Orange County reported 246 new cases of COVID-19 and two additional deaths Sunday, bringing the county's totals to 53,315 cases and 1,216 fatalities.
Hospitalizations increased from 156 Saturday to 165, although the number of patients in intensive care dipped from 47 to 45.
The Orange County Health Care Agency also reported Sunday that 846,896 COVID-19 tests have been conducted, including 8,851 reported Sunday. There have been 47,783 documented recoveries.
Of the two deaths reported Sunday, none were living a skilled nursing or assisted living facility. Since the pandemic began, 446 of the deaths were among skilled nursing facility residents, and 85 among assisted living facility residents.
Officials are hopeful their overall trends are improving enough to lift the county into the orange tier of the state's monitoring system by Tuesday when new rates of positivity and cases per 100,000 people are updated. The county has been averaging rates below and slightly above the orange tier over the past week, so it's unclear how that will average out on Tuesday.
"We're cautiously optimistic for Tuesday," said Supervisor Lisa Bartlett. "We have been trending in a good direction, but we have to see where we are... Now we're having little blips with those spikes, but it depends on how it averages out."
The tier systems reflects metrics used by the state to rate counties' efforts to slow the spread of the virus using the number of new daily cases per 100,000 residents.
Bartlett and Orange County CEO Frank Kim said it is unclear what might be driving the spikes. The most persistent and common problem continues to be extended family gatherings, Kim said.
Bartlett is concerned that the return of students to campus at UC Irvine this week will affect the county's caseload the way an outbreak at San Diego State University did.
"San Diego barely held on to the red tier," Bartlett said of the tier just above the most restrictive purple tier.
"You're getting students from other counties, other states and other countries," Bartlett said. "Even with a robust testing program, we saw firsthand what happened at San Diego State. I would hate to replicate that here in Orange County."
The overall positivity rate went from 3.9% to 3.1%, and the daily case count per 100,000 people dropped from 4.7 to 3.6. The county has to remain within that range for another week, then it can move up from the red to the orange tier.
Moving up to the orange tier means retail businesses could operate at full capacity, instead of 50% in the current 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% capacity to half capacity. Gyms and fitness centers could boost capacity from 10% to 25% and reopen pools.
The orange tier also allows family entertainment centers like bowling alleys and wall-climbing to open indoors to 25% capacity.
Orange County's schools are already eligible to reopen for indoor, personal instruction, but not all of them will reopen right away. Schools in Fountain Valley and several other districts reopened on Tuesday.
It is up to school districts to decide and many are offering "hybrid models" of some in-person instruction and some online-only instruction, Kim said. Some school districts will allow parents to continue with distance learning only.
If there is a breakout at any of the schools, they would have to close for two weeks and have no more COVID-19 cases before reopening, said Dr. Clayton Chau, the county's Health Care Agency director and chief health officer.
Dr. Matthew Zahn of the county's communicable disease control division told reporters Thursday that if 5% of a school's population of students or teachers get infected, the campus will be shut down for two weeks, according to the state's guidelines.
Zahn said the county is reluctant to post information about outbreaks at schools because it tends to send the wrong message that schools without an outbreak are safer, and parents and students may let their guard down.
He also said that when there was a measles outbreak traced to Disneyland, the county attempted at first to post where the infected went, but then it became too cumbersome to do so.
School officials will respond within 24 hours when there is a COVID-19 infection reported, Zahn said.
With regard to college dormitories, Zahn said, "A significant issue associated with (what happened in San Diego) was off-campus housing and transmission of the virus. We have been talking with UC Irvine and other colleges and universities not only about classroom sites and what's appropriate but dorm facilities and off-campus housing."
University officials are stressing to students the importance of sticking to guidelines to help curb the spread of the virus.
"We know UC Irvine is planning to do regular testing of staff and students," Zahn said. "And on a national level, there seems to be evidence that is helpful, and that is encouraging ... But we're all learning how this works in all settings."
"Move-In Week" began Tuesday at UCI and will continue through next Tuesday. Students are being tested and getting results within 48 to 72 hours.