.

Those who had come into contact with Cage were also tested, including Gov. Steve Sisolak, who tested negative.

Officials also reported 569 new confirmed cases and 3 new deaths on Monday. The number of new cases and positivity rate remain higher than they were in early September, before Sisolak relaxed restrictions on gatherings and before a state task force loosened thresholds for “high risk” counties.

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HUNTINGTON, W.Va. — Officials at a West Virginia health system have said the network is again banning visitors from its hospitals as community spread of the coronavirus increases in the region.

News outlets reported that Mountain Health Network announced Monday that most visitors will not be allowed in its medical centers, including at St. Mary’s in Huntington, one of the largest hospitals in the state.

Officials say essential caregivers will be allowed for patients in labor and

The Best Time to Switch From a Medicare Advantage Plan to a Medigap Plan

Last of a three-part series.

Medicare’s annual election period runs from Oct. 15 through December 7.

And that’s the best time to switch from a Medicare Advantage plan to a Medigap plan, according to Jae Oh, author of Maximize Your Medicare.

According to Oh, it’s critical that your Medigap carrier your application before you switch out of your Medicare Advantage and sign up for a standalone Part D plan. The worst outcome, he says, would be to have your Medigap application denied and choose a Part D plan. That would “eject” the Medicare Advantage plan that you may have in place and leave you without additional health benefits, said Oh.

Watch Oh’s videos on the topics on YouTube. Also read Buying your Medigap policy.

So, why might you switch from a Medicare Advantage plan to a Medigap plan?

There are a few reasons, according to Oh. The annual contracts are subject to change every year. And those changes could include premiums, copays, deductibles and doctors. By contrast, under Medigap, there is no concept of network. Every health care provider accepts a Medigap plan. To be sure, the premiums might cost more. But buying a Medigap plan could be one way to manage and mitigate the risk of unexpected health care costs in retirement,

So, what’s the best way to search for and select a Medigap policy?

1. Start with Medicare’s Plan Finder tool. One drawback with the tool, according to Oh, is this: The transparency of Medigap premiums is not very good. “The prices don’t accurately reflect the most updated premiums from carrier to carrier,” he says.

And as a result, it can be too high in certain instances. And that can be a disincentive; people might look at the list and think it’s too expensive when in fact the actual price in the marketplace is much lower. “It’s just been my general observation that the prices are not exactly at the razor’s edge of where the market sits at that time,” said Oh.

One bit of good news, according to Medicare.gov, is this: Every Medigap policy must follow federal and state laws designed to protect you, and it must be clearly identified as “Medicare Supplement Insurance.” Insurance companies can sell you only a “standardized” policy identified in most states by letters. All policies offer the same basic benefits but some offer additional benefits, so you can choose which one meets your needs. In Massachusetts, Minnesota, and Wisconsin, Medigap policies are standardized in a different way.

When selecting a plan, Oh said the two most important factors to consider are the type of plan that best suits your needs and the carrier. And it’s really important to get the carrier right. You shouldn’t choose just any carrier, he says. Since underwriting is involved, there are certain instances where oh might suggest one carrier that is more likely to accept an applicant versus another.

2. Your local State Health Insurance Assistance Program (SHIP) will provide you in-depth, one-on-one insurance counseling and

The Latest: Judge Won’t Block NY Plan to Limit Gatherings | World News

ALBANY, N.Y. — A federal judge has refused to block New York’s plan to temporarily limit the size of religious gatherings in COVID-19 hot spots.

U.S. District Judge Kiyo Matsumoto issued the ruling Friday after an emergency hearing in a lawsuit brought by rabbis and synagogues who said the restrictions were unconstitutional.

They had sought to have enforcement delayed until at least after Jewish holy days this weekend. The rules limit indoor prayer services in certain areas to no more than 10 people.

The judge said the state had an interest in protecting public safety.

HERE’S WHAT YOU NEED TO KNOW ABOUT THE VIRUS OUTBREAK:

— President Trump credits antibody drug for quick recovery

— Spain declares state of emergency in Madrid to contain surge

— As virus fills French ICUs anew, doctors ask what went wrong

— British government will announce more support for businesses to retain staff in the coming months if they are forced to close because of lockdown restrictions.

— President Donald Trump says he wants to try to hold a campaign rally in Florida on Saturday, despite his recent COVID-19 diagnosis.

— Follow AP’s pandemic coverage at http://apnews.com/VirusOutbreak and https://apnews.com/UnderstandingtheOutbreak

HERE’S WHAT ELSE IS HAPPENING:

RENO, Nev. — A recent spike in COVID-19 cases at the University of Nevada, Reno is prompting the school to suspend all in-class instruction effective Nov. 30.

UNR officials also are telling most students not to return to residence halls after Thanksgiving.

School officials said Friday they plan for students to return to dormitories for the spring semester and resume a combination of remote and in-class instruction Jan. 25. But during the period in between, all classes will be conducted remotely.

Only students facing extenuating circumstance will be allowed to live in campus housing. In recent weeks, one-out-of-nine of the county’s new cases have been tied to UNR.

ANCHORAGE, Alaska — Health officials in Alaska’s largest city on Friday recommended up to 300 people associated with a youth hockey tournament quarantine or isolate after “a cluster” of COVID-19 cases were identified.

The Anchorage Health Department said players, coaches and fans from parts of south-central Alaska and Juneau attended the tournament, which was held Oct. 2-4.

The department said it encouraged everyone who attended who does not have symptoms to quarantine for 14 days, except to get tested, and encouraged those with symptoms to isolate for 10 days, except to get tested.

Dr. Janet Johnston, the department’s epidemiologist, said that means the department is recommending up to 300 isolate or quarantine.

Heather Harris, the department’s director, could not provide “concrete” numbers of positive cases associated with the tournament. She said the tournament organizers said they tried to enforce masking guidelines and kept a contact log of participants.

Contact trace investigations indicated “significant close contact in indoor spaces, including locker rooms, with inconsistent use of face coverings,” the city health department said in a release.

CHARLESTON, W.Va. — Gov. Jim Justice announced Friday that bars around West Virginia University in Morgantown can

CDC launches new plan to tackle antibiotic-resistant infections

Oct. 9 (UPI) — U.S. Centers for Disease Control and Prevention officials announced Friday what they describe as a “national action plan” to fight antibiotic-resistant infections.

The bacteria that cause these diseases cannot be treated by currently available antibiotic drugs, meaning patients who suffer from them may experience severe health complications or even death.

Antibiotic-resistant bacteria have been linked with an estimated 35,000 deaths across the United States annually, and treating them costs the nation’s healthcare system an estimated $4.8 billion per year, according to the CDC.

“The National Action Plan for Combating Antibiotic-Resistant Bacteria gives the U.S. government its marching orders for the next five years to accelerate the nation’s efforts to stop the spread of antibiotic-resistant bugs,” the agency said in a statement.

The CDC did not provide details on the cost of the plan, but reports suggest that, in the past, more than $150 million has been allocated annually by the agency to fight antibiotic-resistant threats in all 50 states and Puerto Rico. It is a follow-up to a similar initiative launched in 2015, the agency said.

Examples of common antibiotic-resistant infections include staph — such as methicillin-resistant staphylococcus aureus, or MRSA — as well as sepsis and Clostridioides difficile, or C. diff.

The emergence of these bacteria has been linked with the overuse of antibiotics. About 30% of all antibiotics are administered unnecessarily, according to the CDC.

Roughly 2.8 million Americans are diagnosed with drug-resistant infections annually, and disease like MRSA can spread in public places, while sepsis and C. diff typically circulate in healthcare facilities, the agency said.

The goal of the action plan is to reduce by 2025 the prevalence of healthcare-associated antibiotic-resistant infections like sepsis and C. diff by 20% and community-acquired antibiotic-resistant infections like MRSA by 10%.

To do so, the agency plans to expand its antibiotic resistance lab network internationally to identify and respond to emerging disease threats “in every corner of the world.”

Domestically, the initiative will support investments in state and local health departments across the country, providing up to $2.5 million per agency to “detect, contain and prevent antibiotic-resistant infections.”

The plan also includes the establishment of a “Center of Excellence for Whole Genome Sequencing,” which identifies the DNA make-up of bacteria, at the National Institutes of Health’s National Center for Biotechnology Information to gain better understanding of how these diseases are transmitted.

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Trump outraged by Democrats’ plan to assess president’s fitness to serve

Democrats provoked an angry tirade from Donald Trump on Friday by proposing a congressional commission to assess whether US presidents are capable of performing their duties or should be removed from office.



a group of people sitting at a table: Photograph: Carlos Barría/Reuters


© Provided by The Guardian
Photograph: Carlos Barría/Reuters

The gambit came a week after Trump was flown to a military hospital for treatment for coronavirus and 25 days before an election. The president returned to the White House on Monday but has caused concern with erratic behaviour.

Related: Trump unlikely to travel for rally while Pelosi says medication has him ‘in an altered state’ – live

“This is not about President Trump. He will face the judgment of the voters but he shows the need for us to create a process for future presidents,” Nancy Pelosi, the speaker of the House of Representatives, told a press conference in which she also took a swipe at the British prime minister, Boris Johnson.



a group of people sitting at a table: The House speaker, Nancy Pelosi, and Representative Jamie Raskin introduce legislation to create 25th amendment commission in Washington on Friday.


© Photograph: Carlos Barría/Reuters
The House speaker, Nancy Pelosi, and Representative Jamie Raskin introduce legislation to create 25th amendment commission in Washington on Friday.

But the timing was impossible to ignore as Trump has continued to give rambling TV interviews, tweet false and contradictory statements and potentially endanger his own White House staff by defying public health guidance.

The president tweeted in response: “Crazy Nancy Pelosi is looking at the 25th Amendment in order to replace Joe Biden with Kamala Harris. The Dems want that to happen fast because Sleepy Joe is out of it!!!”

The 25th amendment to the US constitution provides the procedure for the vice-president to take over the duties of president if he or she dies or resigns or it is determined that he or she cannot fulfill the functions of the office.

The Democratic congressman Jamie Raskin of Maryland, introducing the legislation on Friday, said: “The 25th amendment is all about the stability of the presidency and the continuity of the office.

“Now, it’s never been necessary, but the authors of the 25th amendment thought it essential in the nuclear age to have a safety valve option and, as they often said, we have 535 members of Congress but we only have one president.”

He added: “In the age of Covid-19, which has killed more than 210,000 Americans and now ravaged the White House staff, the wisdom of the 25th amendment is clear. What happens if a president – any president – ends up in a coma or on a ventilator and has made no provisions for the temporary transfer of power? This situation is what demands action.”

This panel would be known as the Commission on Presidential Capacity to Discharge the Powers and Duties of Office. Raskin, a constitutional law professor, said it would be bipartisan and consist of 17 members, including medical personnel, and could only act in concert with the vice-president.

Asked about the timing of the bill, Raskin explained “this situation has focused everyone’s mind” on the 25th amendment.

Pelosi repeated her insistence that it did not

China joins WHO’s plan for global distribution of COVID-19 vaccine

Oct. 9 (UPI) — China on Friday said it has joined a World Health Organization-led initiative that aims to manufacture and provide equitable access to a COVID-19 vaccine.

Hua Chunying, a spokeswoman for China’s foreign ministry, said the Asian nation signed an agreement with Gavi on Thursday to join COVAX, the vaccine pillar of the WHO’s Access to COVID-19 Tools Accelerator program.

Launched in April by the WHO, the ACT Accelerator aims to ramp up development, production and equitable distribution of COVID-19 tests, treatments and vaccines, and is co-led by the U.N. health body, Gavi and the Coalition for Epidemic Preparedness Innovations.

Hua did not state China’s financial contribution to the program but said it pledges to make domestically developed vaccines a public resource.

“This is an important step China has taken to uphold the concept of a shared community of health for all and to honor its commitment to turn COVID-19 vaccines into a global public good,” Hua said in a statement. “We are taking this concrete step to ensure equitable distribution of vaccines, especially to developing countries, and hope more capable countries will also join and support COVAX.”

As of Friday, more than 150 economies equalling nearly two-thirds of the world’s population have signed commitment agreements to the COVAX Facility in its effort to ensure low- and middle-income countries have equitable access to a vaccine when one is developed.

The United States, which has formally requested to leave the WHO, has declined to participate in the effort, as it accuses the U.N. health body of colluding with China in its efforts to cover up its initial outbreak of the virus late last year.

“We will not be constrained by multilateral organizations influenced by the corrupt World Health Organization and China,” Judd Deere, a spokesman for the White House, said early last month.

In late August, WHO Director-General Tedros Adhanom Ghebreyesus said more than 170 nations were in talks to join the program, explaining that the plan consists of delivering at least 2 billion doses of a COVID-19 vaccine by the end of next year with a global rollout to begin with those who are at the greatest risk.

“There is light at the end of the tunnel,” said Tedros, who has warned against so-called vaccine nationalism.

Gavi said Thursday it has raised roughly $1.8 billion, nearly reaching its goal of $2 billion by the end of this year for the program.

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Verma, Meadows push to finalize $200 drug-card plan for seniors by Election Day

Caught by surprise by President Donald Trump’s promise to deliver drug-discount cards to seniors, health officials are scrambling to get the nearly $8 billion plan done by Election Day, according to five officials and draft documents obtained by POLITICO.



a person posing for the camera: Seema Verma, administrator of the Centers for Medicare and Medicaid Services.


© Tasos Katopodis/Getty Images
Seema Verma, administrator of the Centers for Medicare and Medicaid Services.

The taxpayer-funded plan, which was only announced two weeks ago and is being justified inside the White House and the health department as a test of the Medicare program, is being driven by Centers for Medicare and Medicaid Services Administrator Seema Verma and White House chief of staff Mark Meadows, the officials said. The administration is seeking to finalize the plan as soon as Friday and send letters to 39 million Medicare beneficiaries next week, informing seniors of Trump’s new effort to lower their drug costs, although many seniors would not receive the actual cards until after the election.

The $200 cards — which would resemble credit cards, would need to be used at pharmacies and could be branded with a reference to Trump himself — would be paid for by tapping Medicare’s trust fund.

“The goal is to begin the test by distributing cards starting in October 2020,” according to a draft proposal circulated within the White House last week and obtained by POLITICO.

Career civil servants have raised concerns about the hasty plan and whether it is politically motivated, particularly after Verma pushed Medicare officials to finalize the plan before the Nov. 3 election, said two officials.

The plan to lower seniors’ drug costs comes as administration officials grapple with Trump’s falling support among older Americans, a significant threat to his re-election. Trump is currently lagging challenger Joe Biden by as much as 27 points in recent polls among Americans ages 65 and older, a major reversal from the 2016 campaign, with seniors now voicing concerns about Trump’s handling of the coronavirus pandemic and his chaotic leadership style.

“This has nothing to do with politics. It’s good policy and demonstrates the president is continuing to deliver on his promises to our nation’s seniors,” said Judd Deere, a White House spokesperson. The White House did not make Meadows available for an interview.

CMS did not make Verma available for interviews and declined comment.

Democrats have dismissed the cards as a “gimmick” that will do little to achieve Trump’s 2016 campaign pledge of lowering drug prices.

“It’s a shameless stunt that steals billions from Medicare in order to fund a legally dubious scheme that’s clearly intended to benefit President Trump’s campaign right before Election Day,” said Rep. Frank Pallone, the chairman of the House Energy and Commerce committee.

The administration previously ordered that Trump’s name appear on millions of stimulus checks sent out by the IRS this spring, which Democrats have alleged was an effort for the president to take credit for a congressional relief package.

Trump abruptly announced the drug-discount cards on Sept. 24, a last-minute decision that surprised even some of his own

Distrusting Trump, States Plan to Vet COVID Vaccines Themselves. Bad Idea, Say Experts. | Best States

By JoNel Aleccia and Liz Szabo

As trust in the Food and Drug Administration wavers, several states have vowed to conduct independent reviews of any COVID-19 vaccine the federal agency authorizes.

But top health experts say such vetting may be misguided, even if it reflects a well-founded lack of confidence in the Trump administration — especially now that the FDA has held firm with rules that make a risky preelection vaccine release highly unlikely.

At least six states and the District of Columbia have indicated they intend to review the scientific data for any vaccine approved to fight COVID-19, with some citing concern over political interference by President Donald Trump and his appointees. Officials in New York and California said they are convening expert panels expressly for that purpose.

Photos: Daily Life, Disrupted

TOPSHOT - A passenger in an outfit (R) poses for a picture as a security guard wearing a facemask as a preventive measure against the Covid-19 coronavirus stands nearby on a last century-style boat, featuring a theatrical drama set between the 1920s and 1930s in Wuhan, in Chinas central Hubei province on September 27, 2020. (Photo by Hector RETAMAL / AFP) (Photo by HECTOR RETAMAL/AFP via Getty Images)

“Frankly, I’m not going to trust the federal government’s opinion and I wouldn’t recommend [vaccines] to New Yorkers based on the federal government’s opinion,” New York Gov. Andrew Cuomo said last month.

“We want to make sure — despite the urge and interest in having a useful vaccine — that we do it with the utmost safety of Californians in mind,” Dr. Mark Ghaly, California’s health and human services secretary, said at a recent news conference.

“Do you really want a situation where Texas, Alabama and Arkansas are making drastically different vaccine policies than New York, California and Massachusetts?” asked Dr. Saad Omer, an epidemiologist who leads the Yale Institute for Global Health.

Separate state vaccine reviews would be unprecedented and disruptive, and a robust regulatory process already exists, said Michael Osterholm, an epidemiologist and director of the Center for Infectious Disease Research and Policy at the University of Minnesota.

“States should stay out of the vaccine review business,” Osterholm said. “I think the Food and Drug Administration is doing their job right now. Unless there’s something that changes that, I do believe that they will be able to go ahead.”

The administration has given reasons for states to worry. Trump has repeatedly signaled a desire for approval of a vaccine by the Nov. 3 election, arousing fears that he will steamroll the normal regulatory process.

The president wields “considerable power” over the FDA because it’s part of the executive branch of government, said Lawrence Gostin, faculty director of the O’Neill Institute for National and Global Health Law. The president nominates the FDA commissioner and can replace that official at any time.

Trump has already contradicted the advice of his own scientific advisers in order to promote unproven therapies to fight COVID-19. The FDA approved two treatments — hydroxychloroquine and convalescent plasma — without strong evidence of safety and efficacy after Trump pushed for the therapies to be widely available.

Late Monday, The New York Times reported that top White House officials planned to block FDA guidelines that would bolster requirements for emergency authorization of a COVID vaccine — because the new guidelines would almost certainly delay approval until after the election.

The White House’s actions undermine

In a first, 2 counties move backward on state’s reopening plan; Ventura moves forward

Patrons ate in May at Ventura's BusyBee 50's Cafe. In July, Gov. Gavin Newsom closed all indoor dining at restaurants, but on Tuesday, Ventura County advanced in the state's reopening blueprint, allowing a return to limited indoor seating. <span class="copyright">(Wally Skalij / Los Angeles Times)</span>
Patrons ate in May at Ventura’s BusyBee 50’s Cafe. In July, Gov. Gavin Newsom closed all indoor dining at restaurants, but on Tuesday, Ventura County advanced in the state’s reopening blueprint, allowing a return to limited indoor seating. (Wally Skalij / Los Angeles Times)

Although a handful of counties advanced in the state’s COVID-19 reopening plan Tuesday, two moved backward — the first time since California launched its tiered system that parts of the state have regressed.

Following an increase in cases, Tehama County moved back to Tier 1, the most restrictive, and Shasta County moved back to Tier 2. The setbacks will affect business sectors that had been given the green light to reopen or expand capacity in those areas.

Shasta County, which averaged 173.7 COVID-19 cases per 100,000 residents in the last seven days, and Tehama County, with 124.3 cases per 100,000 residents during the same period, are among the five counties in the state where the most new cases are concentrated, according to The Times’ tracker.

Among the counties that moved forward was Ventura, the fourth in Southern California to advance on the state’s blueprint for reopening. It joined Merced and Yuba counties in advancing from Tier 1, also known as the purple tier, with widespread risk of the virus, to Tier 2, or the red tier, with substantial risk of the virus.

Inyo County moved from Tier 2 to Tier 3, also known as the orange tier, with moderate risk of the virus. Humboldt, Plumas, Siskiyou and Trinity counties moved from Tier 3 to Tier 4, also known as the yellow tier, with minimal risk of the virus.

Ventura County officials were prepared for the move following a decrease in positivity rate and case count. The progressive step will allow the county to expand operations and capacity at business sectors, including restaurants and shopping centers, and to partially reopen other businesses, including movie theaters, for the first time.

If the county remains in the tier for two consecutive weeks, it will be allowed to open all schools. That is true for any county that moves to Tier 2.

Ventura County is currently reporting 5.5 infections per 100,000 residents and a seven-day average positivity rate of 3.0%.

Those metrics have also dipped statewide. The seven-day average for daily infections is 3,005, and the current 14-day positivity rate is 2.7%.

“Our cases have decreased from our peak over the summer, but they have been plateauing,” acting state health officer Dr. Erica Pan said Tuesday. The state’s goal is to continue to see a steady decrease in infections in order to ensure that the projected transmission rate does not rise.

Additionally, the state’s health equity metric went into effect Tuesday.

In order to ensure that communities disproportionately affected by COVID-19 — including Black and Latino residents, Pacific Islanders and low-income residents — get ample attention as each county progresses, the state will examine the positivity rate of a county’s lowest quartile and compare it to the countywide