SANTA ANA, Calif. (CNS) — As federal health officials Wednesday recommended that all vaccinated Americans get COVID-19 booster shots, Orange County's weekly coronavirus averages appeared to be stabilizing — offering hope the county may have reached a peak in case rates, though hospitalizations continue to climb.

According to weekly averages released on Tuesdays, the county's average daily case rate per 100,000 residents increased from 19 last week to 20.2, while the test positivity rate ticked down from 8.3% to 8.1%.

The county's Health Equity Quartile rate, which measures the impact on disadvantaged communities, slipped from 8.5% to 8.4%.

Meanwhile, as expected, federal health officials Wednesday recommended that all vaccinated Americans get booster shots eight months after they become fully vaccinated. That amounts to a third dose of the Pfizer or Moderna vaccine — and "likely" an additional dose for people who received the one- dose Johnson & Johnson shot.

Those shots could begin the week of Sept. 20, according to a joint statement Wednesday from the Centers for Disease Control and the U.S. Department of Heath and Human Services.

The CDC and HHS said data "make very clear" that protection against SARS-CoV-2 infection begins to decrease over time following the initial doses of vaccination.

"Based on our latest assessment, the current protection against severe disease, hospitalization, and death could diminish in the months ahead, especially among those who are at higher risk or were vaccinated during the earlier phases of the vaccination rollout," the agencies said. "For that reason, we conclude that a booster shot will be needed to maximize vaccine- induced protection and prolong its durability."

They added: "We have developed a plan to begin offering these booster shots this fall subject to FDA (the Food and Drug Administration) conducting an independent evaluation and determination of the safety and effectiveness of a third dose of the Pfizer and Moderna mRNA vaccines and CDC's Advisory Committee on Immunization Practices issuing booster dose recommendations."

In Orange County, there is hope that the recent surge is subsiding.

"Technically, we should be peaking now for cases ... and then in September peaking in hospital and ICU (numbers) ... so we're not out of the woods yet, and people need to be careful over the next two weeks," Dr. Regina Chinsio-Kwong, deputy health officer for the Orange County Health Care Agency, told reporters Tuesday.

Dr. Clayton Chau, the county's chief health officer and director of the OCHCA, said he thinks "we're pretty stable now" with infection rates.

"I am confident to say that we're probably reaching a peak now, a plateau," Chau said. "But we're keeping an eye on the hospitalizations."

Andrew Noymer, an epidemiologist and UC Irvine professor of population health and disease prevention, was less sure.

"I'm starting to worry that this wave will morph into one big fall wave," Noymer told City News Service. "So, have we found the peak? And the answer is nobody knows."

Even if the county is seeing a peak from the delta variant-fueled summer wave, the virus could find a second wind as children return to in-person learning for fall classes, Noymer said.

Noymer was troubled by another rise in hospitalizations on Tuesday, ticking up from 538 to 549, with the number of intensive care unit patients going from 124 to 126.

The county has 21.6% of its ICU beds available, and 70% of its ventilators.

"It's been six weeks since there was a decline in hospitalizations," Noymer said. "They can talk about case rate averages, but the hospital numbers haven't gone down in a single day in the last six weeks. I don't want to be doom and gloom, but I'm being a realist."

The county recorded 668 new infections Tuesday, raising the cumulative total to 276,632 since the pandemic began. The county also reported 14,594 tests, raising the cumulative total to 4,511,113.

Three more fatalities were logged — one in May and two others in January. The cumulative death toll is 5,161.

The death toll for August so far is four. The death toll for July is 14; 16 for June; 23 for May; 43 for April; 199 for March; 612 for February; 1,565 for January -- the deadliest month of the pandemic — and 968 for December, the next deadliest.

Fatalities have decreased because of the high vaccination rates of seniors who are most vulnerable to the virus, experts said.

Of those eligible to get a shot, 75.4% of Orange County residents have received at least one dose, up from 73% last week, Chau said. Of the eligible residents, 67% are fully vaccinated now, up from 65% last week.

The county is also seeing an increase in interest for a third shot of the two-dose vaccines from Pfizer and Moderna that have already been authorized for immunocompromised people, Chau said. That population includes organ transplant recipients and individuals undergoing therapies that suppress their immune system.

"We have seen a rise in the cases of people coming into everywhere, not just the county, who qualify for the third dose of MRNA vaccines," Chau said. "CVS ran out of appointments for the first time in quite some time."

Chau also said many nurses and physicians are struggling with morale problems as they slog through a year-and-and-half of the pandemic with another surge.

At least 90% of the hospital patients in the county are unvaccinated, he said.

"They're not happy putting themselves and family at risk again because, compared to the last few surges, people now have an option and (medical personnel are) not understanding why they're not taking that option," Chau said of vaccines.

There are four children in intensive care at Children's Hospital of Orange County due to COVID 19 — accounting for about half of its ICU beds, Chau said. In all, the hospital has 11 patients with the virus, he said.

"The fact that we have kids in ICU, I don't like," Chau said, adding all of the children are unvaccinated, including patients 12 and over who are eligible for inoculation.

Chau recommended that when students return to school, if they are in large groups of other unvaccinated students outdoors they should mask up.

Supervisor Katrina Foley, whose husband teaches teenage students, said, "If the adults model, the children will follow."

Of the infections affecting vaccinated patients locally, about half have compromised immune systems for a variety of reasons such as being an organ transplant recipient or having to take medication that suppresses the immune system, Chau said. Officials also suspect that some of the breakthrough infections are being caught because COVID-19 testing is mandated for all patients including those who come to the hospital for other reasons, he said.

Chau warned against relying on natural immunity from a previous infection because reinfection is possible, and he said a prior infection offers less protection than a vaccine.

The case rate for fully vaccinated residents is significantly lower than the case rate for not fully vaccinated residents, according to the OCHCA. According to the update on Thursday, the seven-day case rate is 7.4 per 100,000 for fully vaccinated, but 40.1 for those not fully vaccinated.

Dr. Jose Mayorga, executive director of the UCI Health Family Health Centers, told CNS that he was alarmed by the rising number of pregnant mothers getting infected.

He noted that the American College of Obstetrics and Gynecology is strongly recommending vaccines for expectant mothers. The U.S. Centers for Disease Control and Prevention has also reported the vaccines are effective and do not increase the risk of miscarriage, Mayorga said.

"Women who are pregnant and going through delivery have a five times greater risk of ending up the intensive care unit during childbirth" if they are infected with COVID-19, Mayorga said.

According to another recent study that UCI scientists were involved in, there has been a 40% increase in miscarriages for COVID-19 infected moms, Mayorga said.

"Forty percent is pretty significant," he said. "When I read that article, I was taken aback."

Millions of mothers around the world have received the vaccines with no effects, he said. There is a risk, however, to the health of an unborn baby with the virus, Mayorga said.