California stay-at-home order looms as COVID-19 cases explode to new levels

California reached another troubling COVID-19 milestone Tuesday, averaging 14,120 cases per day with more than 8,200 hospitalized — both new records.

The continuing surge is putting more pressure on state and local officials to take more aggressive action to slow the spread before it overwhelms hospitals. Los Angeles County, which has been particularly hard hit, reported more than 7,500 new cases — the most in a single day. Projections suggest L.A. County could reach 9,000 cases by next week.

Officials have said they would consider a restrictive stay-at-home order if cases kept rising, which is now expected because the Thanksgiving weekend likely spread the virus even more.

What are the options?

Gov. Gavin Newsom warned Monday that a new stay-at-home order could be coming.

It’s possible such an order would be imposed only on counties in the worst shape among those in the purple tier — although the vast majority of counties are in that tier. “We will be coming out with some additional information, some additional recommendations in the very, very near future,” Newsom said.

Few details of such an order have been announced. Dr. Mark Ghaly, California’s health and human services secretary, said Monday that officials could learn from the spring lockdown.

“One of the most important things we’ve learned is we can be not just more surgical with what we do, but we can really prescribe it for a shorter or a different amount of time,” Ghaly said. “Early on, some of those orders really were open-ended; we weren’t sure. Today, we know that we can get impact from certain interventions in a reliable way more quickly, and that’s part of what we’re considering.”

But it might take some cues from L.A. County, which now has the toughest restrictions in the state.

Officials in L.A. County rolled out a “targeted safer-at-home order” that is in effect through Dec. 20. It closes public playgrounds; places new capacity limits on retail stores, outdoor museums, galleries, zoos and aquariums; and prohibits all gatherings among people from different households, except for outdoor religious services and political demonstrations.

Those limitations are on top of other restrictions that went into effect last week, including a renewed ban on outdoor dining.

On Saturday, L.A. County Public Health Director Barbara Ferrer held out hope these restrictions could be enough to slow the spread. But she stressed it only works if people follow the rules.

“If this doesn’t work, and two to three weeks from now we find ourselves in a worse place than we are, we’re going to have to go back and look at what else do we have as options, because we cannot continue to risk overwhelming the healthcare system,” Ferrer said. “I don’t think there’s any disagreement about that — that’s a disaster that we have to avoid at all costs.”

Other counties have their own various restrictions.

In Santa Clara County, hotel use has been restricted to essential travel or to people needing medical isolation or quarantine. Capacity at retail establishments was further capped. Authorities also suspended contact sports for professional teams, forcing the San Francisco 49ers to look elsewhere to play their home games scheduled for December.

San Francisco this week will announce more rollbacks, including a possible quarantine order for travelers and reduced indoor capacity at businesses, as the coronavirus continues to surge, city officials said Tuesday.

Dr. Grant Colfax, San Francisco’s director of public health, said: “We know unfortunately that the worst is likely yet to come.”

What is the situation at hospitals?

Newsom on Monday said Southern California is forecast to run out of intensive care unit capacity by mid- to late December if current trends continued. By Christmas Eve, ICU beds are forecast to be at 107% of capacity across the region. While intensive care treatments have improved since the early days of the pandemic, all bets are off once ICUs are pushed beyond capacity.

The average net increase in people hospitalized in California with COVID-19 is now about 342 patients a day over the last week, according to a Times analysis. The acceleration is twice as bad as the summertime surge, which saw the average net increase in hospitalizations top out at 173 patients a day over a weeklong period in late June.

In L.A. County, hospitalizations have more than tripled since Halloween, when there were about 800 people hospitalized, and surged past 2,400 on Monday. It was the second consecutive day that the high for hospitalizations in L.A. County has been broken, and a number that’s 9% higher that the peak from the summer wave.

Santa Clara County officials warned Wednesday that its system of hospitals are at risk of exceeding the capacity soon. As of Tuesday, intensive care units were at 93% of capacity at hospitals that traditionally serve the agricultural southern part of the county, like Gilroy, and the East San Jose, which is heavily Latino and hit hard by the pandemic.None of those hospitals had more than five ICU beds available Tuesday, including Regional Medical Center of San Jose, Kaiser Santa Clara, and the three county-run hospitals, Santa Clara Valley Medical Center, O’Connor Hospital, or St. Louise Regional Hospital.

How about the vaccine?

The development of COVID vaccines offers hope for 2021. But it will not help with this winter surge.

California expects to receive about 327,000 doses of Pfizer’s vaccine, to go to front-line health workers.

The CDC’s Advisory Committee on Immunization Practices met Tuesday to debate and vote on who should be first in line to receive initial doses of a COVID-19 vaccine. They recommended that the initial vaccination effort focus on front-line healthcare workers, as well as residents of long-term care facilities, such as nursing homes and assisted-living facilities. As more vaccine becomes available, more groups will be eligible.

Most experts feel that the immunization effort in the United States will be in high gear by late spring and early summer, as Pfizer and Moderna continue to ramp up production and other vaccine candidates complete their clinical trials and apply for emergency-use authorization.

Times staff writers Tom Curwen and Alex Wigglesworth contributed to this report.