While the trend concerning the status of COVID-19 in Tulare County has been improving, the county now has a dubious distinction of having one of the top death rates in the state due to the coronavirus.

As of Friday, Tulare County reported it has had 263 deaths due to COVID-19. That's the fifth highest total in the state when measuring deaths per 100,000 residents. With a population of 465,861 people, Tulare County's COVID-19 death rate is 56 per 100,000 residents.

The two counties that have been hit the hardest by COVID-19, Imperial and Los Angeles, have the highest death rates in the state. Imperial far and away has the highest death rate at 174 deaths per 100,000 residents followed by Los Angeles Count at 63 deaths per 100,000 residents.

A total of five counties in Central California are in the top 10 when it comes to the death rate. Stanislaus County is third at 62 deaths per 100,000 residents, San Joaquin County is fourth at 58 deaths per 100,000 residents, Merced County is sixth at 51 deaths per 100,000 residents and Kern is 10th at 40 per 100,000 residents.

The rest of the top 10 is Riverside County (48 per 100,000), Marin County (44 per 100,000) and San Bernardino County (42 per 100,000).

The figures have been complied by UC Irvine associate professor Andrew Noymer, who has been tracking COVID-19 deaths. Kern County has steadily been in the top 10 since July. But the four other Central California counties, including Tulare County, has joined Kern County in the top 10.

Health experts have always attributed health issues such as a high rate of diabetes and heart disease in Central California to such matters as socioeconomic challenges, poor air quality. While there's no clear cut reasons why, those issues and Central California's underlying health problems are considered as possible reasons why COVID-19 death rates are higher in this region. The region's issue when it comes to access to health care could be another reason.

The reasons why Kern and other rural Central Valley communities are dominating the top of the list is not easy to pinpoint but the valley has long been known for its poverty, poor air quality, high rates of chronic illness such as diabetes and heart disease and issues with access to health care.

California's death rate is 39 per 100,000 residents. New York leads the nation in deaths with 181 per 100,000 followed by New Jersey with 168 per 100,000. New York City has 282 deaths per 100,000.

Tulare County also had an outbreak in several nursing homes, which contributed considerably to the death rate.

In its last report, of 256 deaths in Tulare County, 200 were ages 65 and older. Four were below the age of 41 and 52 were ages 41-64. There were 119 deaths related to nursing homes and 137 deaths not related to nursing homes.

The state model projects Tulare County to have 265 deaths by October 25.

As far as its progress with COVID-19 is concerned, Tulare County has met one of the two metrics to move from the most restrictive category — purple — to the next least restrictive category, red. Tulare County's positive test rate is 7.7 percent, which is below the 8 percent threshold.

Tulare County's rate of cases per 100,000 residents over a 7-day period was 9.5 per 100,000. The county needs to bring that total down to 7 per 100,000 to meet the standard.

On the first Tuesday Tulare County meets the positive test and case rate standards, it would need to maintain those numbers for two weeks to move into the red category.

At that point, restaurants could open indoors at 25 percent capacity, churches could open indoors at 25 percent capacity, movie theaters could open on a limited basis and schools could open to all students.

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