SANTA ANA, Calif. - Orange County reported 15 coronavirus-related deaths and 187 new diagnoses Tuesday, raising the death toll to 581 and the cumulative case total to 34,833, while the county's top health officer said the number of hospital nurses falling ill with the virus was a "point of concern."
The number of patients being treated for COVID-19 in Orange County hospitals dropped from 661 on Monday to 640, while the number of patients in intensive care units decreased from 204 to 203, according to the Orange County Health Care Agency.
Since Sunday, the county has reported 19 deaths. Last week, the county reported 70 COVID-19-related deaths, down from 73 the week before.
One-third of the deaths reported Tuesday involved skilled nursing facility residents.
Of the total deaths, 253 were skilled nursing facility residents, 21 lived in assisted living facilities, and one was homeless. Of the total cases, 1,556 were skilled nursing facility residents, 472 were jail inmates and 136 were homeless.
Orange County is on the state's watch list for counties experiencing high rates of new cases and hospitalizations. It has shown some improvement, but with some continuing concerns.
The county's case rate per 100,000 residents dropped from 188.9 to 150.8, but is still far higher than the California Department of Public Health threshold of 25 per 100,000 residents. The rate of residents testing positive for COVID-19 dropped from 11.7% to 11.1%, which is still higher than the state's desired rate of 8%.
The change in the three-day average of hospitalized patients was - 1.9%, much lower than the state's threshold of 10%.
Available ICU beds increased from 32% to 40%, and the percentage of ventilators available dropped from 63% to 58%. The state's threshold is 20% of ICU beds available to handle a surge and 25% ventilators on hand.
Dr. Clayton Chau, director of the Health Care Agency and interim chief health officer, told the Board of Supervisors that the county's positivity rate "has seen a trend of decreasing, so that's a good sign," but is still at a "concerning level."
Chau, however, said the most important statistics to keep an eye on are the number of ICU beds and availability of ventilators and, "from that perspective we're doing quite well."
He said heightened hygiene, physical distancing and the wearing of face coverings "seems to be working to slow down the spread."
Chau said the main concern has been "staff fatigue."
Many nurses "have been infected," so "the availability of nurses to make sure hospitals function is a point of concern for us ... We have people who cannot go to work because they have been exposed or infected," Chau said.
Three larger hospitals in the area have been "requesting support from the state for more staffing, specifically nursing staffing," Chau said. "So that's something we're watching very closely... It does not mean those beds are available if you don't have the nursing staff."
Supervisor Don Wagner grilled Chau as to why the state has set 8% as the threshold for positivity rates, questioning its legitimacy. Chau said he could not say, but said it could have something to do with studies globally showing the positivity rate ranges between 8% to 18%.
Wagner also asked Chau about a recent study out of South Korea that concluded children 10 and younger transmit the virus at a lower rate than any other age group. Chau noted the study was done while schools were not in session.
Chau said experts still do not know at what rate children transmit the virus to adults. He said the county is working on a contact tracing study with experts from UC Irvine and Children's Hospital of Orange.
"That will answer some of the questions we have," Chau said.
Wagner questioned why the state is preventing students from returning to classes until the county meets the 8% threshold for positivity rates.
"Doesn't the flu kill more people than COVID?" Wagner said. "Don't we keep schools open during the flu season?"
Chau said he objected to comparisons between the flu and COVID-19.
"When I hear people compare the regular flu to COVID, I feel like we've been missing the point," Chau said.
Wagner, board Chairwoman Michelle Steel and Supervisor Andrew Do pressed Chau to lean on state officials to parse the number of people who go to a hospital for another reason, but test positive for COVID-19 after admittance versus patients who are taken to a hospital with coronavirus.
Supervisor Lisa Bartlett encouraged Chau to press state officials to allow indoor malls to open to alleviate crowded outdoor malls, where she said it is increasingly difficult to socially distance. Bartlett argued that indoor malls are more uniquely situated to promote social distancing because of the space as opposed to other businesses such as movie theaters and gyms.
The county has administered 399,424 coronavirus tests and documented 21,066 recoveries, according to the HCA.
Santa Ana has the most cases in the county with 6,570, and a case rate of 1,945.4 per 100,000 residents, followed by Anaheim with 5,954, and a case rate of 1,656.9 per 100,000 residents. They are the county's two largest cities by population, and home to many care facilities.
Two of the county's other biggest cities have much lower case rates, with Huntington Beach at 806.3 per 100,000 and Irvine with a case rate of 404 per 100,000.
In the jails, 53 inmates are in medical isolation with symptoms, with 419 having recovered. Officials are waiting for the results of 83 tests.