SANTA ANA (CNS) — Orange County Friday reported seven additional COVID- 19 fatalities and 276 new coronavirus cases, continuing a trend of rising case counts that may threaten its status in the red tier. 

The death toll stands at 1,475 and the cumulative case count at 59,718. Six of the seven reported fatalities were skilled nursing facility residents.

The relatively high number of daily cases continues to jeopardize the county's chance to move into a less restrictive tier of the state's re-opening road map. County officials have said the daily average would have to come down to about 130 for Orange County to move from the red to the orange tier, allowing for more businesses to reopen and for some already open to increase their capacity. But if the trend continues, the county could slip back into the most restrictive purple tier.

"Not this Tuesday, but I do think there is a risk two weeks from now" that the county could slip back into the purple tier, Orange County CEO Frank Kim said.

It's not unique to Orange County, Kim said.

"There's a trend of increasing cases in Southern California," Kim said. "It's a concern for all of us because we're going to move as a region."

Orange County officials have not seen a corresponding increase in hospitalization and intensive care unit occupancy, Kim said. That may indicate that the case rates are rising among young adults, he added.

"So how do you get these young people 18 to 24 to test at a higher quantity?" Kim said. "I want to be like San Francisco. I want to be a massive tester. If you're asymptomatic, we can't identify you and get you moved away from your family and friends and get you isolated and treated."

Officials are hoping another round of stimulus spending from the federal government will include enough funding for a massive upscale in testing and contact tracing, Kim said. The county is also eyeing a number of ways to reach out to young adults to get tested.

Dr. Clayton Chau, director of the county's Health Care Agency and chief health officer, noted the "fluctuation" in case rates over the past week.

"It's fluctuated between 4.6 to 5.4," Chau told reporters in a weekly news conference Thursday. "But we are still consistently on the low range of the red tier, knock on wood, hoping we will keep it that way. Obviously, there have been cases rising these past two days and my colleagues have seen that as well. Hopefully we're not looking at a second wave."

Chau acknowledged that "there's always that risk" of falling back into the most-restrictive purple tier.

"All of us are working very hard and together as a region to ensure that the community is not running into the fatigue issue with masks and social distancing," he said.

He also said higher education officials in the county will tell students who intend to go home outside the state for the holidays to remain home and continue the rest of the term studying online "rather than traveling back to Orange County."

He said he understands that residents "will have a hard time adjusting" to socially distanced holiday celebrations.

But the health officer encouraged parents and educators to hold drive- through Halloween events instead of door-to-door trick-or-treating. He noted the county is holding a drive-through Halloween event at Mile Square Park Saturday evening.

"So make sure children are not missing out on the festivity, but doing it in a safe way," Chau said.

The number of hospitalizations related to the virus increased from 181 Thursday to 182 Friday, with the number of intensive care unit patients increasing from 59 to 61, according to the Orange County Health Care Agency.

The change in the three-day average of hospitalized patients went from 9.3% to 15.1%. The county has 36% of its intensive care unit beds and 67% of its ventilators available.

According to OCHCA data, 1,098,630 COVID-19 tests have been conducted since the start of the pandemic, including 7,189 reported Friday. There have been 53,265 documented recoveries.

The county's positivity rate, which is reported each Tuesday, has remained at 3.2% for the last three weeks, but the daily case rate per 100,000 population increased from 4.6 last week to 5.1. That leaves the county still close to moving up from the red to the orange tier in the state's four-tier monitoring system. 

The county's Health Equity Quartile Positivity Rate, which is a mandate to focus on hot spots in counties, stands at 6%. The county has to reach at least 5.2% in that metric to move into the orange tier.

Moving into the orange tier would mean retail businesses could operate at full capacity, instead of 50% 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.

On Wednesday, however, a study released by UC Irvine found coronavirus infections in the county to be seven times higher than previously thought.

County officials hired UCI to do a serological study of a large cross- section of residents to check antibodies for COVID-19 to get a better handle on how prevalent the highly infectious disease has been in the community, according to Kim.

The study showed that "the disease prevalence is about seven times greater than previously identified by positive tests," Kim said. It also showed that coronavirus infections were "greater in Latino and lower-income residents, which we knew because they had a higher positivity rate."

The reluctance to get tested can help fuel the spread of the virus, particularly among those who do not show any symptoms, Kim said. "Some don't want to submit to government testing, so if you don't test you might transmit it to a family member."

Dr. Matthew Zahn, the medical director of the county's communicable disease control division, said at Thursday's weekly news conference on the county's response to the disease that while coronavirus is particularly risky for people with underlying health conditions and the elderly, "we have certainly seen significant illness and death in younger populations."