SANTA ANA (CNS) — Orange County set a new record Thursday for COVID-19 patients hospitalized -- 735 -- with 179 of those patents in intensive care units, which is nearing a mid-July high.

The "third wave" of coronavirus in the state prompted Gov. Gavin Newsom Thursday to slam again on the "emergency brake" and issue another stay-at- home order that will shut down bars, wineries, personal services businesses such as hair salons and barbershops and restricts restaurants to just takeout and delivery. Retail businesses that remain open will be restricted to 20% capacity.

When ICU rates fall below 15% in any region, such as Southern California, then the new restrictions kick in within 48 hours. A well-placed source said that will happen Friday, meaning businesses throughout Southern California will have to abide by the new restrictive stay-at-home order. 

Orange County CEO Frank Kim said he would be on a call with state public health officials Thursday evening to discuss details of how the new regional approach affects individual counties.

"But if you're worried about hospital beds, looking at it within regions makes sense because in the past we received overflow from other counties," Kim told City News Service.

In Orange County, the number of hospitalized patients reported Thursday exceeds the previous high of 722 recorded on July 14. The ICU high -- 245 -- was set in mid-July.

Three of the eight fatalities reported Thursday were skilled nursing facility residents and the remaining lived in assisted living facilities. So far this week, nine deaths have been reported, compared with 26 logged from Nov. 22 through Saturday.

Deaths are a lagging indicator, however, officials say.

Andrew Noymer, a UC Irvine associate professor of population health and disease prevention, said deaths will rise a couple of weeks from now.

"I guarantee it," he told CNS on Wednesday. "There's no cases without deaths."

The death toll increased to 1,586 Thursday, and 1,102 newly diagnosed coronavirus infections raised the cumulative case count to 81,653.

The county's hospitalization rate increased from 689 on Wednesday to 735 on Thursday, and ICUs bulged from 171 patients to 179.

On Monday, there were 605 hospitalized in county medical centers, with 146 in ICUs.

"We can't take much more than the 722 we had in July," Noymer said Wednesday. "It's going to get worse is the problem. It's going to exceed 722. We're pushing into unknown territory."

The last time hospitalization rates were this high was July 25 -- with 687 patients -- and the last time ICU rates were this high was Aug. 2, with 175 patients.

On Tuesday, the county had 23% of its ICU beds available, but that number dropped to 17% on Thursday. The percentage of ventilators available decreased from 61% to 57%.

Availability of beds is not as much of a problem as staffing them with the necessary medical personnel, Noymer said.

"You could rent all the motels in Orange County and have the beds, so it's not the bed itself -- it's the staff," he said.

This most recent surge does not take into account Thanksgiving Day or Black Friday shopping gatherings, Kim said.

"By the time we see the impacts from those gatherings, that will be anywhere from seven to 10 or 12 days out," he said.

Kim said county officials were already in discussions with business leaders in anticipation of the stay-at-home order before it was officially announced by the governor.

"This one is a little more flexible than the original" in March, Kim said, noting at that time indoor malls were entirely closed.

"We're obviously hoping that our community members take this very seriously so we can quickly restore our (hospital) bed capacity and transition back into the red tier," Kim said.

County officials are eyeing a reopening of the Fairview Medical Center in Costa Mesa to care for the ill, Kim said. Newsom announced that Fairview would provide 180 beds.

"It's a good thing we have that flexibility in capacity and can do that," he said.

Hospitals are struggling with an ongoing nursing shortage, Kim said.

"It has been exacerbated by what is happening in the Midwest," he said. "They have had a shortage there with a growth in Covid, so they have offered very good-paying jobs, so we're competing for limited resources across the United States."

Orange County Supervisor Lisa Bartlett, who is the immediate president of the California State Association of Counties, has expressed similar concerns.

"There's plenty of space for ICU expansion and equipment like ventilators and (personal protective equipment), but there's a potential major shortage of hospital staffing" for ICU beds, which require a higher degree of care skills and experience, she said Tuesday.

Orange County "has been in a bit of a bubble where we have significant hospital bed capacity that can be staffed and we've got ventilators and PPE," Bartlett said. "But other counties may not be in the same situation we're in, and that concerns me."

The state's tiered monitoring system metrics were updated again Tuesday. The adjusted daily case rate per 100,000 rose from 18.7 on Monday to 22.2 on Tuesday, with the positivity rate going up from 7.6% to 8.8%.

The county's Health Equity Quartile Positivity Rate, which measures the cases in highly affected, needier parts of the county, stands at 13%, nearly three times higher than it was last reported Nov. 10.

All of the county's metrics now fall within the state's most- restrictive, purple, tier of the four-tier coronavirus monitoring system.

The county's unadjusted case rate per 100,000, which doesn't take into account testing rates and other factors, stands at 29.8. That is "middle of the pack" in Southern California with San Bernardino at 46.1 and Riverside at 28.5, according to Kim.

He said the county is "increasing capacity at our testing sites (in Anaheim and Costa Mesa). That's one thing that's important for the public to understand. Our testing sites are in high demand for each of the appointment slots, so we continue to add to our testing capacity."

He said he was encouraged to see the county's testing rate per 100,000 at 411.2. Officials hope that testing will encourage the afflicted to quarantine and contact others about exposure, encouraging them to socially distance.

The number of tests conducted in the county stands at 1,498,188, including 15,903 reported Thursday.

The county has also received about 500 some take-home testing kits that were disseminated starting last week. About 50 of them came back positive, in keeping with the general positivity rate, Kim said. The county expects another shipment of about 5,000 of the take-home tests soon, he said.

Officials recommend waiting at least two days after traveling or attending an event or gathering to get tested because the infection might not be detected right away.

The county is expecting to receive its first shipment of vaccines by mid-December, Kim said. Larger hospital systems will get them directly, but the county will receive vaccines to hand out to individual, stand-alone hospitals, Kim said.

Frontline health care 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 are concerned about whether enough people will get shots to achieve herd immunity, so they sent out a survey and received about 20,000 responses that they hope to use to guide a public awareness campaign, Kim said.

Diocese of Orange Bishops Kevin Vann, Thanh Thai Nguyen and Timothy Freyer endorsed the state's conference of bishops' approval of coronavirus vaccines from Pfizer and Moderna.

"After thorough research and reviewing the statement from the Pontifical Academy for Life, we find the vaccines morally acceptable and imperative in the ongoing effort to curb the coronavirus pandemic."

The bishops "urge the 1.3 million Catholics in Orange County to take any and all appropriate steps to protect themselves and their families."