Thirty Orange County schools have received state waivers to begin allowing in-classroom instruction as the county grows closer to being removed from California’s watchlist, health officials said Thursday.

The O.C. Health Care Agency reported another 429 cases of COVID-19 and 23 more deaths Wednesday, bringing the total number of cases to 44,936 with 856 lives lost to the virus. Among the 23 most recently reported deaths was a teenage girl who had underlying health conditions.

While the case count and death toll continues to climb, Orange County has made some recent improvements in testing and infection rates that led to the school waivers and other developments. The 30 schools are all private institutions, with the exception of the Los Alamitos School District and its six campuses.

The county currently meets all the criteria required for being taken off the state’s COVID-19 watchlist. That includes holding a case rate of less than 100 cases per 100,000, something that hasn’t happened in nearby counties of Riverside, Los Angeles, San Bernardino and Ventura.

“We received confirmation from the state that Aug. 19, which was yesterday, was the first day that Orange County is below all of the state data monitoring thresholds,” said Dr. Clayton Chau, the county’s acting health director.

But O.C. needs to keep down those rates of infection and other key sets of data for three consecutive days in order to actually be taken off the list of counties being monitored by state health officials.

If that happens, the county could be removed from the list on Aug. 22, Chau said. But then it must maintain those conditions for another 14 days to stay off the list. If it successfully does that, all K-12 schools could reopen for in-class instruction.

However, the state’s guidelines are expected to change within just days of the county’s potential removal. Gov. Gavin Newsom has announced a new set of criteria will be released Aug. 24 but it’s unclear how the new standards will differ, or whether they will be more or less strict.

On Wednesday, the county reported the first death of an underage person due to the virus. The patient, a teenage girl, had underlying conditions health officials have described as “significant.”

No other details were given about her health issues due to patient confidentiality laws.

“This tragedy serve as a reminder that underlying health conditions put individuals of all ages at greater risk of complications and severe illness,” Chau said.

While those oldest are at greatest risk of dying from the virus, it has still infected more than 3,570 people under 18 in Orange County, according to public health data. In much denser, more populated Los Angeles County, over 20,000 cases of coronavirus have surfaced among children.

As part of reopening dozens of elementary school campuses, the county has put together a medical team with help from physicians with the UC Irvine. The team will ensure a pediatrician and pediatric infectious disease specialist are on call for each school, Chau said.

Chau also said the county will provide testing to staff and students but did not give details on how.

The health director said he struggled emotionally with the prospect of reopening schools as the virus keeps spreading — even with what he described as widespread support from staff and students at schools with waivers.

“Since the waiver (application process) started this last 10 days, I wake up every night — in the middle of the night,” Chau said. “And the first thing came to my mind is this, this business of bringing our children back for in-person education. Do I have fear and anxiety? Of course I do. Do we expect that there might be an outbreak? Of course we will. But we have to do it.”

Chau said the “emotional turmoil” children have experienced with schools closures and the poorer quality of an online education are some of the reasons why in-classroom instruction is necessary — despite the remaining health concerns.

He said he hopes Orange County residents can wear facial coverings and take steps to physically distance whenever possible, following the lead of countries that have managed to contain the virus.

“We can beat it,” Chau said. “I get emotional when I read some of these (waiver) applications, and there are letters from teacher who say, ‘I am a vulnerable person but I’m willing to do this. I want to make sure that we bring our children back.’

“If you have an individual teacher who’s vulnerable risked their life to do this for our children, I don’t think it’s too much to ask the adults in the community,” Chau said.

Correction: A previous version of this story gave an incorrect number of schools reopening. The post has been updated.