On Nov. 30, Humboldt County Public Health reported that it had confirmed 47 new cases, bringing the county's cumulative tally nine months into the pandemic to 898 cases and capping the record-setting month with 327 new cases confirmed. Conditions, officials warned, were worsening.

In the 36 days between Nov. 30 and Jan. 5, when this edition of the Journal went to press, the county had confirmed another 1,030 cases, with officials still bracing for a surge in cases stemming from Christmas and New Year's gatherings and travel. The virus, local health officials have repeatedly said, is spreading at unprecedented levels.

On the cusp of this current surge, which has seen Humboldt County break a string of daily and weekly case records, the state announced Nov. 24 it was moving the county from its orange "moderate" risk tier directly to its most restrictive purple "widespread" tier, skipping the red "substantial" tier entirely and shuttering indoor operations at restaurants, movie theaters, gyms and places of worship, while also imposing a nighttime stay-at-home order. That status held as cases — and the percentages of local COVID-19 tests coming back positive — surged. Then, on Dec. 29, the state caught local officials off guard when it — without consultation, according to county Health Officer Ian Hoffman — moved Humboldt County back to the substantial tier, allowing restaurants to resume indoor dining and other businesses to re-open indoor operations.

As the Journal went to press Jan. 5, the state doubled down on that decision, keeping Humboldt County in the red, even as local officials had said the data doesn't appear to support the designation. Addressing the Board of Supervisors that day, Hoffman said he expected Humboldt County to move back into the widespread risk tier when the state reclassified counties again Jan. 12.

"My update today is that the numbers do look solidly purple for this week," he said.

The state primarily looks at two metrics to determine a county's tier status — the daily average of confirmed cases per 100,000 residents and the average test-positivity rate, both over a seven-day period — as well as an "equity" adjustment designed to make sure counties are trying to prevent COVID-19 spread across all demographics.

According to the state data released Jan. 5, Humboldt County had recorded an average of 15.1 new COVID-19 cases per 100,000 residents per day with a test-positivity rate of 5.2 percent over the seven-day period.

Humboldt County's test positivity rate alone would qualify it for its current red "substantial" tier, but the case tallies are more than double the state's criteria for the purple "widespread" tier. When a county straddles two tiers, the state metrics say it should fall into the more restrictive category. It remains unclear why the state surprised local officials by moving the county into the red tier Dec. 29, though officials have said it has to do with the health equity metric.

The numbers in the 14 days before the Journal went to press were far worse, with the county having recorded an average of 22 new cases daily per 100,000 residents with a test positivity rate of 8.6 percent. In the seven-day period ending Jan. 5, the county had recorded 29.7 new cases daily per 100,000 residents with a test positivity rate of 10.9 percent. For context, the seven-day period immediately prior to the state's initially placing Humboldt County purple tier saw a daily case average per 100,000 residents of 11.2 with a test-positivity rate of 4 percent.

"Our data is worsening, not improving," Hoffman said in a Jan. 5 press release. "I would urge every member of our community to take precautions as if we're in the purple tier because there is a lot of virus circulating in our community right now. Local businesses should also be cautious about planning for the next few weeks because we anticipate a move back to purple next week."

The Jan. 5 press release also brought news that another Humboldt County resident had died after testing positive for the virus, making 23 since the pandemic's start. Of those, 14 have come since Dec. 1, including a dozen residents of Eureka's Granada Rehabilitation and Wellness skilled nursing facility, where an outbreak had infected at least 99 people at last report.

Hovering in the background of the tier designation is the statewide stay-at-home order that's already in place for 98.3 percent of the state's population and will be implemented locally if the Northern California region — comprising Humboldt and 10 other counties — sees its cumulative available hospital intensive care unit capacity dip below 15 percent. If triggered, the order would close all non-essential businesses, force restaurants to shift to pick-up or delivery only and order residents to generally stay at home.

On Jan. 5, the state reported the Northern California region had a cumulative available ICU capacity of 29.8 percent. Health officers in the region have warned the state's 15-percent threshold may be precariously low, as there are only about 120 ICU beds spread through the 11 counties and 15 percent availability would leave just 18 beds.

Other areas of California, meanwhile, are already seeing capacity pushed past the brink, with the U.S. Army Corps of Engineers deploying to upgrade oxygen systems amid shortages at Southern California hospitals in the face of an onslaught of COVID-19 patients. Due to a shortage of hospital beds and staff, some ambulance services in Los Angeles have also instructed paramedics not to transport patients who are unlikely to survive.

And while news of an effective, approved vaccine was met last month with open arms, its rollout has been slower then hoped for or promised by the federal government. Locally, Hoffman reported the county has received about 5,600 doses of the Pfizer vaccine, which proved 95 percent effective in preventing COVID-19 infection during clinical trials. Of those, Hoffman said about 2,000 doses remain to be distributed, with frontline healthcare workers first in line to receive them.

St. Joseph Health spokesperson Christian Hill said "all frontline" healthcare workers at St. Joseph and Redwood Memorial hospitals have been offered the vaccine and that 1,183 had been administered as of Dec. 31. Hill said clinics administering both first and second doses — immunity comes after a second dose of the vaccine is administered 21 days after the first — this week.

In a Jan. 4 press release, SoHum Health reported vaccination of "local volunteer fire agencies and other healthcare providers" is beginning this week, and that it has vaccinated staff members at Singing Trees Recovery Center, as well. This seems out of step with the phased vaccination schedule issued by the state, which prioritized frontline healthcare workers with high risk of COVID-19 exposure and long-term care residents, with first responders, educators and essential service employees in the next phase of vaccine distributions.

Statewide, it is estimated about 3 million people fall into the first phase of prioritized distribution, though the state has only received about 1.3 million vaccine doses to date, according to a report in the San Francisco Chronicle.

Locally, Hoffman said while Humboldt County was enthusiastic about the rate it was receiving vaccine doses initially, it has not received any this week and has no new shipments of first doses in the immediate pipeline.

During the Jan. 5 report to the board of supervisors, Sheriff William Honsal said he'd been on a recent call between the state sheriff's association and California Secretary of Health and Human Services Mark Ghaly.

The sheriffs, Honsal said, were told it will likely be six to nine months before members of the general public can sign up to be vaccinated.

's news editor. Reach him at 442-1400, extension 321, or [email protected]. Follow him on Twitter @thadeusgreenson.