SANTA ANA, Calif. (CNS) — Orange County Health Care Agency officials Tuesday reported two more people have succumbed to COVID-19, raising the death toll to 1,289, and 138 new diagnoses, but the county's case rate fell below the threshold that would help launch it up to the less-restrictive orange tier.

The cumulative case count since the pandemic began stands at 54,898.

The positivity rate, which is reported each Tuesday, inched up from 3.1 percent last week to 3.2 percent, but the daily case rate per 100,000 people rose from 4.4 to 5.2, which is higher than the cutoff of 3.9 to qualify for a move from the red to the orange tier in the state's coronavirus monitoring system.

According to the HCA, hospitalizations increased from 168 Monday to 176 Tuesday, with the number of patients in intensive care up from 53 to 63. The change in three-day average hospitalized patients increased from -7.1 percent to 4.5 percent.

The county has 35 percent of its intensive care unit beds and 70 percent of its ventilators available.

The latest reported deaths were skilled nursing facility residents. Since the pandemic began, 465 skilled nursing facility residents and 89 residents of assisted living facilities have succumbed to the virus.

Falling short of reaching the orange tier frustrated some supervisors, who grumbled about how difficult it will be for urban counties such as Orange to ever reach the standard to get to the orange tier.

"We have to do more testing to meet the next step," Orange County Board Chairwoman Michelle Steel. "But when you do more testing there's more people, but most people are asymptomatic. At this point our hospitals are very low and we don't have any death[s] yesterday or something like that. We are doing really well so how can we jump out of this (red) tier."

Dr. Clayton Chau, the director of the HCA and the county's chief health officer, said increased testing can lower the positivity rate, but it can also lead to an increase in the case rate per 100,000. The state introduced the health equity measure, which launched Tuesday, to help counties address high case counts concentrated within certain zip codes that include high-density housing and language barriers, among other issues.

"If you're able to bridge the gap and bring it to the overall positivity rate you can move up to the next tier," Chau said.

Orange County got a head start on that weeks ago with its Latino Health Equity program that raised awareness of coronavirus within hot spots in Santa Ana and Anaheim, Chau said. Positivity rates as high as 20 percent have fallen to single digits in some of those neighborhoods, Chau said.

There is an "accelerator" in the state's formula that if the positivity rate makes it to the least-restrictive yellow tier but the case rate is in the red then a county can move up to orange, Chau said.

Supervisor Don Wagner asked why if there has been an increase in cases there hasn't been a significant impact on local hospitals. Chau said that is because the case rates are increasing among a younger demographic that can usually weather the virus without hospitalization.

Supervisor Doug Chaffee encouraged Chau to "keep pushing" on the reopening of theme parks such as Disneyland and Knott's Berry Farm.

Bartlett, the president of the California State Association of Counties, said she serves on a "kitchen cabinet" committee of the organization that is lobbying the state to let theme parks move into the orange tier category instead of being lumped in with mass gatherings like live concerts and sporting events in the yellow tier. Chau said he is the only county health officer who has made that recommendation to the state.

Bartlett said the yellow tier would reflect when a county has "eradicated COVID," so it would be unfair to restrict theme parks to that status before reopening.

"Disneylands have opened across the world and have not seen any spikes in COVID," Bartlett said. "And they have significant health and safety protocols. We are collectively pushing, pushing, pushing to have that done sooner rather than later."

The increase in cases was expected as more businesses reopened with the county moving from the most restrictive purple tier to the red tier, officials say.

State officials were expected on Friday to announce new guidelines for mass gatherings but did not do so. The mass gatherings include theme parks, concerts, and sporting events. The expectation was that those types of activities will not be allowed until a county moves up to the least restrictive tier of yellow, which could take months.

To qualify for the orange tier, the positivity rate must be 2 percent to 4 percent, and the case rate per 100,000 must be 1 percent to 3.9 percent.

Moving to the orange tier means retail businesses could operate at full capacity, instead of 50 percent as required in the red tier. Shopping malls could also operate at full capacity, but with closed common areas and reduced food courts, just as in the red tier.

The orange tier boosts capacity for churches, restaurants, movies, museums, zoos and aquariums from 25 percent capacity to half capacity. Gyms and fitness centers could boost capacity from 10 percent to 25 percent and reopen pools.

The orange tier also allows family entertainment centers like bowling alleys and wall-climbing to open indoors at 25 percent capacity.

According to HCA data, 905,296 COVID-19 tests have been conducted, including 5,286 reported Tuesday. There have been 49,141 documented recoveries.