Nearly 4,300 of Los Angeles County’s health care workers and first responders have tested positive for the coronavirus and 26 have died of COVID-19, officials said Monday.

That’s more than half of all cases and deaths among health care workers throughout California.

The L.A. County Department of Public Health reported 684 new cases and another six deaths among the health care workers since last week.

Twenty of the workers who died of the respiratory illness worked in skilled nursing or assisted living facilities, four worked in hospitals, one worked at a correctional facility and another in an outpatient facility, county public health director Barbara Ferrer said.

“For the families and friends who are grieving the loss of their health care hero, we are grieving with you. Your loved ones dedicated their lives to caring for others and we are truly grateful for their service,” Ferrer said during a news conference. “And to all our health care workers, we thank you from the bottom of our hearts. Your dedication and courage to do your jobs each day is keeping us all safer and healthier.”

Though the infections were found in people working in a variety of different roles, 46% of workers who tested positive are nurses.

The health department had exposure information for more than half of the health care workers who tested positive, and 79% of them were exposed to the virus while at a health care facility, Ferrer said.

Of those who tested positive, 6% of health care workers ended up hospitalized for the respiratory illness.

As the virus spread throughout California, hospitals and government officials alike were left scrambling to bring in personal protective equipment for their workers amid nationwide shortages.

And while the state has distributed PPE by the millions throughout the California, many health care workers have reported having to reuse face masks or make protective gowns out of raincoats and trash bags. Some have also reported not having access to N95 masks, which provide better protection than surgical masks.

Machines that could decontaminate tens of thousands of N95 masks each day started arriving in late April, providing some relief.

In L.A. County, the health department’s goal is to have at least 60% of hospitals stocked up on at least 15 days’ worth of protective equipment.

And while the county is on track with masks, goggles and face shields, hospitals were short on supplies of gloves and gowns, according the health department.

Nursing homes hit hard by the pandemic

The vast majority of the infected workers were employed at nursing homes and in hospitals — 44% of them in skilled nursing facilities and 27% at hospitals.

Ferrer attributed the high number partly to increased testing at nursing homes, which are among the hardest hit in the county. More than half of the 1,839 people who died of COVID-19 in L.A. County lived in institutional settings, and the majority of them were in skilled nursing homes.

With the homes becoming hotbeds for the virus as they grapple with major outbreaks and staff shortages, the county began testing all staff and residents at the facilities — regardless of whether they were showing symptoms.

As of Monday, all residents and staff were tested at 141 of the county’s more than 300 skilled nursing facilities, and efforts are underway to do the same at another 75.

Officials found that 86% of the people who tested positive were asymptomatic.

“These results highlight the fact that there may be, in any setting, significant numbers of people who are positive for COVID-19 with no symptoms, and this is particularly problematic in our institutional settings,” Ferrer said.

The health director said the strategy is to simultaneously conduct mass testing at facilities both with and without outbreaks, adding that routine testing, proper infection control and adequate personal protective equipment are essential to manage the outbreaks.

Infection, hospitalization and death rates

Los Angeles County reported 18 new COVID-19 deaths and another 477 positive cases Monday, bringing the countywide total to 38,451. The county’s public health director noted that the numbers reported Mondays are usually lower with labs closed on weekends.

As the county slowly allows more businesses and recreational areas to reopen with modifications, health officials said they will be tracking certain metrics that will paint a clearer picture of the trajectory of the virus in the county and help guide decisions on reopening.

The department is looking at percent change in seven-day periods for the number of  COVID-19 deaths, hospitalizations, bed and ventilator capacities across the county, supplies of personal protective equipment for health care workers and testing capacity.

While the weekly average number of COVID-19 deaths overall has not increased over the past two weeks, it still continues to rise among African Americans and in areas where 20% to 30% of the population live below the poverty line, according to the health department.

The county has been ramping up coronavirus testing in recent months, but is behind on its goal is to test at least 15,000 people a day. About 11,400 people are tested each day countywide.

But overall, despite earlier projections, COVID-19 hospitalization rates have been steady in recent weeks.

Of those who tested positive for the coronavirus, 5,835 people have been hospitalized for the respiratory illness it causes — that’s 15% of all positive cases.

“That rate has dropped steadily the last two weeks,” Ferrer said.

The health director also reported that the infection rate of the virus is down.

In the beginning of the pandemic in L.A. County, each infected person spread the coronavirus to three others on average. Now, one person is infected per infected person, she said.