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California extends strict stay-at-home order as hospital capacity dwindles

California has extended its strict stay-at-home orders in areas where hospital ICU capacity is rapidly dwindling, as the state’s governor warned residents to brace for a “surge on top of a surge” following the holiday season.

The state’s top health official, Dr Mark Ghaly, said that southern California and the agricultural San Joaquin Valley still have effectively zero ICU capacity and that the state’s restrictions would continue longer there.

California’s governor, Gavin Newsom, said on Monday that even with hospital admissions plateauing in some places, the state was destined to move into a “new phase” that it has been preparing for as it sets up hospital beds in arenas, schools and tents, though it is struggling to staff them.

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“As we move into this new phase, where we brace, where we prepare ourselves for what is inevitable now ... based on the travel we have just seen in the last week and the expectation of more of the same through the rest of the holiday season of a surge on top of a surge, arguably, on top of, again, another surge,” Newsom said.

The state is battling its deadliest phase of the pandemic thus far, with daily case numbers breaking records and intensive care units running out of beds, particularly in hard-hit southern California and the Central Valley.

Related: How California went from a leader in the Covid fight to a state in despair

California reported more than 31,000 new cases on Tuesday and 242 deaths, but the numbers are likely to climb this week as labs and counties catch up their reporting from the holiday week.

State officials also notified hospitals that the situation is so dire they should prepare for the possibility that they will have to resort to “crisis care” guidelines established earlier in the pandemic, which allow for rationing treatment.

The surge of infections is due in large part to Thanksgiving travel and celebrations, which happened despite warnings from health officials not to gather because the nation’s most populated state was already seeing explosive growth in cases.

Models used for planning show hospitalizations more than doubling in the next month from about 20,000 to more than 50,000.

Although there are indications more people are heeding stay-at-home orders that apply to all of the state but the northernmost rural counties, there was a bump in air travel in Los Angeles similar to Thanksgiving, with a high of 43,000 passengers on 23 December, the highest figure since the start of the pandemic, spokesman Heath Montgomery said.

The state has several makeshift hospitals that are taking patients, but more healthcare workers are needed to staff them, the Democratic governor said. It has deployed more than 1,000 people to 116 hospitals and other facilities through a volunteer corps or the national guard. On the upside, Newsom said California finally expects to receive more of the traveling healthcare workers it had requested in anticipation of the shortage.

Over the weekend, most Los Angeles county hospitals reached a crisis point where they had to divert ambulances because they did not have beds available. Dr Barbara Ferrer, the county’s public health director, said the “situation may only get worse as we begin 2021”.

Los Angeles county, which accounts for a quarter of California’s nearly 40 million residents, has about 40% of the state’s 24,000 deaths. The county is approaching a milestone of 10,000 deaths. Anyone who has traveled out of Los Angeles county is required to quarantine for 10 days when they return, the health department announced on Monday.