SANTA ANA, Calif. — Orange County officials again Thursday emphasized the importance of social distancing and mask usage to tamp down the recent surge in COVID-19 as case rates continue to rise.

"While Orange County remains in the red tier, it is important we continue that trend so that we can eventually go downward to the next tier," said Orange County Board Chairwoman Michelle Steel at the county's weekly news conference on its COVID-19 efforts.

"As we get closer to the holiday season, it is important we continue to wear a face mask when in public and practice social distancing when possible," Steel said.

The Orange County Healthcare Agency on Thursday reported 271 new diagnoses of coronavirus, raising the cumulative to 61,112, and three more fatalities, hiking the death toll to 1,494. Two of the fatalities reported Thursday were skilled nursing facility residents and the third resided in an assisted living facility.

The rate of deaths has been trending down over the past few weeks. From Oct. 25 through last Saturday, there were 39 deaths reported, up from 35 the week before, but lower than 69 the previous week. Since Sunday, 12 deaths have been reported.

The number of hospitalizations related to the virus went from 182 Wednesday to 178 Thursday, with the number of intensive care unit patients ticking down from 78 to 76, according to the Orange County Health Care Agency.

The change in the three-day average of hospitalized patients went from -1.6% to -2.7%. The county has 35% of its intensive care unit beds and 64% of its ventilators available.

According to OCHCA data, 1,148,439 COVID-19 tests have been conducted since the start of the pandemic, including 9,881 reported Thursday. There have been 54,429 documented recoveries.

The county's positivity rate, which is reported each Tuesday, but was reported Wednesday this week because of the election, rose from 3.2% to 3.6%, and the daily case rate per 100,000 population increased from 5.1 last week to 6.

The county's Health Equity Quartile Positivity Rate, which measures a county's response to hot spots, decreased from 6% to 5.7%. The county has to reach at least 5.2% in that metric to move into the orange tier from the red tier in the state's coronavirus monitoring system.

One of the peskiest issues county officials have been dealing with is the socializing among teens and young adults.

"It's a major issue," said Dr. Matthew Zahn, medical director of the county's communicable disease control division.

"I think our biggest goals, our most consistent goals, is reaching out to these populations," Zahn said.

Zahn said efforts are being made to reach out to students on campus to reinforce the importance of social and physical distancing and mask usage.

He said that often, however, on campus or at a work place, there is more mindfulness of social distancing, but not so much after class or work.

"The natural human habit is to let their guard down in social settings," Zahn said. "And it's the social settings where so much spread happens."

Health officials have been warning of a potential rise in cases during the holidays as residents seek to fraternize more and stay inside more often because of the changing weather.

"There seems to be an inevitability over the next couple of months," Zahn said. "But it's important we don't let our guard down."

Zahn advised residents to just celebrate the holidays in a different way than usual "because there is a risk there" of spreading the virus with family get-togethers.

He also commented on increasing youth sports activities in which parents and children are traveling out of states for competitions. He said the traveling back and forth isn't so much a concern, but the "crowding" that sports contests encourage "is a major driver of risk."

When asked about a swim meet in Irvine this weekend, Zahn said he wasn't aware of it, but was concerned the organizers had not reached out to the agency for guidance.

Officials have said the daily average of new cases would have to come down to about 130 for Orange County to make the orange tier, allowing for more businesses to reopen and for some already open to increase their capacity. However, if cases rise too much, the county could slip back into the most- restrictive purple tier.

Orange County's unadjusted rate per 100,000 is at 6.1, but the volume of testing brought it down to 6, Orange County CEO Frank Kim said Wednesday.

"It's OK, but it looks really good compared to our neighbors," Kim said of the county's rising case rates.

Kim noted that case rates were rising because of infections among university students.

"For us, we're not seeing that trend. It's not in our schools," Kim said.

There was a relatively small outbreak at Chapman University, but "we're not seeing a huge number" among higher education students in the county, Kim said.

"We're hanging on to red, so we're happy about that, but we're seeing a slow rise in case rates when we look at what's happening with our peers," Kim said. "We know our residents and their residents come and go between the counties and it's obviously a communicable disease so we're concerned about our peers." 

Dr. Clayton Chau, director of the OCHCA and the county's chief health officer, told the Orange County Board of Supervisors on Tuesday that he expects the case rate per 100,000 would likely be in the "high 5 to 6" range, which will keep the county within the red tier. The county cannot exceed 7, Chau said.

"For the month of October it's been 4.5 to about 5 or so," he said. "Since Oct. 29, the number has gone up quite a bit. We've seen cases going up statewide. Our colleagues in San Diego are on the edge of red and purple."

The county remains within the orange tier for the positivity rate, Chau said.

"We are encouraging our community to, number one, if they're sick they need to stay home," Chau said. "We encourage people to get their regular flu vaccine and because the weather is getting colder, a lot of activity will move indoors, so we encourage people to be really careful and follow [public health guidelines]."

Chau said there have been no outbreaks in the county's schools since they have reopened, "so you will see some of the school districts will reopen for in-person education throughout the month of November, December into January."

Family gatherings during the upcoming holidays is "my source of anxiety now," Chau said, adding, "just folks gathering, getting fatigue about all the [social distancing] behavior they need to do. It's not just happening in California, but it's happening elsewhere in the U.S. as well as worldwide. Several countries in Europe have entered lockdown for a month."