"We must keep transmission low and that's to avoid flooding the healthcare delivery system," said California Health Secretary Dr. Mark Ghaly.
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On October 16, Fresno County was adding 79 new coronavirus cases every day.
On November 16, the number is up to 240 and the state's health secretary says the drastic increase will impact hospitals in the near future.
"Cases today will end up in our hospital beds in about two to three weeks consistently at a rate of about 12%," Dr. Ghaly said.
The state moved 28 counties back to the purple tier to avoid overwhelming hospitals.
The fall back to purple in Fresno, Kings, and Merced Counties impacts several types of businesses with much tighter restrictions, but restaurants may take the hardest hit.
"It's happened before, so we already prepared for it," said Silvia Wahyudi, who owns and manages Kikku in downtown Fresno.
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Restaurant owners may already know what to do when they can't have people eat inside anymore, but they're not convinced those restrictions are necessary.
"I don't think that closing of restaurant dine-in will make it much different," said Wahyudi. "I would say, you know, it's not just restaurant dine-in that makes the numbers go up."
Restaurants got a lifeline when Fresno County moved to the red tier on Sept. 29 and they could let diners inside again.
But now, just as the weather is getting cold, the lifeline is going away.
Restaurants at the Galleria in downtown Fresno are all expecting some kind of financial damage. Some of them can actually seat people outdoors, but they're not expecting that to be very popular because the weather has gotten colder.
The Quirky Cafe is in a similar spot and owner Dean Martin says the cafe is barely keeping the doors open.
"We lost like probably 75% of our business right now," Martin said. "Our numbers are really low right now."
Martin's employees put a few chairs and small tables out on Kern St. Monday as they tried to attract just a couple customers to the Cafe.
"We're barely able to stay open," Martin said. "We're not making enough right now even to pay the rent and our employees. Good thing we have our food truck going because our food truck does help maintain this building."
Downtown restaurants like Martin's don't have a lot of space for sidewalk dining, but it'll be the only way people can sit and eat their lunch with the county reverting to the purple tier, where indoor dining is not allowed.
Dr. Ghaly, the health secretary, says it's necessary because indoor dining without masks is an ideal situation for the virus to spread.
He says the data right now shows hospitals are on track to get overrun with COVID patients without intervention.
But a lot of restaurants are on track to go out of business without indoor dining, and the economic damage spreads too.
Reduced restaurant revenues trickle down to employees losing wages, and up to landlords not getting rent.
"It's going to hurt not only me, it's going to hurt my neighbor, all of the businesses around here are going to hurt," Martin said.
Several restaurant owners told us being in the red tier allowed them to get out of the red financially.
To stay alive now, they'll be relying on dedicated customers willing to support them even when dining conditions are not ideal.
"It's hard to predict the future, but we're going to try our best to do takeout and delivery," said Kikku's Wahyudi.
Mariposa County is alone in the Central Valley as a county not in the purple tier. It's one of just two California counties in the least restrictive yellow tier, and its businesses can operate with very minor restrictions.
Businesses in the rest of the Valley are moving backward or treading water.
So far, the state hasn't offered a financial boost.
"I'm deeply empathetic to their plight and deeply committed to doing everything in our power as a state, working with local government to augment and support their local efforts," said Gov. Gavin Newsom.
The governor mentioned state revenues coming in higher than expected and discussions about a new federal stimulus package but didn't provide specifics about what kind of help could be coming, or when.