Cases of coronavirus in Los Angeles County continued to go in the wrong direction on Tuesday, July 20, with public health officials confirming a slight uptick in skilled nursing facilities partly because of “breakthrough” cases among people already vaccinated.

L.A. County Public Health reported that for the week ending July 11, 25 people at skilled nursing facilities tested positive for COVID-19, including three new cases among residents and 22 among staff. The spike has caught the attention of public health officials, who had seen a period of stability at such facilities since the devestating early days of the pandemic, when the virus was circulating rapidly — and tragically — through them, claiming many lives along the way.

In the weeks leading up to the recent spike, skilled nursing hubs were seeing an average of about 16 new cases, officials said.

The spike at nursing homes follows an overall case increase that has worried public health officials enough to reinstitute a mask mandate that requires everyone older than 2, regardless of vaccination status, to wear a mask indoors when in such public spaces as transit stations, restaurants or stores.

Officials on Tuesday reported 1,821 new infections, and five new deaths, bringing the total lives claimed by the virus to 24,587. All told, a total of 1,270,886 people have been confirmed infected by the virus, though that number is thought to be much higher.

Among cities with independent health departments: Pasadena reported 14 new cases to add to its total of 11,572 but zero deaths; the death toll remained at 341. Long Beach reported a total of 949 deaths and 54,750 cases since the pandemic began.

L.A. County Public Health Director Barbara Ferrer offered condolences to “everyone mourning the loss of a loved one,” but also more red flags.

Officials say the recent spike is following the patterns of past surges, with numbers increasing after holidays, and the associated intermingling of people.

L.A. County reported a positivity rate of 4.8%, more than double the rate of two weeks ago.

Breakthrough cases remain rare, but are nonetheless expected, according to the Centers for Disease Control. Most cases, hospitalizations, and deaths are now among people who were not previously vaccinated, officials said. Among the five reported deaths reported Tuesday, three people were between the ages of 65 and 79, one person was between 50 and 64, and one person was between the ages of 30 and 49.

Officials are paying particular attention to rising hospitalizations due to COVID-19, considered a stronger barometer of the trajectory of the virus than positivity rate numbers.

Hospitalizations in L.A. County jumped by 41 from Monday, according to the state’s dashboard. And the number of patients in intensive care units also jumped, by 13 day to day.

“What we’re seeing now is a rapid growth in community transmission of COVID-19 that is resulting in an increase in people being ill, hospitalized and critically ill, and it’s being driven completely by unvaccinated people who are eligible for the vaccine,” said Dr. Roger Lewis, professor and chair of Harbor-UCLA Medical Center’s Department of Emergency Medicine.

Several experts have noted that so many people have been vaccinated, and so many have acquired natural immunity, that a mammoth surge like the kind the county experienced in January is unlikely. But with 4 million people in the county still unvaccinated, officials say the pandemic is now blanketing the region’s unvaccinated population, which could still lead to a substantial surge and more dire outcomes.

The strengthening outbreak also jeopardizes a fuller economic recovery, officials said. It was a point punctuated on Capitol Hill on Tuesday, as U.S. Sen. Mitch McConnell, R-Kentucky, urged Americans to get the shot.

“If there is anybody out there willing to listen: Get vaccinated,” McConnell, R-Ky., said at his weekly press conference at the Capitol.

“These shots need to get in everybody’s arms as rapidly as possible or we’re going to be back in a situation in the fall that we don’t yearn for — that we went through last year,” he said. “This is not complicated.”

McConnell’s angst came as UCLA Fielding School of Public Health’s UCLA Center for Health Policy Research released new data from the 2021 California Health Interview Survey, attempting to shed light on Californians’ views on getting the vaccine and following suggested safety protocols.

Highlights from the report:

• More than 1 in 10 (12%) adults stated that they would not get the vaccine. Adults in the Northern/Sierra and San Joaquin regions were more likely to report that they would not get the vaccine at 20.6% and 20.5%, respectively.
• Groups that reported the highest rates of being unwilling to get the vaccine were Black residents (22.1%), multiracial adults (21.1%) and Latino residents (13.6%).  American Indian and Alaska Native and Native Hawaiian and Pacific Islander (NHPI) data were not reported due to small sample size.
• The poorest adults were more likely to report that they would not get the vaccine, compared to adults with the highest income levels.  And the survey found that 18.1% of adults with incomes of 0–99% of the federal poverty level said they would not get the vaccine, compared to 9.4% of adults with incomes at or above 300% the poverty level.
• The survey also reported that adults with a high school degree or less than a high school degree were more likely to report that they would not get the vaccine. That was compared with adults who had higher educational attainment. It found that 15.7% of adults with less than a high school degree and 18.3% with a high school degree said they would not get the vaccine, compared to adults with a bachelor’s degree (7.7%) or a graduate degree (3.2%).

Ferrer acknowledged the shots aren’t perfect, but they continue to be “a powerful tool for reducing transmission. ” And so was the low-tech use of masks indoors, she said.

“Adding masking for everyone indoors provides an additional layer of protection to counter the very infectious Delta variant,” she said Tuesday. And while it is disappointing that we are again witnessing a surge in cases, compliance with the new mask directive and increasing vaccination rates provide us with strategies for getting back to low rates of transmission.”