SANTA ANA, Calif. (CNS) — Orange County's hospitalization rates for COVID-19 and its case rate per 100,000 residents continued to climb Tuesday as officials implored people to not socialize over the Thanksgiving holiday and, if they do, to get tested before and after a gathering.

The county's Health Care Agency reported 837 new diagnoses of COVID- 19, raising the cumulative case total to 71,953, and two more fatalities, hiking the death toll to 1,556.

In the state's tiered system, which is updated on Tuesdays, the county's adjusted daily case rate per 100,000 residents jumped from 10.8 to 17.2 and the positivity rate swelled from 4.6% to 6.8%. The positivity rate fits in the red tier of the state's four-tier reopening roadmap, but the daily case rate per 100,000 is well past the 8% threshold for the second most- restrictive red tier.

The case rate per 100,000 is adjusted based on the level of testing a county does, said Orange County CEO Frank Kim. The unadjusted case rate per 100,000 is 20.2, which is similar to the 21.5 unadjusted rate in San Diego County, he noted.

"Historically, we have similar demographics and we tend to trend together," Kim said of the neighboring county.

Other neighboring counties have much higher rates, but it is due to many factors and Kim said it wasn't fair to compare counties.

"The main message I want to share is it's all around us and the spread of the virus within Southern California counties is significant. It's going to take awhile for us to identify and isolate all those individuals infected," Kim said. "It's going to take several weeks to ensure those people don't end up in hospitals."

Kim said he was a "bit surprised" that the surge in hospitalizations hasn't led to a corresponding increase in intensive care unit patients, but he cautioned it has been a lagging indicator and it is difficult to predict what will happen to the hospitalized patients.

The number of county residents hospitalized with the coronavirus increased from 428 on Monday to 463 on Tuesday, with the number of patients in intensive care rising 105 to 116, according to the HCA.

The change in the three-day average of hospitalized patients inched up from 26.4% to 26.8%. The county has 28% of its intensive care unit beds and 66% of its ventilators available.

The worst day for COVID-19 hospitalizations so far in the county was July 14, when there were 722 patients. The last time it was as high as it is now was in mid-August.

"That is not good," Kim said of hospitalization rates rising.

Kim, who is himself recovering from COVID-19, said it is the most difficult illness he has ever had to cope with.

"Every day you wake up feeling worse or the same and you start to lose your positive mojo," Kim said. "With any other flu I've ever had, after a few days you start to feel better."

Kim said he was optimistic, however, that vaccines are on the way and are scheduled to arrive by year's end. Hospital systems will get the vaccines directly and individual hospitals will receive doses from the county, Kim said.

Frontline healthcare workers will be among the first to receive vaccinations, along with people with underlying health conditions that make them especially vulnerable to the disease.

County officials on Tuesday again emphasized the importance of getting tested before and after any social events around the holidays. The hope is that increased testing and awareness of infections will encourage more quarantining and isolation and other social distancing practices that help curb the spread of the virus, Kim said. 

Although many officials have speculated that extended family gatherings and fraternization among friends has spurred the recent spread of coronavirus, Kim said the truth is most experts are unable to pinpoint a specific cause.

"I just keep hearing it's not within any specific industry," Kim said. "Because the disease transmission is so broad across the community it's really difficult to isolate if it's happening at retail or schools. It's all over the community."

Clamping down on business activity such as al fresco dining likely won't help stem the tide, Kim said.

"I think it's pointless," he said of canceling outdoor dining at restaurants. "I think it makes more sense that people are armed with good information and exercising responsible behavior, and the vast majority of people are."

Kim added that "the fear is that if you clamp down too hard, they'll be so upset that will they even at that point tune out and not even respond to the good information It's a delicate balance. It's a conversation I have with my peers regularly. There's a line you have to follow and people will support you and understand, but once they believe it's less based on science and it's straying into politics, they'll be less likely to follow the good advice."

Another looming issue for the county is how to finance continued testing when federal stimulus money from the CARES Act runs out at year's end, Kim said.

"I can't shutter my testing programs," he said. "We'll have to dig heavily into reserves."

Kim hopes that any future stimulus funding will include retroactive reimbursement for COVID-19 testing.

"One of the things they (federal lawmakers) could have done was pass an austere stimulus that maintained testing infrastructures," Kim said. "To pull that plug is a huge mistake I think they'll get something done. I just hope it's sufficient."

The county's tests per 100,000 stands at 354.1, outstripping the county's goals for testing at this point, he said.

Kim said the county is focusing on encouraging testing. The number of tests conducted in the county stands at 1,370,111, including 12,251 reported Tuesday. There have been 58,289 documented recoveries.

If residents insist on a Thanksgiving gathering, they need to consider a meal outdoors and keeping the number of the party as small as possible, he said.

"If you're going to get together anyway, there's a value in getting tested," Kim said. "It's a snapshot in time of how you're doing, but you can't get yourself tested and then run 20 different errands and show up to Thanksgiving. It defeats the whole purpose of how you're managing all that, but the concept is test yourself more frequently, reduce the amount of activities outside your stable cohorts and after an event -- if you're going to have one -- it wouldn't be harmful to get a second test. But, obviously, the safest thing is to stay at home."