SANTA ANA (CNS) — Orange County continued setting new daily COVID-19 hospitalization records Friday, and public health officials also reported 22 additional fatalities.

The number of coronavirus patients hospitalized jumped from 1,025 Thursday to 1,122 Friday, including an increase of intensive care unit patients from 257 to 265. The previous record for ICU patients was 245 in mid-July, and the overall hospitalizations have been breaking records daily since Dec. 2.

The Orange County Health Care Agency reported 2,655 new coronavirus diagnoses on Friday, raising the cumulative case total to 97,302.

The death toll stands at 1,662. Multiple sources provide the death notices, so there can be a delay of up to a few weeks. Of the 22 deaths reported on Friday, four were skilled nursing facility residents and five lived in assisted living facilities.

Orange County's percentage of available ICU beds went from 11.3% Thursday to 10.7% Friday, but according to a new state metric for "adjusted" ICU bed availability, the rate went from 3.5% to 2.3%, according to the HCA.

County CEO Frank Kim said the "adjusted" case rate essentially reflects the estimated number of beds available for COVID-19 patients when factoring in the number of beds needed for patients without the coronavirus.

The 11-county Southern California region's available ICU capacity diminished from 7.7% to 6.2%.

Orange County has 54% of its ventilators available.

Dr. Carl Schultz, the HCA's EMS medical director, put the county's hospitals and ambulance providers on notice Wednesday night to prepare for the surge of COVID-19 patients by considering the cancellation of elective surgeries.

"Hospitals are overwhelmed with admitted patients to both the floors and the ICUs. At the current rate of deterioration, the EMS system may collapse unless emergency directives are implemented now," he wrote.

The letter urges hospitals to activate surge plans, establish alternate treatment areas in emergency departments to expand capacity, cancel all elective surgeries, apply for state waivers in support of surge plans and establish emergency operations centers.

"To those facilities that have activated these initiatives, all health care partners and the citizens of Orange County are grateful," Schultz wrote. "To those who have chosen not to take this painful but necessary actions, there is still time, but you must act now."

Dr. Clayton Chau, the county's chief health officer and director of the Health Care Agency, said the letter from his agency to hospitals was triggered by recent reports of patients waiting in an ambulance for more than an hour before being sent to another hospital because it was full.

"If we do have patients sitting in an ambulance for more than an hour, then we will divert them to the next closest emergency room," Chau said. 

Over the last 24 hours, the average time it is taking to transport patients by ambulance is between 18 and 19 minutes, according to the HCA. Over the past month, 15 emergency response coordinators had ambulance transport times greater than 30 minutes and four had times exceeding an hour.

Orange County officials are preparing to reopen Fairview Developmental Center next week to care for COVID-19 patients who have milder symptoms, according to county CEO Frank Kim.

"The numbers across our region are not good," he told City News Service. "There isn't a different way to say that. The case rates continue to climb, and we know anywhere from seven to 12 days after that we're likely to see an increase in hospitalizations because it's directly linked to the new infections we're getting."

The main problem is asymptomatic people who are shedding the virus without knowing it, because most people who are ill are staying at home or are hospitalized, Kim said. Some residents may also be "shrugging off" mild symptoms, chalking it up to a cold or the flu, and should get tested, Kim said. 

Vaccines have already been shipped been Belgium and are on the way to Orange County, with about 25,000 doses en route, Kim said. The county has the necessary deep freezers and dry ice available to store the medicine, he said, noting that frontline hospital workers are expected to be among the first to receive the Pfizer vaccine.

"We also have agreements with local universities and hospitals that if, for some reason, we end up with more than we can handle, there are places to store the vaccines," Kim said. "And we've addressed security and have back- up generators in case the power is shut off. We've tried to address all potential issues."

Kim said the plan is to use the doses as soon as possible.

"Once it is in, we're just going to get it all out in 48 hours," Kim said. "I don't want to sit on it. The minute it comes in I don't care what time of day it is, I'll push it out."

With the first shipment of vaccines soon to arrive, Orange County Sheriff Don Barnes warned residents to beware of fraudulent sales pitches, noting the vaccines will be distributed for no charge.

The county's outbreak in the jails continued to widen, with the number of infected inmates increasing from 102 on Thursday to 138. Of those, 27 are newly booked inmates and 111 are in general population.

The outbreak even affected a current murder trial when defendant Austin Ambriz tested positive for COVID-19. Closing arguments were expected Thursday, but have been put off until Jan. 4 in his trial. 

The county is also dealing with an uptick in outbreaks at skilled nursing and assisted living facilities. As of Friday, 28 skilled nursing facilities have had two ore more confirmed cases of COVID-19, and 29 assisted living facilities had two or more cases.

County officials have been asked to provide personal protective equipment, more training or staffing to help curb the spread of COVID-19 in those facilities, where the main reason for the spread is likely from employees who contract the virus off-site, Kim said.

Chau pleaded with residents to stay at home as much as possible and wear a face covering when mixing with anyone outside of their household.

"Please do not mix households," he said. "Let me repeat that -- do not mix households... Please do not travel. You need to stay put. You need to stay home."

Orange County's adjusted daily case rate per 100,000 rose Tuesday to 30.3, up from 22.2 last week, with the positivity rate increasing from 8.8% to 10.6%.

The county's Health Equity Quartile Positivity Rate, which measures the cases in highly affected, needier parts of the county, rose from 13% last week to 16.2% this week.

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 home test-kit program has been growing, Chau said. Since the program launched in Santa Ana and Anaheim on Nov. 19, the county has sent out 19,233 of the home test kits at no charge. And since it was opened up to the rest of the county this week, the county has received 4,866 orders for the kits, Chau said.

The county received 13,619 tests on Friday. The total since the pandemic began is 1,641,316.