Two California counties moved backwards in Gov. Gavin Newsom’s economic reopening system Wednesday as coronavirus cases rise statewide, prompting a top health official to urge extra caution going into the holiday season.

Shasta County moved backwards from the second-lowest red or “substantial” tier to the lowest purple or “widespread” tier, while Plumas County likewise moved from the highest yellow or “minimal” tier to the second-highest “moderate” tier. Colusa County was the only county to progress ahead in the reopening process, landing in the orange tier.

California Health and Human Services Director Dr. Mark Ghaly acknowledged that the state has seen recent increases in both new infections and hospitalizations, stressing that even as pandemic fatigue takes over — and the excitement of the holidays loom — Californians ought to remain vigilant about social distancing and mask-wearing.

“We know that the pandemic has altered our way of living. We’ve all made sacrifices. Some we’ve been okay with, others have been really hard,” Ghaly said. “Many of us feel exhausted, fatigued, and frankly impatient — and that is truly understandable.”

Since Oct. 20, the state’s 14-day test positivity rate has risen from about 2.6% to 3.3%, according to state data. Hospitalizations have also risen, with 3,241 patients overall and 823 in the intensive-care unit — marking increases of nearly 14% and 20% respectively over the past two weeks.

Even so, the health official painted a contrast between California and the rest of the U.S., where states Wyoming and Iowa have reported test positivity rates topping 30% in recent days, according to Johns Hopkins University of Medicine Coronavirus Resource Center. Both Shasta and Plumas counties had meanwhile been under the state’s watch for several weeks, Ghaly said; in Shasta, “it’s clear that the spread is not just isolated to a couple of venues or locations, but that it really is throughout big parts of their community,” he added.

The six-county Bay Area remains in the orange tier, excepting San Francisco, which is the only major metropolitan area to have made it to the least-restrictive yellow tier. Last week, officials said they would pause some reopening plans amid a small uptick in infections and hospitalizations.

In the coming days, the state plans to release firmer guidelines for the upcoming holidays surrounding family gatherings and celebrations, Ghaly said.

“Our choices matter a great deal — it’s not only what we do, but how we do it,” Ghaly said of the impending winter. “We can keep transmission low, even if it goes up some, using our public health tools and our own choices.”