Fourteen more people have died from COVID-19 in Orange County, hiking the death toll to 1,292, but the county continued its trend of keeping new daily diagnoses below 200 as hospitalizations ticked down, officials said Thursday.

The Orange County Health Care Agency reported 141 new cases of the coronavirus Thursday, raising the total to 55,183. Since Sunday, the county has reported 20 COVID-19 fatalities, compared with 72 last week and 77 the week before.

Of the deaths reported Thursday, 11 were skilled nursing facility residents and one was an assisted living facility resident. Since the pandemic began, 476 of the COVID-19 victims who died were skilled nursing facility residents and 90 resided in assisted living facilities. The death reports are made sporadically from multiple hospitals and other sources, so the fatalities did not happen since the day before.

The positivity rate, which was reported each Tuesday, inched up from 3.1% last week to 3.2%, and the daily case rate per 100,000 people rose from 4.4 to 5.2, which is higher than the cutoff of 3.9 to qualify for a move from the red to the orange tier in the state’s coronavirus monitoring system.

According to the OCHCA, hospitalizations decreased from 183 Wednesday to 172 Thursday, with the number of patients in intensive care down from 64 to 62. The change in the three-day average of hospitalized patients increased from 7.6% to 9.9%.

The county has 32% of its intensive care unit beds and 67% of its ventilators available.

Falling short of reaching the orange tier frustrated some county supervisors, who complained at their meeting Tuesday about how difficult it will be for urban counties such as Orange to ever reach the standard to get to the orange tier.

“We have to do more testing to meet the next step,” said Board Chairwoman Michelle Steel.

Dr. Clayton Chau, director of the OCHCA and the county’s chief health officer, said increased testing can lower the positivity rate, but it can also lead to an increase in the case rate per 100,000. The state introduced the health equity measure, which launched Tuesday, to help counties address high case counts concentrated within certain ZIP codes that include high-density housing and language barriers, among other issues.

“If you’re able to bridge the gap and bring it to the overall positivity rate you can move up to the next tier,” Chau said.

Orange County got a head start on that weeks ago with its Latino Health Equity program, which raised awareness of coronavirus within hot spots in Santa Ana and Anaheim, Chau said. Positivity rates as high as 20% have fallen to single digits in some of those neighborhoods, Chau said.

There is an “accelerator” in the state’s formula that if the positivity rate makes it to the least-restrictive yellow tier but the case rate is in the red, then a county can move up to orange, Chau said.

At a news conference on Thursday, Steel called for more “local control” from the state on determining the reopening of businesses, decrying “Sacramento’s one-size-fits-all” policy that she said “punishes” Orange County with the health equity measure that makes it more difficult to move up to the orange tier.

Chau, however, defended the health equity metric, saying that the county’s own version of it which was implemented before the state instituted its policy was an eye-opener.

“The issue of health equity” in lower socio-economic neighborhoods “existed before Covid, but because of Covid it has brought this issue to the forefront and has forced us together as a community… to really have to come together to address this issue.”

County officials are working on improving the overall health of needy families, which includes reducing diabetes, hypertension, depression, obesity and substance abuse, Chau said. Chau said, for instance, county officials helped an Irvine Valley College student who said recently that he was infected with COVID-19 and so were two of his family members, but they could not quarantine because two families lived in their residence.

Chau pledged to work with nonprofits and other community partners to address the health inequities in poorer communities.

OC CEO Frank Kim agreed with Steel that county officials should get more “flexibility” from the state in reopening plans.

“As a county, we don’t disagree there’s a need to focus on those areas of the community with higher testing and case rates,” Kim said.

But given that the county was already working on tamping down hot spots in Santa Ana and Anaheim, it should get credit for that, Kim said.

Supervisor Lisa Bartlett, the president of the California State Association of Counties, said she serves on a “kitchen cabinet” committee of the organization that is lobbying the state to let theme parks move into the orange tier category instead of being lumped in with mass gatherings like live concerts and sporting events in the yellow tier. Chau said he is the only county health officer who has made that recommendation to the state.

Bartlett said the yellow tier would reflect a point at which a county has “eradicated COVID,” so it would be unfair to restrict theme parks to that status before reopening.

“Disneylands have opened across the world and have not seen any spikes in COVID,” Bartlett said. “And they have significant health and safety protocols … We are collectively pushing, pushing, pushing to have that done sooner rather than later.”

Chau said his staff has made recommendations to Disneyland, which have been implemented in Downtown Disney businesses, which are open.

“As far as we know the plan (to reopen Disneyland) is pretty solid,” Chau said.

To qualify for the orange tier, the positivity rate must be 2% to 4%, and the case rate per 100,000 must be 1% to 3.9%.

Moving to the orange tier means 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.

According to OCHCA data, 918,420 COVID-19 tests have been conducted, including 7,058 reported Thursday. There have been 49,485 documented recoveries.

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