In summary

Gov. Gavin Newsom said California could see “a surge on top of a surge arguably on top of a surge” after the holidays.

Gov. Gavin Newsom today recapped California’s dire COVID-19 condition, painting a bleak picture for this holiday season. 

In the last 24 hours, more than 33,000 people in the state had tested positive for COVID-19. In what is now the epicenter of the pandemic, Los Angeles County, close to 600 people are testing positive every hour.  

On Christmas Eve, health officials in Los Angeles County reported that one person was dying from COVID-19 every 10 minutes. About 96% hospitals in Los Angeles couldn’t take ambulance patients over the weekend and instead were diverting patients to other parts of the region, the governor said. 

Citing the skyrocketing cases and overwhelmed hospitals, the governor signaled the state will likely extend its stay-at-home order. 

The original three-week order, which went into effect when regions dipped below 15% capacity in hospital intensive care units, called for some non-essential businesses to shut down and further restricted indoor activity for others. It had been set to expire soon in Southern California and the San Joaquin Valley.

And things are likely to become worse before they get better. The governor said California could see “a surge on top of a surge arguably on top of a surge as it relates to the holiday movement and the travel that we’ve experienced all across this country.”

Here’s the landscape the governor laid out for Californians in this last week of the year:

Stretched hospital capacity

As of today, California had tallied 24,824 deaths and about 2.1 million positive cases. For months, California managed to have fewer than the recommended 5% of coronavirus tests coming back positive. Today that positivity rate has soared to about 12%. 

The intensity of the situation is felt most acutely in hospitals — more than 20,000 Californians were in the hospital with COVID-19 on Sunday, according to the state’s dashboard.  

Two of the state’s five regions, Southern California and the San Joaquin Valley, are at 0% ICU capacity. State officials have explained that while this does not mean there are absolutely no beds available, it does mean that the region is in surge mode. Hospitals are raising tents in parking lots and building extra space for COVID-19 patients in operating rooms and other areas. 

Newsom today said the state had five alternate care sites ready to take patients and help alleviate hospitals, but only 67 patients were in those sites. The busiest site is at Imperial Valley College, where 31 patients are being treated. The Sleep Train Arena in Sacramento, which could take more than 200 patients if needed, had 11 patients, Newsom said. 

The issue is staffing

State and hospital officials have repeatedly said that their biggest concern isn’t the number of physical beds, but the number of staff available to tend to those beds. Health care workers are drained and in some cases sick themselves. Hospitals, counties and the state have been scrambling to get their hands on temporary staff and traveling nurses to help. 

Today, Newsom said 1,028 additional staff had been deployed to 116 facilities; they came from the California National Guard and the state’s health corps program. 

The state has also approved 86 staffing waivers, allowing hospitals to exceed the staff-to-patient ratios set by state law. As hospitals increasingly seek these waivers, the California Nurses Association, for one, has raised concerns, arguing that assigning more patients to nurses is dangerous for both.

Dr. Mark Ghaly, the state’s health secretary, added that the state is expecting groups of traveling nurses and health professionals to arrive in California the first week of January — although the exact number is unknown.  

That will help “make sure that we’re able to staff some of the beds that today are available, but also open up additional beds, so that our ability to surge is indeed as great as we anticipate,” Ghaly said. 

Where’s the vaccine? 

Starting today, most nursing home residents will start receiving their first shots through CVS and Walgreens pharmacies, which will deliver and administer the vaccine. Officials in Los Angeles County chose to not partner with the pharmacy giants and will instead leave coordination and administration directly to the county and facilities themselves. 

According, to the governor’s office, it will take about three to four weeks to give nursing home residents their first dose. Staff and residents in assisted living, residential care and other types of long-term care facilities will follow. 

Older Californians have borne the brunt of the pandemic death toll. Since Oct. 1, 80% of deaths have been among people 61 and older, according to state numbers.

The state is expecting to receive 1.76 million doses of the Pfizer and Moderna vaccines by the end of the year, enough to vaccinate about 4% of the state’s population with their first dose. As of Saturday, a little over 261,000 vaccines had been administered, Newsom said. Each treatment requires two doses.

California is also expected to announce as soon as Wednesday who will follow right behind health workers and those in skilled nursing facilities in the vaccine line. The state’s panel of experts making the call is currently considering people 75 years and older, education and childcare workers, emergency services workers, and food and agricultural workers. 

That group would likely be followed by people 65 and over with an underlying condition or disability, transportation workers, critical manufacturing workers, incarcerated individuals and people who are homeless, Newsom said. 

A dark January lies ahead

Despite the glimmer of hope that the arrival of the vaccine provides, its arrival may be too late for people who will become infected following holiday travel and gatherings. 

Nationally, the Transportation Security Administration screened more than 1.2 million people at airport checkpoints on Sunday — about half the number of people who traveled on that date that last year, but still the highest number since the start of the pandemic.

Newsom, who has been questioned on many occasions about enforcing stay-at-home orders and travel advisories, has said repeatedly that he believes Californians are in large part doing the right thing. Still, he acknowledged that based on early travel data, many people likely didn’t follow the state’s recommendations. 

“That suggests that we are going to see an increase in cases,” Newsom said. And as cases rise, so does demand in hospitals and their ICUs, setting January to be possibly one of the hardest months for California. 

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Ana is a Sacramento-based health reporter. She joined CalMatters in 2020 after four years at Kaiser Health News, where she covered California health care and policy. She started her reporting career at...