SANTA ANA (CNS) — Orange County's metrics under California's four- tiered system for reopening businesses were up this week as new numbers were reported Wednesday, but the county remained in the red tier despite a big bump in hospitalizations. 

The county reported 237 new COVID-19 diagnoses and seven additional coronavirus-related fatalities, raising the cumulative case count to 60,841 and the death toll to 1,491.

Four of the people who died lived in skilled-nursing facilities.

The rate of deaths has been trending down over the past few weeks. From Oct. 25 through last Saturday, there were 39 deaths reported, up from 35 the week before, but lower than 69 the previous week. Since Sunday, nine deaths have been reported.

The number of hospitalizations related to the virus went from 177 Tuesday to 182, with the number of intensive care unit patients jumping up from 60 to 78, according to the Orange County Health Care Agency.

The change in the three-day average of hospitalized patients went from -1.8 percent to -1.6 percent. The county has 32 percent of its intensive care unit beds and 65 percent of its ventilators available.

According to OCHCA data, 1,138,558 COVID-19 tests have been conducted since the start of the pandemic, including 7,261 reported Wednesday. There have been 54,170 documented recoveries.

The county's positivity rate, which is reported each Tuesday, but was reported Wednesday this week because of the election, rose from 3.2 percent to 3.6 percent, and the daily case rate per 100,000 population increased from 5.1 last week to 6.

The county's Health Equity Quartile Positivity Rate, which measures a county's response to hot spots, decreased from 6 percent to 5.7 percent.

The county has to reach at least 5.2 percent in that metric to move into the orange tier from the red tier in the state's coronavirus monitoring system.

Officials have said the daily average of new cases would have to come down to about 130 for Orange County to make the orange tier, allowing for more businesses to reopen and for some already open to increase their capacity.

However, if cases rise too much, the county could slip back into the most-restrictive purple tier.

Orange County's unadjusted rate per 100,000 is at 6.1, but the volume of testing brought it down to 6, said Orange County CEO Frank Kim.

"It's OK, but it looks really good compared to our neighbors," Kim said of the county's rising case rates.

Kim noted that case rates were rising because of infections among university students.

"For us, we're not seeing that trend. It's not in our schools," Kim said.

There was a relatively small outbreak at Chapman University, but "we're not seeing a huge number" among higher education students in the county, Kim said.

"We're hanging on to red, so we're happy about that, but we're seeing a slow rise in case rates when we look at what's happening with our peers," Kim said. "We know our residents and their residents come and go between the counties and it's obviously a communicable disease so we're concerned about our peers."

Dr. Clayton Chau, director of the OCHCA and the county's chief health officer, told the Orange County Board of Supervisors on Tuesday that he expects the case rate per 100,000 would likely be in the "high 5 to 6" range, which will keep the county within the red tier. The county cannot exceed 7, Chau said.

"For the month of October it's been 4.5 to about 5 or so," he said. "Since Oct. 29, the number has gone up quite a bit... We've seen cases going up statewide. Our colleagues in San Diego are on the edge of red and purple."

The county remains within the orange tier for the positivity rate, Chau said.

"We are encouraging our community to, number one, if they're sick they need to stay home," Chau said. "We encourage people to get their regular flu vaccine and because the weather is getting colder, a lot of activity will move indoors, so we encourage people to be really careful and follow (public health guidelines)." 

Chau said there have been no outbreaks in the county's schools since they have reopened, "so you will see some of the school districts will reopen for in-person education throughout the month of November, December into January."

Family gatherings during the upcoming holidays is "my source of anxiety now," Chau said, adding, "just folks gathering, getting fatigue about all the (social distancing) behavior they need to do. It's not just happening in California, but it's happening elsewhere in the U.S., as well as worldwide. Several countries in Europe have entered lockdown for a month."

Board Chairwoman Michelle Steel asked county staff during Tuesday's meeting about what impact a tentative ruling this week from a Sutter County Superior Court judge restricting Gov. Gavin Newsom's authority to issue executive orders during an emergency will have on Orange County.

"It was a very interesting decision," County Counsel Leon Page said. "It was a tentative decision so it's not final yet, not binding on the court. The judge can change her mind."

Page also noted Newsom can appeal it and will likely do so.