SANTA ANA (CNS) – Twenty more people in Orange County have succumbed to COVID-19, raising the county's death toll to 789, with 683 more coronavirus cases reported Friday, hiking the cumulative total to 42,854.

Case counts have been up and down since Sunday as officials catch up on the backlog with the state's system, but Orange County Health Care Agency officials reported Thursday that their statistics are now up to date.

Orange County CEO Frank Kim told reporters at a news conference Thursday the statistics reported include the backlog of numbers from the state.

"Based on the numbers we see today and the analysis of our team, we do believe we're below the 8% threshold" for the rate of positive tests, Kim said. At the county's peak it was about 14.9%, he said.

"We think we're looking good again, but we can't confirm that until the state posts its monitoring number," he said.

"I'm very confident and optimistic our numbers are close to the state number," said Dr. Clayton Chau, director of the Orange County Health Care Agency and the county's interim chief health officer.

Of the fatalities reported Friday, seven were skilled nursing facility residents. Since the pandemic began, 300 of the victims who died were skilled nursing facility residents, 44 were assisted living facility residents, and one was homeless.

Since Sunday, the county has reported 69 fatalities.

Chau emphasized that not all of the fatalities happened this week. Because of the way hospitals report the numbers, it can take up to a week before a fatality is confirmed as COVID-19 related and reported to the county. The most deadly day during the pandemic was July 8, when 16 people succumbed to COVID-19. Fifteen COVID-19 deaths were reported June 24, July 7, and July 11. The last time the county reached double digits in fatalities was Aug. 3, when 11 people died. The most recent fatalities were Tuesday, when two people died.

The number of people hospitalized for COVID-19 in the county's hospitals dipped from 438 Thursday to 436, according to the HCA, with the number of patients in intensive care units jumping from 143 to 152. 

But the rate of residents testing positive for COVID-19 in the county decreased from 7.6% to 7.2%. The state's desired threshold is 8%. The county's case rate per 100,000 residents increased from 116.2 to 121.7, which is far higher than the California Department of Public Health threshold of 25 per 100,000 residents.

The change in the three-day average of hospitalized patients went from 8.8% to 5.9%, which is lower than the state's threshold.

The county has 31% of intensive care unit beds available, which is better than the state's 20% threshold. And the county's hospitals also have 56% of their ventilators available, higher than the state standard of 25%.

The county reported that 527,578 COVID-19 tests have been conducted, including 9,513 reported Friday. There have been 33,697 documented recoveries.

County officials also announced Thursday they had launched a new outreach program to help provide mental health resources and services with the "What You Feel is Real" campaign.

The campaign was developed to help residents take advantage of no-charge resources available to anyone suffering issues related to the pandemic.

The resources are listed on the county's website or by calling the National Alliance on Mental Illness (NAMI) hotline at 877-910-WARM.

Jeff Nagel, director of behavioral health services at the Health Care Agency, said officials were working on such a program before the pandemic, but the crisis "made it happen. That transition was to shift from in-person services to telephonic and tele-health. We are continuing to build our capacity for tele-health services and equipping our staff with laptops that have the cameras and speakers so that they can be capable of delivering those services both remotely as well as in the work place." 

Nagel said calls to the NAMI hotline have shot up by about 50% since the stay-at-home orders in March. "About 20% of calls coming into the counseling programs are COVID-related," he said.

As local school officials prepare for classes to begin, county officials are tabulating the number of coronavirus cases by various age groups.

Since the pandemic began, there have been 414 children up to age 3 who have been infected; 570 in the 4-to-9-year-old age group; 438 from 10 to 12 years old; 421 among 13- and 14-year-olds; and 1,477 in the 15-to-18-year-old age group.

Many elementary schools are preparing applications for waivers from the county and state that would allow for in-person classroom teaching up to the sixth-grade level. The state has mandated that schools in counties on the watch list must employ distance learning until they get off the watch list.