SANTA ANA (CNS) - Orange County Thursday reported one additional COVID-19 fatality and 229 new coronavirus cases.

The death toll stands at 1,468 and the cumulative case count at 59,442. The person whose death was reported Thursday was a skilled nursing facility resident.

The relatively high number of daily cases continues to jeopardize the county's chance to move into a less-restrictive tier of the state's re-opening road map. County officials have said the daily average would have to come down to about 130 for Orange County to move from the "red" to the "orange" tier, allowing for more businesses to reopen and for some already open to increase their capacity. Conversely, if the trend continues, the county could slip back into the most restrictive "purple" tier.

"The seven-day average is still in the low 5's on case rates," Orange County CEO Frank Kim said Wednesday. "Those high numbers have been spread out over the last week, so hopefully we stay in the red tier."

Orange County Supervisor Lisa Bartlett said the county's "other numbers are looking pretty good to help us into the orange tier, but we're very concerned about surrounding counties," where case rates are rising.

"Everything is regionalized," Bartlett said. "We're a major job center so we employ a lot of people (from surrounding counties) and a lot of our residents go into other counties to work."

Add in tourism and extended families traveling from county to county for visits, and "it can be really problematic," Bartlett said.

The number of hospitalizations related to the virus increased from 177 on Wednesday to 181, with the number of intensive care unit patients dipping from 60 to 59, according to the Orange County Health Care Agency.

The change in the three-day average of hospitalized patients went from 5.3% to 9.3%. The county has 35% of its intensive care unit beds and 66% of its ventilators available.

According to OCHCA data, 1,091,441 COVID-19 tests have been conducted since the start of the pandemic, including 9,102 reported Thursday. There have been 53,054 documented recoveries.

The county's positivity rate, which is reported each Tuesday, has remained at 3.2% for the last three weeks, but the daily case rate per 100,000 population increased from 4.6 last week to 5.1. That leaves the county still close to moving up from the red to the orange tier in the state's four-tier monitoring system.

The county's Health Equity Quartile Positivity Rate, which is a mandate to focus on hot spots in counties, stands at 6%. The county has to reach at least 5.2% in that metric to move into the orange tier.

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

On Wednesday, however, a study released by UC Irvine found coronavirus infections in the county to be seven times higher than previously thought.

County officials hired UCI to do a serological study of a large cross- section of residents to check antibodies for COVID-19 to get a better handle on how prevalent the highly infectious disease has been in the community, according to Kim.

The study showed that "the disease prevalence is about seven times greater than previously identified by positive tests," Kim said. It also showed that coronavirus infections were "greater in Latino and lower-income residents, which we knew because they had a higher positivity rate."

The reluctance to get tested can help fuel the spread of the virus, particularly among those who do not show any symptoms, Kim said. "Some don't want to submit to government testing, so if you don't test you might transmit it to a family member."

Dr. Matthew Zahn, the medical director of the county's communicable disease control division, said at Thursday's weekly news conference on the county's response to the disease that while coronavirus is particularly risky for people with underlying health conditions and the elderly, "we have certainly seen significant illness and death in younger populations."