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Citing soaring COVID-19 cases and hospitalizations, Los Angeles County imposed tightened health restrictions Monday, including a ban on most gatherings and strict capacity limits on most businesses, while forcing closures of playgrounds and card rooms.

But the restrictions are being met with pushback from some residents, business owners and elected officials — including the Lancaster City Council, which will hold a special meeting this week to consider a “no-confidence” vote in county Public Health Director Barbara Ferrer and discuss creating a municipal health department.

A handful of residents even staged a protest outside Ferrer’s Echo Park home on Sunday, challenging the need for strict health orders.

The new “Health Officer Order” that took effect Monday bars all public and private gatherings with people of multiple households, except for constitutionally protected outdoor church services and protests. It also sets occupancy limits at various businesses, while also mandating face coverings and six feet of physical distancing.

The capacity limits are:

— essential retail: 35% maximum occupancy;

— nonessential retail (includes indoor malls): 20% maximum occupancy;

— personal care services: 20% maximum occupancy;

— libraries: 20% maximum occupancy;

— fitness centers operating outdoors: 50% maximum occupancy;

— museums galleries, zoos, aquariums, botanical gardens operating outdoors: 50% maximum occupancy; and

— mini-golf, batting cages, go-kart racing operating outdoors: 50% maximum occupancy.

The order allows most outdoor recreational facilities to remain open, including beaches, trails and parks. But face coverings are required. Also open are golf courses, tennis courts, pickleball, archery ranges, skate parks, bike parks and community gardens, but use is restricted to a single household at a time. Pools that serve more than one household may open only for regulated lap swimming with one person per lane. Drive-in movies/events/car parades are permitted provided occupants in each car are members of one household.

Schools operating with limited numbers of students and day camps can remain open, adhering to reopening protocols. Schools and day camps with an outbreak, defined as three cases or more over 14 days, should close for 14 days. Card rooms are closed, as well as playgrounds, except for those at child care centers and schools.

In announcing the revised order on Saturday, Ferrer said in a statement, “With the recent surge of COVID-19 acros our community, we must take additional safety measures to reduce the risk of illness and death from this terrible virus and protect our health care system. These targeted measures are in effect for the next three weeks and still allow for many essential and non-essential activities where residents are always masked and distanced.”

She added that “acting with collective urgency right now is essential if we want to put a stop to this surge.”

The restrictions will remain in effect until at least Dec. 20. The county last week put an end to all in-person dining at restaurants.

On Sunday, the county reported another 5,014 confirmed cases of COVID-19 and 16 additional deaths, bringing the county’s totals to 395,843 cases and 7,639 fatalities.

Even more concerning was the continued rise in hospitalizations, which reached 2,049 on Sunday, reaching its highest point since summer. Health officials have repeatedly noted that current hospitalizations reflect infections that actually occurred two to three weeks earlier, meaning the continued surge in cases will lead to even higher hospitalization numbers in the ensuing weeks, potentially surpassing the ability of hospitals to treat patients.

Despite the rising case numbers and hospitalizations, the stepped-up health orders were being met with resistance. The city of Pasadena, which has its own health department, hasn’t fallen in line with all of the county’s health restrictions, allowing in-person dining to continue for now. The city insisted that it is better equipped than the county to enforce health restrictions at eateries — evidenced by crackdowns over the weekend that forced the closure of at least five restaurants due to violations of infection-control measures.

Lancaster city officials called a special City Council meeting for Thursday to consider a no-confidence vote in Ferrer — even though the county’s restrictions are technically issued by the county’s Health Officer, Dr. Muntu Davis. The council will also consider asking its staff to begin outlining the process for creating a municipal health department, much like those in Pasadena and Long Beach.

Mayors of the city’s of Commerce, Bell Gardens and Hawaiian Gardens held a news conference late Monday morning pushing the county to allow continued outdoor operations at card rooms, which were closed under the newly enacted health order. Those cities fiercely lobbied the county earlier to allow the card rooms to open, noting that the operations account for up to 75% of the tax revenue generated in the small municipalities.

Restaurant owners also continue to balk at the decision to cut off in-person dining, saying they spent thousands of dollars to open outdoor patios and implement extensive safety protocols, only to have the rug pulled from under them. They also contend there is no evidence linking in-person dining to the current surge in virus cases.

County officials have countered that such dining is the only environment that allows people to spend extended amounts of time in relatively close proximity without masks.

The ban on in-person dining was triggered last week when the county met a five-day threshold of averaging more than 4,000 new COVID-19 cases per day. The new health restrictions that took effect Monday were triggered when the case numbers worsened, with the county reaching a five-day daily average of 4,500 new infections.

Health officials said the county’s surge has surpassed the one seen in mid-summer, with cases spiking at an alarming rate. Health officials said recently that rising case numbers could overwhelm hospitals within two to three weeks if the spike continues.

Ferrer said Saturday officials knew a surge was coming, but, “None of us really thought the increase would be so big, across such a short period of time.”

According to county estimates released last week, every COVID-19 patient in the county is passing the virus to an average of 1.27 people — the highest transmission rate the county has seen since March, before any safety protocols such as face coverings and social distancing were in place.

Based on that transmission rate, health officials estimate one of every 145 people in the county are now infected with the virus and transmitting it to others.

“This doesn’t include people that are currently hospitalized or isolated at home,” county Health Services Director Dr. Christina Ghaly said.

“This is the estimate of people that are out and about and infecting others. They may not know they’re infected. They may know they’re infected and not be isolating. But they’re out there and they’re exposing other people to the virus.”

Ghaly said the number of people hospitalized due to the virus has jumped by 70% in the past two weeks, with the county now averaging about 300 new admissions daily.

Ghaly noted that given the current transmission rate, the number of hospitalized patients could double in two weeks, and quadruple in a month. She said hospitals have “surge” plans to increase the number of beds, but the availability of health care workers to staff those beds and treat patients is more limited.