SAN FRANCISCO – Even as California finally begins to see declines in both COVID-19 deaths and hospitalizations, health officials and experts are preparing for a potential third surge of coronavirus cases fueled by two groups that already have been hit hard: low-wage essential workers and young people.

The summer spike in COVID-19 has started to ease, and governments soon will need to consider how they might begin to reopen the economy further. Gov. Gavin Newsom on Friday outlined a four-tier system in which counties must show consistent success against the coronavirus before businesses are allowed greater flexibility to reopen and group activities can resume.

California’s first effort at reopening was disastrous, with the spring’s worst weekly death counts doubling to nearly 1,000 during the summer. Last week’s total fell to about 900.

There already are warning signs about what the fall may bring.

Even though most college campuses remain closed, there have been outbreaks recently, at the University of Southern California and the University of California, Berkeley for example, tied to fraternities. Large outbreaks persist at workplaces staffed by low-income employees, working in jobs like garment manufacturing and food processing that are largely staffed by Latinos.

A new surge in the pandemic is far from a certainty – but experts said it’s essential that California learn from the mistakes of the last reopening. Of the more than 12,600 California COVID-19 deaths so far, more than 8,800 have been reported since Memorial Day, around the time the economy began to reopen and some people got back to old routines.

“Where I’m worried that we’re going to see a ton of transmission is in middle schools, high schools and colleges,” said Dr. George Rutherford, UC San Francisco epidemiologist and infectious diseases expert. “We all saw the disastrous openings at the University of North Carolina, Notre Dame, Michigan State ... and a couple weeks earlier in high schools in Georgia and other places. I think that’s really where a lot of the action is going to go on.”

Rutherford and others also have concerns about Latino workers and their families, who account for a disproportionate share of COVID-19 cases and deaths in California and will be placed at even greater risk when the economy reopens further. Businesses that employ low-income essential workers have come under scrutiny for their health and safety practices.

Robust coronavirus testing that yields results much faster must be at the centerpiece of a broad reopening of society, experts say. Physicians cheered Newsom’s announcement Wednesday of a $1.4 billion contract with an East Coast medical diagnostics company to more than double the number of tests that can be processed in the state.

The goal is to get test results back within 24 hours, a time frame that will be far more useful to controlling the pandemic than currently, where the average turnaround time can take up to seven days, Newsom said.

“The entire way we control this pandemic – after we do masks and distancing – is for people to be able to test, get results quickly, and then make decisions based on those results,” said Dr. Kirsten Bibbins-Domingo, chair of UC San Francisco’s Department of Epidemiology and Biostatistics.

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