SANTA ANA, Calif. (CNS) — Orange County fell just short of making it from the red to the less-restrictive orange tier in California's coronavirus monitoring system Tuesday, but officials said the county's overall numbers were trending in the right direction.

The Orange County Health Care Agency reported 109 new COVID-19 cases Tuesday and 33 additional deaths. Although the fatalities were the highest number received in one day since the pandemic began, officials said they were spread out over the past few weeks. COVID-19 deaths are received from multiple sources such as hospitals and the coroner's office and come in at staggered times.

The deadliest day for the county since the pandemic began remains August 3 when 19 people died that day from coronavirus. The last day of double-digit deaths was August 31 when 10 people died.

The overall death toll stands at 1,249, with 53,557 total cases.

Of the deaths reported Tuesday, five were skilled nursing facility residents and three lived in assisted living facilities. Since the pandemic began, 451 of the fatalities were skilled nursing facility residents and 88 lived in assisted living facilities.

Hospitalizations inched up from 161 Monday to 162 on Tuesday, with the number of patients in intensive care remaining at 46. The county has 35 percent of its intensive care unit beds available and 67 percent of its ventilators. The change in 3-day average for hospitalized patients rate is 1.2 percent.

The reporting of fewer than 200 new cases for a second day was a good sign, officials say.

The positivity rate was at 3.1 percent on Tuesday, the same as last week, but the daily case rate per 100,000 people went up from 3.6 to 4.4, which is higher than the cutoff of 3.9 to qualify for the orange tier.

It means the county will remain in the red tier for at least another two weeks, but there is hope the trend will continue and the county will be able to move up to the orange tier by mid-October.

Last Thursday's and Friday's numbers put the county over the top, said Dr. Clayton Chau, the director of the Health Care Agency and the county's chief health officer.

"We've had a few days of uptick in numbers, small but significant to affect our tier system," Chau told the Orange County Board of Supervisors on Tuesday. Chau said it appears that Labor Day gatherings led to the increase.

One of the thorniest problems is young adults renting out vacation residences for parties, Orange County CEO Frank Kim said Monday.

The small spike in cases per 100,000 people "doesn't signify something terrible in the community," Kim said. "When you get down to around 3.5 to 4 cases per 100,000 that's very small."

In a county the size of Orange County with a population of about three million that would be about 32 additional cases. It is difficult to pin down the source of outbreaks in a sample size that small, Kim said.

Orange County Supervisor Lisa Bartlett said there is concern about a see-sawing back and forth between the red and orange tiers, because if the county has to step back a tier that locks it into place for at least three weeks even if the metrics match a less-restrictive tier.

Chau said officials do not suspect children returning to school have had an impact on the numbers. Private schools that received waivers were allowed to return to school in August, Chau told the supervisors.

"We have not had any outbreaks in all of the schools," Chau said.

Bartlett raised concerns Tuesday with Chau about UC Irvine students returning to campus because many are coming from out of the country and out of state. But Chau reassured her that the university has a regular and strict testing protocol in place. UC Irvine is bringing back 7,500 of its 30,000 students to campus.

"It looks like UCI is one of the strictest UC campus, which is good for us," Chau said. "They have a great testing protocol and contact tracing system and what have you."

The OCHCA also reported that 857,884 COVID-19 tests have been conducted, including 7,899 reported Tuesday. There have been 48,146 documented recoveries. 

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

Moving to the orange tier means retail businesses could operate at full capacity, instead of 50 percent in the 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 percent capacity to half capacity. Gyms and fitness centers could boost capacity from 10 percent to 25 percent and reopen pools.

The orange tier also allows family entertainment centers like bowling alleys and wall-climbing to open indoors to 25 percent capacity.

Kim informed city managers on Monday that the county is shutting down its Project Roomkey participation, which provides hotel rooms for transients who are infected or most at-risk of contracting coronavirus.

The county has to phase out the program because it needs to negotiate damage claims with the hotel operators by the end of the year so the county can use federal funding for the program to pay for the repairs, Kim said.

With the flu season approaching and the potential for what experts are calling a "twindemic," county officials are working to house some transients most at risk of coronavirus and the flu into longterm care facilities and they are ramping up flu vaccinations for the homeless, Kim said.