SANTA ANA, Calif. (CNS) — Nineteen more people succumbed to COVID-19 in Orange County, raising the death toll to 1,268, and officials also reported 194 new diagnoses of coronavirus Wednesday, hiking the cumulative total to 53,751. 

The reporting of COVID-19 fatalities comes from multiple hospitals and the Orange County coroner's office and are often delayed, so the 19 deaths happened over the past few weeks. But the county has reported 54 fatalities since Sunday, following 77 last week.

Of the 19 deaths reported Wednesday, four were skilled nursing facility residents and one was an assisted living facility resident. Since the pandemic began, 455 of the fatalities were skilled nursing facility residents and 89 were assisted living facility residents.

The deadliest day for the county since the pandemic began remains August 3 when 19 people died that day from coronavirus. The last day of double-digit deaths was August 31 when 10 people died.

Hospitalizations jumped up from 162 Tuesday to 172 on Wednesday, with the number of patients in intensive care inching up to 48. The county has 33 percent of its intensive care unit beds available and 65 percent of its ventilators. The change in 3-day average for hospitalized patients rate increased from 1.2 percent Tuesday to 3.8 percent Wednesday.

The positivity rate, which is reported each Tuesday, stands at 3.1 percent, the same as last week, but the daily case rate per 100,000 people went up from 3.6 to 4.4, which is higher than the cutoff of 3.9 to qualify for the orange tier.

It means the county will remain in the red tier for at least another two weeks, but there is hope the trend will continue and the county will be able to move up to the orange tier by mid-October.

Last Thursday's and Friday's numbers put the county over the top, said Dr. Clayton Chau, the director of the Health Care Agency and the county's chief health officer.

"We've had a few days of uptick in numbers, small but significant to affect our tier system," Chau told the Orange County Board of Supervisors on Tuesday. Chau said it appears that Labor Day gatherings led to the increase.

One of the thorniest problems is young adults renting out vacation residences for parties, Orange County CEO Frank Kim said Monday.

The small spike in cases per 100,000 people "doesn't signify something terrible in the community," Kim said. "When you get down to around 3.5 to 4 cases per 100,000 that's very small."

In a county the size of Orange County with a population of about three million that would be about 32 additional cases. It is difficult to pin down the source of outbreaks in a sample size that small, Kim said.

Orange County Supervisor Lisa Bartlett said there is concern about a see-sawing back and forth between the red and orange tiers, because if the county has to step back a tier that locks it into place for at least three weeks even if the metrics match a less-restrictive tier.

Chau said officials do not suspect children returning to school have had an impact on the numbers. Private schools that received waivers were allowed to return to school in August, Chau told the supervisors.

"We have not had any outbreaks in all of the schools," Chau said.

Bartlett raised concerns Tuesday with Chau about UC Irvine students returning to campus because many are coming from out of the country and out of state. But Chau reassured her that the university has a regular and strict testing protocol in place. UC Irvine is bringing back 7,500 of its 30,000 students to campus.

"It looks like UCI is one of the strictest UC campus, which is good for us," Chau said. "They have a great testing protocol and contact tracing system and what have you." 

The OCHCA also reported that 864,947 COVID-19 tests have been conducted, including 7,063 reported Wednesday. There have been 48,326 documented recoveries.

To qualify for the orange tier, the positivity rate must be 2 percent - 4 percent, and the case rate per 100,000 must be 1 percent - 3.9 percent.

Moving to the orange tier means retail businesses could operate at full capacity, instead of 50 percent in the red tier. Shopping malls also could operate at full capacity, but with closed common areas and reduced food courts just as in the red tier.

The orange tier boosts capacity for churches, restaurants, movies, museums, zoos and aquariums from 25 percent capacity to half capacity. Gyms and fitness centers could boost capacity from 10 percent to 25 percent and reopen pools.

The orange tier also allows family entertainment centers like bowling alleys and wall-climbing to open indoors to 25 percent capacity.