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Eleven counties moved back to more restrictive tiers in California’s coronavirus reopening system Tuesday, an unprecedented regression as the state contends with an increasingly worrying surge in infections.

Among the backsliders were San Diego, Sacramento and Stanislaus counties, all of which moved into the purple tier — the strictest category of the state’s reopening roadmap.

This week also marked the first time that no counties moved forward into a less restrictive tier, said California Health and Human Services Secretary Mark Ghaly.

“We anticipate, if things stay the way they are, that between this week and next week, over half of California counties will have moved into a more restrictive tier,” he said Tuesday. “And so that certainly is an indication that we’re concerned and that we have to keep a close watch on what’s happening.”

With the three new additions to the purple tier, nearly one-quarter of California counties now find themselves living under the most stringent coronavirus-related restrictions. The others are Los Angeles, Riverside, San Bernardino, Imperial, Monterey, Tulare, Madera, Sonoma, Tehama and Shasta counties.

California’s system, which determines the extent to which businesses, schools and other public spaces can operate, is broken into four color-coded tiers: purple, followed by red, orange and yellow.

Moving to the purple tier forces many businesses and organizations to either reduce capacity or move their operations outdoors.

Counties are placed into tiers based on two primary metrics: the average daily number of new COVID-19 cases for every 100,000 residents and the percentage of conducted tests that detect the coronavirus.

The counties are at risk of regressing if their metrics fall in the defined range of a more restrictive tier for two straight weeks.

“To advance back into the red Tier 2, Sacramento County needs to have lower daily case rates. The only way to do that is to do what we know works,” said Sacramento County’s health officer, Dr. Olivia Kasirye. “We all have a part in this.”

The other counties that moved backward Tuesday were Amador, Contra Costa, El Dorado, Placer and Santa Cruz, which are now in red; and Modoc, Siskiyou and Trinity, now in orange.

State officials have said the tiered system is deliberative by design — meant to give officials time to review and digest data before deciding whether wider reopenings or further restrictions are warranted.

“This is exactly why we designed the tier status the way we did,” Gov. Gavin Newsom said during a briefing Monday. “It was about being more and less restrictive — not based upon political whim, but based upon the data, based upon the epidemiology, based upon the facts on the ground and, again, based upon local conditions in the 58 counties throughout the state of California.”

As of Tuesday’s tier update, 13 counties are in the purple tier, 22 are in red, 17 in orange and six in yellow.

“I think a number of counties are indeed experiencing quite high levels of cases — not necessarily the highest they’ve ever seen, but certainly compared to the lows we’ve been experiencing over the past couple months,” Ghaly said.

Business owners in counties that now find themselves in the purple tier will have to adjust their operations to meet the stricter guidelines. For instance, restaurants will no longer be allowed to offer indoor dine-in service.

At tiny Masullo Pizza in Sacramento, though, the new restrictions won’t be felt too hard.

When word first came that indoor dining would be allowed at reduced capacity, the neighborhood favorite — with its open kitchen and communal tables — decided to play it safe and keep diners outside, said cook Paul Quiroz.

“We’ve been really stringent,” he said, adding that the pandemic hasn’t hurt sales too badly so far. “We’ve been fortunate in that. We have a decent amount of business.”

Not everyone has been so lucky. At Solfire Yoga in the core of Sacramento’s once-thriving midtown district, owner Ellen Moe said she has lost about 70% of her revenue since the pandemic started, but had just seen a minor uptick since being able to resume in-studio classes with 10% capacity at the end of September.

The latest news, though, has her feeling like “every time we get a little momentum, we get shut down again.”

The studio moved classes outside during the warm summer months, but “now it’s pretty chilly here in Sacramento,” she said. While she wants to keep her customers safe, Moe said she wished there was more help for businesses such as hers.

“My business has been decimated,” she said.

Randall Selland, who owns six restaurants in Sacramento — including Ella, a favorite of legislators in the nearby Capitol — said he was frustrated by what he sees as “no coherent message on how to get through this.”

Ella has been closed since March because its overhead and location in an area with a large homeless population made it difficult to do outdoor dining, Selland said.

Though his other establishments have invested in outdoor dining, fall temperatures hit hard in Northern California this week, and he thinks diners willing to brave the cold will be “few and far between.”

He said he would like to see a more targeted approach to closures.

“This blanket shutdown, I don’t think it’s right,” Selland said. “It should be a case-by-case effort. If you are not following the rules, you get shut down, instead of just going back and forth all the time.”

While moving to a more restrictive tier will undoubtedly present challenges from a business perspective, Ghaly said he views the larger issues of public and economic health as intertwined.

“We do think about it very broadly, and a number of us believe and see evidence that working to control the transmission of COVID — making sure that it doesn’t have the horrific impact in California that we’ve seen in other parts of the nation and other parts of the globe — is protecting not just our public health in the narrow sense, but our broad sense of public health, which includes our economic health,” he said.

While the reasons for increased coronavirus spread — and the type of behaviors and venues driving those trends — can vary from county to county, Ghaly said this week that “almost each county that’s having increased transmission, they mention private household gatherings as a major source of spread.”

Health officials throughout the state have been emphasizing that mantra for months, saying that residents’ choices on gatherings, as well as the precautions they do or don’t take when doing so, will play a major role in shaping how the pandemic plays out.

“I implore all Californians to sort of look in the mirror, ask what you can do differently, how much more can you keep your mask on, how much more can you work with your own communities, your own family members, to plan events in a lower-risk way,” Ghaly said. “Each of those efforts makes a difference. We know that it does.””

California already finds itself at a new crossroads. Coronavirus cases are beginning to trend distressingly upward in the state and are skyrocketing in many parts of the nation.

The latest seven-day average for new cases statewide is 6,078, up from the 14-day average of 5,216.

The state is fast approaching 1 million total cases and, as of this week, had officially recorded more than 18,000 deaths.

Dr. John Swartzberg, an infectious disease expert at UC Berkeley, said he believes the coronavirus is likely to swamp California in December and that parts of the state economy will have to be shut down.

Swartzberg said the virus is spreading through travel from states where it is out of control, and California will not be spared.

“Within a month after Thanksgiving, the number of cases is going to be up significantly,” Swartzberg said. “California is going to be very worried, and we will start to see things close down.”

Newsom said the increases in the state are “for obvious reasons: People are letting their guard down.”

“They’re taking their masks off; they’re starting to get together outside of their household cohorts; they’re starting to see businesses reopen; and we’re starting — again — to see more people mixing,” he said. “As it gets colder, we’ll see more still. So this was anticipated. No one is surprised by this.”

While a fall/winter wave was perhaps not unexpected, officials stressed that residents need to step up to keep it as mild as possible and continue to wear masks in public, wash their hands regularly, keep physical distance from those with whom they do not live and avoid gathering with others — or at least take precautions when doing so.

“We don’t have the luxury of ignoring our individual and collective responsibilities if we want to see more children go to school and businesses remain open,” said L.A. County Public Health Director Barbara Ferrer.

“Recovery just doesn’t continue when you have thousands of new cases each day. And many of these cases stem from people taking risks that are, frankly, not appropriate. It isn’t that hard to play by the rules, especially since these rules are what keep some people alive and allow our economy to improve.”

Times staff writer Maura Dolan contributed to this report.