States across the nation are facing a new wave of COVID-19 cases, including California.
"That is what we are concerned about. That is why we are watching things very closely," said Dr. Mark Ghaly, California Health and Human Services Secretary.
Dr. Ghaly says the test positivity rate statewide is 3.7% compared to 2.9% last month.
Hospitalizations have increased by nearly 32% over the last 14 days with ICU hospitalizations surging to nearly 30%.
As of Tuesday, there are more than 5,300 cases in California with many counties seeing spikes, meaning more restrictions for 11 counties.
"With these increases, we are not seeing any counties move forward this week," said Dr. Erica Pan, California Acting State Public Health Officer.
In fact, this is the first week since the tier system was put into place back in August that no county improved its status.
It's all based on the case and positivity rates and health equity.
In San Luis Obispo County, cases are also increasing.
An outbreak at Atascadero State Hospital has resulted in 20 patients and at least nine staff members testing positive for the virus.
San Luis Obispo County remains in the red tier but Public Health said on Tuesday that statistics have deteriorated to the point that the county now meets criteria for the purple tier.
The county would need to keep these worsened statistics for another week before having to move back a tier.
More than 4,800 cases have now been reported in SLO County since the start of the pandemic with more than 460 of them being Cal Poly students.
In Santa Barbara County, there's been an outbreak associated with Isla Vista but health leaders said on Tuesday that numbers seem to be improving.
The region remains in the red tier.
With the holidays around the corner, health officials warn to not let your guard down.
"I think it's important to say that just because you haven't been infected or you knew you were infected, doesn't mean you are protected or safe," Dr. Ghaly said.
Health experts stress the importance of wearing a mask and social distancing to get the numbers down.