Orange County's run in the COVID-19 red tier ended Monday with a lapse back into the most-restrictive purple tier of California's four-tier reopening roadmap.
Orange County -- which has seen a big spike in new cases along with the rest of the state -- joined 28 other counties with a jump back into the purple tier.
County health officials reported 380 new cases of the coronavirus on Monday, raising the cumulative count to 65,605. There were no new fatalities so the death toll stands at 1,526.
Although cases have risen sharply -- with more than 500 cases announced Friday and Saturday and more than 600 on Sunday -- deaths have been decreasing. Last week, the county reported 18 deaths, compared with 24 the week before.
But Orange County Supervisor Lisa Bartlett, the president of the California State Association of Counties, said deaths are a lagging indicator and as hospitalizations increase, eventually so do fatalities.
County officials expected to learn they would fall back into the purple tier on Tuesday, but state officials moved it up a day due to concerns about hospital staffing shortages, Bartlett said.
"We have 78,000 hospital beds statewide, but staffing for only 45,000 to 55,000," Bartlett said.
"Hospitals are having a difficult time keeping staffing levels up," she said.
The number of county residents hospitalized with the virus rose from 242 Sunday to 257 Monday, with the number in the intensive care unit declining from 90 to 85, according to the Orange County Health Care Agency.
The change in the three-day average of hospitalized patients went from .3% to -0.7%. The county has 31% of its intensive care unit beds and 65% of its ventilators available.
Previously, a relatively small percentage of infected people needed hospitalization but that number has crept up to 12% who test positive requiring a stay in a hospital, Bartlett said. Orange County, which has long boasted ample hospital capacity, is also reporting concerning staffing issues, Bartlett said.
"I've spoken to several individuals relative to our hospitals and they are very concerned about not being able to keep up their staffing levels," Bartlett said.
Many medical professionals are going to jobs elsewhere where there is greater need and some are not taking on the overtime they previously accepted, officials said.
The rise in cases hit home locally when Orange County CEO Frank Kim was infected with COVID-19. Contact tracers suspect Kim was infected Nov. 5 and developed symptoms Nov. 7 before he was diagnosed as positive Nov. 10.
Kim, who is known for being careful with regard to social distancing and mask usage, told City News Service that his case was a cautionary tale about how highly infectious coronavirus is.
"You can have COVID, you can be infectious even if you're not symptomatic, so it's important for everyone to take it seriously so we're able to stem the growth of infections," Kim told CNS.
Kim is frequently tested and he quarantined as soon as he felt symptoms so no one else he has been in contact with has been infected, he said.
According to OCHCA data, 1,255,178 COVID-19 tests have been conducted since the start of the pandemic, including 4,848 reported Monday. There have been 56,548 documented recoveries.
The county's positivity rate, which has been reported each Tuesday but was moved up to Monday, jumped up from 3.3% last week to 4.6%, and the daily case rate per 100,000 population ballooned from 5.6. to 10.8 on Monday.
The county's Health Equity Quartile Positivity Rate, which measures a county's response to virus hot spots, decreased from 5.7% to 5.5% as of Nov. 10. It was not updated yet on Monday. The county has to reach at least 5.2% in that metric to be upgraded from the red tier to the orange tier.
Kim said the case rate per 100,000 jumped higher than 8 as officials expected because the state began using a 4-day lag, instead of a 7-day lag.
The county is providing 277.9 tests per 100,000 residents on a 7-day average with a 7-day lag, but Kim said the county is aiming for 300 and may open up more lanes at super sites in Anaheim and Costa Mesa to speed up wait times.
Orange County Board of Supervisors Vice Chairman Andrew Do said the county this week will announce a plan to provide coronavirus testing home kits to residents to help stem the tide of COVID-19.
The county has acquired 500,000 test kits that can detect coronavirus from saliva. Plans are to make them available at public libraries and city halls throughout the county, Do said.
"We want it to be mobile and at the neighborhood level, so people can see testing as part of their holiday safe practices," he said. "Before you go to see your grandparents, two or three days before you get tested, and after the family get-together, you wait two or three days and get tested again.
Then that way you know going in or coming out of a get-together if you're safe and the people you are with are safe."
Experts recommend the two- to three-day buffer because it can take that long before the infection is detected from a test.
"We haven't worked through the protocol yet" but this week Orange County will have a program that will include locations that are easily accessible to people, Do said.
The rise in cases is "alarming," he said. "It points to a very difficult winter season coming up, and couple that with the holiday season and people need to be very vigilant."
County officials will also soon issue recommendations on best practices for get-togethers over the holidays, which include dining outdoors and keeping the gatherings small in number, Do said.
"Make it a lunch thing where the weather is more tolerable," he said.
County officials had expected to fall back into purple, but under earlier state guidelines that would have given enough time to allow for indoor dining at restaurants on Thanksgiving and Black Friday shopping for malls at a higher capacity, but new state rules mean the tighter restrictions will be implemented sooner.
Instead of a 10-day lag, now businesses are expected to comply with the tighter restrictions as quickly as possible.
Schools won't be closed, but there would be no new school reopenings unless they were able to acquire a variance from the county.
Among the businesses and institutions that would be closed for indoor activity would be churches, museums, zoos, aquariums, gyms, restaurants and movie theaters.
Do said residents should reconsider how they gather for holiday celebrations.
"We have to be very thoughtful now how we celebrate the holidays,"
Do said. "It is a time of reflection and family bonds and friendship, but this year in particular we have to weigh the very severe price we will all have to pay if this pandemic goes unchecked… Increasing the risk of infecting them would far outweigh the benefit of getting together with friends and family."
Do said he is also mindful of the burden the restrictions are having on businesses.
"I want to emphasize this is something deep in my heart that there are a lot of people suffering," Do said. "Not just from COVID, but a lot of business owners and families are seeing their livelihood and not knowing what the future will hold. This holiday season will be a strain on a lot of people."
But cutting back on social gatherings and staying home as much as possible is important "so we can get back to rebuilding what a lot of business owners have lost."