The county logged 2,173 new COVID-19 infections Tuesday, raising the cumulative case total to 107,937.
Hospitalizations jumped from 1,287 Monday to 1,371, including 296 ICU patients, up from 288 the previous day. Both are new records -- a daily occurrence since last week.
The county received its first shipment of Pfizer's coronavirus vaccine Wednesday -- expected to total about 25,000 doses, according to Orange County CEO Frank Kim.
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A handful of healthcare workers at Saint Joseph Hospital in Orange received the county's first doses of Pfizer's COVID-19 Wednesday, and top county leaders are expected to announce more details about vaccine distribution.
Nurses are respiratory therapists were among the first to be inoculated in O.C. Names were pulled from a jar that contained a list of eligible workers, those at highest risks, at Saint Joseph.
Hoag Hospital in Newport Beach received nearly 2,000 doses, and nearly 4,000 shots were delivered to UCI Medical Center in Orange.
While fighting back tears, the county's chief health officer and director of the Orange County Health Care Agency thanked frontline workers.
"I salute our healthcare professional who have bravely stepped into the fight against coronavirus for risking your life -- and not only your life, but the life of your family -- to make sure you take care of the community," said Dr. Clayton Chau. "I want you to know that we deeply appreciate the work that you do."
Next week, the county is expected to receive an additional 17,000 doses of the Pfizer vaccine.
OC's ICU bed availability increased from 9.3% Monday to 10.4% in the unadjusted category, and increased from zero to 1.4% in the "adjusted'' metric the state created to reflect the difference in beds available for COVID-19 patients and non-coronavirus patients.
The 11-county Southern California region's percentage of available ICU beds stands at 1.7%.
Orange County's adjusted daily case rate per 100,000 rose Tuesday from 30.3 last week to 42.7, with the positivity rate increasing from 10.6% to 13.2%. The county's Health Equity Quartile Positivity Rate, which measures the cases in highly affected, needier parts of the county, rose from 16.2% last week to 18.8%.
The county is testing 526.8 per 100,000 on a 7-day average with a 7-day lag, which is an all-time high.
All of the county's metrics now fall within the state's most-restrictive purple tier of the state's four-tier coronavirus monitoring system.
One new fatality was reported Tuesday in Orange County, hiking the death toll to 1,695. On Sunday, 14 COVID-19 fatalities were reported. Last week, the county reported 62 fatalities, up from 41 and 26, respectively, in the two previous weeks.
Most of the fatalities reported since Friday were in the 75 and older category, but at least one was 25 to 34 years old.
Prior to this month, the record for ICU patients in Orange County was 245 during a mid-July surge. Overall hospitalizations have been breaking records daily since Dec. 2.
As has been the case for months, dozens of residents appealed to the Board of Supervisors on Tuesday to ignore the state's stay-at-home order and railed about face coverings. Orange County counsel Leon Page explained that Gov. Gavin Newsom's executive order is the final say on the stay-at-home order and county cannot do anything to change it.
Chau made an emotional appeal to residents to adhere to physical distancing and face-covering mandates.
"The one thing we know is people should stay at home when sick, do not mix households and wear a mask, and do all the cleaning measures like washing hands, etc.,'' Chau said. "That's the only thing that works.''
Chau speculated that new treatments have perhaps helped keep most of the hospitalized patients out of intensive care.
"But people are still ending up in the hospital and still in ICU,'' Chau said. "Without all these newly approved treatment options the number of those in ICU would probably be worse.''
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County health officials are particularly struggling with housing the elderly with dementia, who are infected and do not exhibit symptoms, Chau said.
"We can't send them to a hospital... They don't need that level of care,'' Chau said. "And we can't send them to a nursing facility... and we can't send them to a hotel.''
Those patients will likely be housed at Fairview Developmental Center in Costa Mesa, which is expected to open on Thursday.
"But we only have the availability of 50 beds,'' Chau said. "We're going to run out of options to take care of these people.''
"I lose sleep every night,'' Chau said. "I am afraid. ... I've never been so afraid of Christmas and New Year's in my whole life ... I can't imagine what it would be like after the holidays if people don't listen and don't comply.''
Dec. 27 was the day the county could emerge from the governor's latest restrictions, but with the surge in cases and patients, Chau said, "I don't think we can get out of it."
Supervisor Doug Chaffee said he received a text message from a medical professional at St. Jude Medical Center on Monday night that indicated the hospital is at "99% capacity.''
The hospital's 301 beds are full with 138 COVID-19 patients, Chaffee said.
"The ICU is at 105% capacity,'' Chaffee said. "They're using every available bed. The emergency department has an overflow ... All the Orange County hospitals are in the same situation. It is dire, so they'll soon be erecting a tent in the parking lot, probably for triage. I think what we're seeing is not a surge, but a tsunami.''
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Orange County Supervisor Lisa Bartlett said emergency rooms and ICUs in the county "are getting overwhelmed, not just in our county, but other counties.''
Bartlett blamed various types of gatherings of people not wearing face coverings for the recent surge in cases.
"Our health care system could easily be overwhelmed at this point,'' Bartlett said. "Whatever we need to do to message about gatherings, we really need to drive home that message to the public. We have to slow the spread of COVID-19 within our county.''
Chau added, "The message is very simple. In the United States today, every minute there's two people who have died in the United States of COVID-19. Every minute we talk someone lost a loved one ... It is an astounding number and just an embarrassing number from an American perspective because we're supposed to be the best in what we have in medical care ... Do not gather at home ... Do not hang out with friends ... because you not only infect them, but they will infect other people. ... You can get together socially through Zoom or Skype or FaceTime.''
Orange County Supervisor Andrew Do appealed to state officials to recognize that some of the stay-at-home orders have been shown by studies to not be effective, leading residents to acts of civil disobedience. Do pointed to a study of 98 million people from the journal Nature that showed no evidence that outdoor dining contributes to the spread of the virus.
"Could it be that we have higher rates because of simple fatigue that comes with a policy that is not supported by science and does not necessarily save us from anything, but imposes heavy personal and economic stress on the community that causes people to feel hopeless, there is no way out, so no matter what they do they'll be damned so, therefore, who cares?'' Do asked.
"I am fully supportive of the things we need to do on the health side to protect people and I share the passion that you have to protect the public,'' Do said. "But (state officials) need to be able to articulate better as to why these particular measures work when we have a study that says clearly the opposite.''
Do, whose father died unexpectedly over the weekend, noted the congestion of patients he saw in the hospital where his father was treated.
"I can tell you from personal observation every single bed was taken,'' Do said. "As I contacted funeral homes for my father they said their business has increased by 300% this year. The wait time and lack of availability of services whether they're for viewings or cremation it is unbelievable. They've never seen that kind of scarcity before.''
To address the need, mobile field hospitals are being set up and will be housed in large trailers and include canvas tents with hard flooring and temperature-controlled units that feature running water, toilets, showers and generators as well as air purifiers.
Fountain Valley Regional Hospital will get 50 more beds, St. Jude's in Fullerton will receive 25 beds and UC Irvine will get 50 beds.
An outbreak in the county's jails, which started last week, now has 412 inmates infected, down from 416 reported Monday, said Carrie Braun of the Orange County Sheriff's Department.
"The vast majority are asymptomatic,'' Braun said, adding that most of the infected inmates are housed at the Theo Lacy jail in Orange and the men's Central Jail in Santa Ana.
Sheriff Don Barnes, who had earlier kept testing restricted to newly booked inmates, anyone showing symptoms, or those exposed to an infected person, will now seek to test everyone in the jails, Braun said. Inmates who test positive are restricted to a single cell in isolated status, and any others exposed are being quarantined together as they await test results, Braun said.
The sheriff is awaiting results of 276 more tests.
Meanwhile, Barnes has been ordered by an Orange County Superior Court judge to reduce his jail population by half by Friday, meaning 1,800 inmates could be released to home confinement or ankle-bracelet monitoring or just fully set free.
The county supervisors unanimously voted to hire outside counsel to help Barnes in the legal struggle with the American Civil Liberties Union, which sued to reduce the jail population. The supervisors also voted to sue the California Department of Corrections and Rehabilitation to challenge the department's to take on convicted felons from the county's jails during the pandemic.
The county is also dealing with an uptick in outbreaks at skilled nursing and assisted living facilities. As of Tuesday, 32 skilled nursing facilities have had two or more confirmed cases of COVID-19, and 36 assisted living facilities had two or more cases.
County officials have been asked to provide personal protective equipment, more training or staffing to help curb the spread of COVID-19 in those facilities, where the main reason for the spread is likely from employees who contract the virus off-site, Kim said.
City News Service contributed to this report.