LOS ANGELES, CA — Los Angeles County reached a stark milestone in the coronavirus pandemic Thursday with the death toll soaring passed the 200 mark. As the overall number of cases climb, there are clear signs of outbreak hitting exposed populations including first responders, the homeless, the incarcerated and folks living in nursing homes and rehab centers. Yet disease has not spread as quickly across Los Angeles County as it has in other densely populated cities.

This week, the COVID-19 diseases surpassed heart disease as the leading cause of death in the United States, Newsweek reported. Thanks to early and strict social distancing measures and shutdown orders, Los Angeles County has effectively slowed the spread of the disease locally. The outbreak is expected to peak in May statewide, while places such as New York appear to be peaking now. County leaders see this week as critical in curbing the local outbreak. If residents can avoid holiday shopping and gatherings, the peak of the outbreak in May would hopefully be muted. Experts warn that California may require a prolonged shut-down to continue to suppress the outbreak.

“Yes, it can mean that it stretches out longer, but that is a better price to pay than with unnecessary death,” Dr. Robert Kim-Farley, medical epidemiologist and infectious diseases expert at the UCLA Fielding School of Public Health told the Los Angeles Times. “We are really buying for ourselves the reduced peak. And that is a thing that will save us from a lot of unnecessary deaths because of an overloaded healthcare system.”

Another 25 people died in Los Angeles County due to COVID-19 over the last day, bringing the overall toll to 223 so far and the death rate to 2.8%. That is higher than the national average. Over the last week, coronavirus patients are dying at a higher rate — a full percentage point — for some reason. County health officials also confirmed 425 cases of the disease for a total of 7,995, said Barbara Ferrer, head of the county public health department. Ferrer said the rising percentage is concerning, but it could come down once more people are tested.

The ranks of the sickened increasingly include the counties homeless residents, sparking fears of an outbreak among the massive and vulnerable homeless population in Los Angeles. There have now been 20 such cases reported, up from 12 on Wednesday. Most of those patients were living on the streets, Ferrer said, but officials are investigating four homeless people who are believed to have been living in shelters.

One of those patients was living at a shelter that was established by the city of Los Angeles at the Granada Hills Recreation Center, which underwent a deep cleaning after the case was confirmed. The shelter is one of several temporary housing sites set up at city recreation facilities in an effort to prevent the disease from spreading among the homeless.

Ferrer noted that while the cases involving four patients believed to have been living in shelters are under investigation, “a number of people at a couple of shelter sites” have been placed in quarantine and tested.

Ferrer also confirmed the death of a homeless-services worker — identified earlier as an employee of the Union Rescue Mission on skid row in downtown Los Angeles. Mission President Andy Bales told the Los Angeles Times the employee, who was formerly homeless and began working for the mission after completing a recovery program, died at Los Angeles County-USC Medical Center.

The county’s coronavirus cases now include 47 cases that occurred in jail settings — six inmates and 41 staff members — along with 11 cases in the state prison system — eight inmates and three staffers. Two cases have been reported in a county juvenile facility, both involving staff members at the Barry Nidorf juvenile hall in Sylmar.

Ferrer said there are now 155 institutional settings — such as nursing homes, skilled nursing facilities, assisted living facilities, shelters, jails and prisons — that have had at least one case. Those institutions have had a total of 716 cases and 51 deaths, all among residents.

As of Wednesday, roughly 38,300 people have been tested for the virus in the county, with about 15% turning out to be positive. Ferrer again noted that the percentage of positive cases is artificially high because some labs haven’t reported numbers of negative tests.

The county has set a goal of testing 10,000 people per day. With roughly 10% of those people ultimately testing positive, Ferrer has warned that the daily increases in case numbers will likely approach about 1,000.

She said new testing centers have opened almost every day this week across the county. But Ferrer again noted that testing has continued to be more prevalent in more affluent areas of the county. She earlier released partial figures indicating that the black community has a higher mortality rate from the illness, but said there continues to be less access testing in lower-income communities.

In hopes of rectifying that issue, new testing centers opened Wednesday at East Los Angeles College and at the Charles Drew University medical campus in Willowbrook. The county now has more than 20 testing centers across the region. Those centers and others operated by individual cities are restricted to people showing symptoms of COVID-19.

Ferrer stressed the people who are tested because they are showing symptoms of coronavirus should assume they are positive and isolate themselves from others while awaiting their results.

“If you’ve been tested, and since the majority of people being tested are symptomatic, if you’ve been tested and you’re waiting for your results, you have symptoms, you need to stay home and self-isolate while you’re waiting for your test results,” she said. “Please, please don’t wait for a conformation that you’re positive to begin your self-isolation. You actually need to self-isolate at the moment you started having symptoms. And this is particularly important because there’s still a lag time from the time you’re getting tested ’til the time you’re getting your test results.”

She also reminded parents that while residents are being urged to leave home only for essential purposes, their children’s health-care appointments are definitely essential.