Cities in South Orange County saw the biggest percent growth in coronavirus cases within the county last month, while Santa Ana and Anaheim continued to be hardest hit by new cases per capita, according to testing data released by county officials.

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Overall, south county continues to have lower confirmed cases per capita than the countywide average, the data shows. But in terms of percentage growth in cases, six of the top 10 cities were in south county, led by Lake Forest, Dana Point and San Clemente.

[Click here to see a chart of increases by city.]

“It’s absolutely in line with what I’ve seen,” said Andrew Noymer, an epidemiologist at UC Irvine who has been tracking the city case counts over time.

“I think there’s no part of the county that can be construed to be COVID-free at this point,” he added.

“Once the pandemic grew, it’s clear that Anaheim and Santa Ana have been the sort of weight of the infections. But there may be a pendulum back a little bit now to countywide.”

“Per reports, south county has been a center of mask defiance. And masking does work, so I do believe this has contributed to the worsening situation in South County,” Noymer added.

South county cities also may be growing faster because they started out July with less prevalence of the virus, which can create higher percentage growths, he said.

“You can get higher percentage growth with just a few cases. And so that is a phenomenon,” Noymer said of south county. “But I do believe there’s real growth there because of the masking, or lack thereof.”

County health officials say it’s unknown exactly why some cities are more affected than others, since so many factors are at play in how a disease spreads. But they said the virus is more likely to spread in places where people aren’t following safety measures as much, like face coverings and staying home.

“It is difficult to draw definitive conclusions because there are so many factors that contribute to disease transmission and case identification,” said Marc Meulman, acting director of public health services at the Orange County Health Care Agency, in a written answer to Voice of OC’s questions.

“However, compliance with all the mitigation strategies is critical to slowing the spread, so for communities with lower level of compliance with staying home, wearing face coverings, hand washing, etc., there is a greater likelihood of seeing greater increases in disease transmission as more people engage in more risky behaviors,” he added.

Meulman also cautioned that case rates – the number of new cases per capita – is a better metric than percentage increases.

“Percentage increases in raw case counts isn’t necessarily the best way to measure increases in disease transmission as small numbers can create large percentage increases with relatively few number of cases, with Coto De Caza being a good example. Case rates is a better metric,” he said.

The acting mayor of San Clemente, which had the third highest percent increase in cases in July, attributed her city’s increase to more testing at the MemorialCare hospital in her city, as well as more people dining out and socializing.

“I do see a connection in terms of the increase in the diagnosed cases and the testing,” particularly a tripling of testing at the hospital, said Laura Ferguson, San Clemente’s mayor pro tem, who has been filling the mayoral duties since the previous mayor resigned in April.

The increase “also could be the fact that midway through July…we fully implemented our open-air dining at the various restaurants in town. So more people are going out, more people are socializing,” Ferguson said. After people dine out, they socialize and walk in the area, she added.

“I’m guessing that might have something to do with it as well…I just recommend that the citizens exercise caution,” she added.

The mayors of the two South County cities with the largest percent increases, Lake Forest and Dana Point, didn’t return phone messages seeking their perspective, nor did county Supervisor Lisa Bartlett, who represents South County.

Meanwhile, Santa Ana and Anaheim continued have the highest new cases per-capita in Orang County in in July, as the virus hits working class Latino neighborhoods especially hard.  Many residents are essential workers, like grocery clerks and warehouse distributors, while they wrestle with trying to quarantine in overcrowded housing.

Santa Ana, for example, had about four times as many new cases per capita in July as Irvine.

“I’ve met parents who have said look, the dad got [infected]. He was told he couldn’t work, so he goes home to quarantine, but he can’t. And now the entire family has it,” said Mayor Miguel Pulido of Santa Ana, which had the highest rate of new cases in Orange County last month, in an interview with Voice of OC.

“So we need to offer people the ability to quarantine in a hotel, or outside of the immediate environment, and we have that available. But every solution makes another problem. Now we have people that don’t want to quarantine away from their home and their loved ones.”

Both Pulido and Anaheim Mayor Harry Sidhu are calling for residents to wear face coverings.

“We are still not out of the woods yet,” Sidhu told Voice of OC in an interview.

“We’ve been promoting since day one…have the face coverings wherever you go, whichever facility you visit, keep a six-foot distancing. And wash hands more often,” he said.

“It’s not for your safety, it’s for other people’s safety that you should be very much concerned about that.”

“I don’t go anywhere without wearing a mask,” added Pulido, saying the state’s health director told him masks reduce virus transmission by 90 percent.

Meulman, the county health executive, noted that while Santa Ana and Anaheim continue to have the highest rates of coronavirus cases, the virus is spreading throughout the county and elsewhere.

“While the noted cities reflect the highest case rates for OC, what readers should keep in mind is that COVID-19 transmission is widespread throughout the county, region, state and nation, and people should consider risk to be everywhere,” Meulman said in an emailed response to questions.

“Putting too much emphasis on particular city case rates can be misleading as it only reflects the residence of the cases and that does not necessarily indicate where people are infected as people move about the county and region frequently for work and other activities. It is important to assume risk everywhere and to always practice behaviors to help mitigate spread including” wearing face coverings and social distancing, he said.

Some tests conducted in the latter part of July haven’t yet had their results entered into the systems, due to processing delays and problems with the state’s reporting system, according to county officials.

State and county officials say that means there’s likely an undercount statewide of confirmed cases in the last couple weeks, creating the appearance of a large drop in daily cases in the last couple weeks that may not exist.

“They need to fix it,” Noymer said of the problems with the state’s CalREDIE system that labs report results into.

“If you want to have a better outcome than the 1918 flu, then you have to be better than 1918. We have all this modern 102-years’-worth of [technology], but if we’re not going to use any of it, then it should be incorrect to expect a different outcome.”

That being said, the case data released by the county is the best-available info, he said.

“I don’t know of a better data source,” Noymer said. “Nobody – and I mean nobody – outside of the government, be it the county or state government, has access to the data of tests by municipality.”

[Click here for the county’s raw database of each city’s new confirmed coronavirus cases each day, listed by date the test was conducted. County officials say they update it every Wednesday. Some tests conducted in the latter part of July haven’t yet had their results entered into the systems, due to processing delays and problems with the state’s reporting system.]

Pulido, the mayor of Santa Ana, underscored that the pandemic is a society-wide issue, and what people do in one community affects people who may work there but live elsewhere.

“It’s a major major major problem. And I’ve told everybody what we do in the next few weeks could define us for decades to come,” Pulido said.

“As a society, we have to put out the fire everywhere.”

Nick Gerda covers county government for Voice of OC. You can contact him at

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