San Diego County health officials Thursday reported four additional deaths and 152 new confirmed COVID-19 cases, marking the largest single-day increase in positive cases since the coronavirus pandemic began.

The total number of COVID-19 cases now stands at 2,643 and the death count has reached 100. The previous highest case increase was April 2, when 146 new cases were reported. Tuesday marked the biggest increase in the death count, with 15 reported fatalities.

The latest deaths involved two women and two men, ranging in age from their mid-60s to late 70s, and all had underlying health issues, said Dr. Wilma Wooten, the county’s public health officer.

Dr. Eric McDonald, the county’s epidemiology director, said Wednesday the uptick in deaths this week may not reflect the direction the pandemic is taking locally. Calling deaths a “lagging indicator,” he noted that physicians have eight days to file death certificates and nine deaths reported Wednesday occurred over a four-day period from last Friday through Monday.

Deaths are not being used as an indicator to make decisions such as when to loosen or lift public health orders, McDonald said.

The county reported 28 deaths from the respiratory illness over the three-day period ending Thursday, the deadliest three-day stretch since the coronavirus outbreak began. The number of COVID-19-related hospitalizations rose to 624 on Thursday, and the number of patients being treated in intensive care units climbed to 213, representing increases of 23 and seven, respectively, from Wednesday.

Of the 100 people who have died of the disease, 53 were white, 30 were Latino and nine were Asian.

Despite the growing death toll, county officials are cautiously optimistic.

“At this time, the response of San Diego residents to stay home, physical distancing and other orders and requests is bending the curve and has prevented the type of surge seen elsewhere,” according to a county statement announcing that a federal medical station loaned to the county is now ready for patients if needed.

The 202-bed emergency overflow medical facility — which will not be used unless the county’s resources are stretched too thin — occupies two formerly vacant floors of Palomar Medical Center Escondido.

Officials also announced that San Diego County received $334 million in CARES Act funding on Thursday. Supervisor Nathan Fletcher said the federal money, designated for COVID-19 emergency response, will be doled out in the coming weeks per federal guidelines.

Fletcher said increased testing numbers were also a good sign, as it helps more accurately trace cases of the novel coronavirus, while noting that a side-effect of accurate testing would be an increase in reported cases.

The second-highest number of total daily tests since the pandemic began — 2,255 — was reported Thursday. The county and regional hospitals have now completed more than 38,000 tests, with a positive test rate of around 6.7%. The county estimates that 1,528 people have recovered from COVID-19, but it does not have an exact, verifiable recovery number.

Of all positive-testing coronavirus cases, 24% of the patients have been hospitalized and 8.1% sent to intensive care. Nearly 4% of COVID-19 patients have died, a rate higher than most jurisdictions are reporting.

“This is one of several indicators that there are undiagnosed cases in our community,” McDonald said.

The county’s public health officer said Tuesday the county would measure five metrics when deciding whether to lift public health orders.

Those metrics, designed by the federal government, are:

— a downward trend in influenza-like illnesses;

— a downward trend in COVID-like illnesses;

— a downward trend in percentage of total tests turning up positive for COVID-19;

— treating patients with a normal level of staff and resources and not using emergency resources;

— robust testing in place for at-risk health care workers.

On the north side of the county, some groups are growing restless. The Oceanside City Council voted 4-1 Wednesday night to send a letter to the county demanding an amendment to county health orders surrounding COVID-19 to permit local agencies to decide when beaches, parks, harbor and local businesses can reopen.

The county has barred entry into the water in the region, but has left it up to jurisdictions if beaches and parks can remain open — provided social distancing guidelines and other health orders are followed.

Oceanside City Councilman Christopher Rodriguez has spearheaded the effort to allow cities to decide.

“Oceanside has put forth extraordinary efforts to flatten the curve but as we push down the curve, like a large balloon, a new curve is created. In this case it is an unemployment and loss of essential revenues curve,” Rodriguez said. “Oceanside residents and businesses are fully capable of practicing social distancing and sanitary policies that current essential businesses follow.”

The county is preparing for a path to reopen some outdoor spaces sooner rather than later.

Officials announced plans Wednesday for a phased reopening of county beaches and bays once the region meets certain county public health goals regarding COVID-19.

The region-wide plan calls for a two-phase reopening across all coastal cities in the county, which would begin with beaches and bays open initially for walking and running only, according to San Diego Mayor Kevin Faulconer.

Physical distancing would be required, and face coverings strongly recommended.

Gatherings would be prohibited under Phase 1 of the plan, and piers, boardwalks and parking lots would remain closed.

The ocean would be open to all recreational uses, while San Diego Bay and Mission Bay would be open to boating and single-person paddling only.

Under Phase 2, all activities that allow for physical distancing would be allowed at the beaches, bays, piers, boardwalks and parking lots.

The city of Vista, meanwhile, announced that its city parks will reopen for “passive use” starting Friday. Parkgoers will be required to practice physical distancing and will be limited to individual or household unit activities, such as walking, jogging or running. Dogs on leashes will be permitted.

Group activities and active sports will not be allowed, meaning athletic fields, skate parks, playgrounds, and all other areas related to group activities would remain closed until further notice.

In the South Bay, restrictions are tightening.

National City ordered Tuesday that every person out in public is required to wear a facial covering. Chula Vista followed suit Thursday, requiring anyone at essential businesses to wear a face covering.

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