California becomes first state to record 2 million COVID-19 cases on Christmas Eve - as hospitalizations soar and ICU capacity falls to just 1.1%

California has become the first state to record 2 million COVID-19 cases, reaching the milestone on Christmas Eve, as nearly the entire state was under a strict stay-at-home order and hospitals were flooded with the largest crush of cases since the pandemic began.

The country's most populous state had recorded 2,010,157 infections as of Thursday afternoon. The California Health Department has not yet updated its daily figures. 

Close to 19,000 people were hospitalized in the state Wednesday, and models project the number could top 100,000 in a month - unimaginable for medical systems that are already running out of room. More than 23,000 people with COVID-19 have died in California, and the number is only expected to climb. 

The grim milestone comes as a COVID-19 crisis that health officials say stems from Thanksgiving gatherings strains the state's medical system. 

The state has seen its number of cases climb exponentially in recent weeks, fueled largely by people who ignored warnings and held traditional Thanksgiving gatherings, health officials say. 

Soaring rates of hospitalizations and deaths have overwhelmed intensive care units and prompted hospitals to put emergency room patients in tents and treat others in offices and auditoriums.

Close to 19,000 people were hospitalized in California on Wednesday, and models project the number could top 100,000 in a month - unimaginable for medical systems that are already running out of room

The country's most populous state had recorded 2,010,157 infections as of Thursday afternoon. The California Health Department has not yet updated its daily figures

Nearly the entire state is under a stay-home order that imposed an overnight curfew, shuttered many businesses and restricted most retail to 20% capacity. Restaurants may only serve takeout. 

Pleas to avoid social gatherings for the Christmas and New Year's holidays rang with special desperation in Southern California. Los Angeles County is leading the surge, accounting for one-third of the state's COVID-19 cases and nearly 40% of deaths.

'We know that this emergency is our darkest day, maybe the darkest day in our city´s history,' Los Angeles Mayor Eric Garcetti said Wednesday, when the county reported its highest death toll and hospitalizations in a single day since the pandemic began - 145 deaths and more than 6,000 people in hospitals.

More than 9,000 people have died from the coronavirus in the county.

If LA County continues to see the same growth in COVID-19 infections in the next two weeks, hospitals may find themselves having to ration care because of a lack of medical staff, Garcetti said.

'That means the doctors will be forced to determine who lives and who dies,' he said.

Medical workers are discouraged and outraged over scenes of crowded outdoor malls, packed parking lots, and parents and children walking around without masks, county Health Services Director Dr. Christina Ghaly said.

Santa Clara County near San Francisco was down to 35 ICU beds, putting hospitals dangerously close to rationing care, said Dr. Ahmad Kamal, the county´s director of health care preparedness.

'We are talking about people in gurneys without a bed to go to. We are talking about people not getting hospital care; we are talking about rationing what scarce resources our exhausted health system has left to those who would benefit the most,' he said. 

Close to 19,000 people were hospitalized in the state Wednesday, and models project the number could top 100,000 in a month

Ninety-eight percent of the state is currently under some form of stay-at-home orders as of Christmas eve 

Overall, California on Wednesday recorded its second-highest number of deaths, at 361. The number of coronavirus patients in intensive care units nearly doubled in just three weeks, to 3,827 cases, while the state´s ICU capacity fell to 1.1%, down from 2.5% just two days ago. The number of hospitalizations jumped to 18,828 patients, more than double since December 1, with 605 new patients in one day.

Yet there were slight but encouraging signs of hope.

The transmission rate - the number of people that one infected person will in turn infect - has been slowing for nearly two weeks. The rate of positive cases reached a new high of 12.3% over a two-week period, but was starting to trend downward over the last seven days from a peak of 13.3% to 12.6%.

The state also has nearly 1,000 health workers assisting at 91 facilities in 25 of the state´s 58 counties, and is opening a fifth alternative care site in San Diego County.

The California National Guard was setting up about 200 beds on vacant floors of the Palomar Health Center near San Diego, within the existing hospital complex, said Brian Ferguson, a spokesman for the Governor's Office of Emergency Services. It could begin accepting patients Christmas Day, relieving overburdened hospitals particularly in nearby Imperial County.

California expects more federal medical workers to arrive by the weekend, and Gov. Gavin Newsom said he expects more of the 3,000 contract health care workers the state is seeking to arrive after the holidays.

The governor also said more than 128,000 vaccine doses had been administered as of Tuesday, in another encouraging sign beyond the modest decline in the transmission rate.

But Newsom also warned that any progress could dissipate quickly, leading to the nearly 100,000 hospitalizations some models project in one month if people don´t heed calls to avoid holiday gatherings, particularly indoors.

'This virus loves social events,' Newsom said. 'This virus thrives in that atmosphere.' 

Clinicians care for a COVID-19 patient in the Intensive Care Unit at Providence St. Mary Medical Center amid a surge in COVID-19 patients in Southern California on Wednesday

The 213 bed capacity hospital in San Bernardino County is currently treating at least 140 COVID 19-positive inpatients while operating at approximately 250 percent of ICU capacity

The nurses of California are afraid.

It's Christmas Eve, and they aren't home with their families. They are working, always working, completely gowned up — and worn down.

They're frightened by what people are doing, or not doing, during a coronavirus pandemic that has already killed more than 320,000 nationwide and shows no signs of slowing down.

They're even more terrified of what's next.

'Every day, I look into the eyes of someone who is struggling to breathe,' said nurse Jenny Carrillo, her voice breaking.

A charge nurse at Providence Holy Cross Medical Center in Los Angeles' San Fernando Valley, Carrillo is haunted by the daily counts of COVID-19 patients. Dark shadows circle her eyes.

By Tuesday evening, the hospital had 147 coronavirus patients — a record for Holy Cross but a tiny fraction of the 2 million cases recorded in California since the pandemic began.  

Dr. Jim Keany, associate director of Mission Hospital's emergency department in Southern California's Orange County, wonders how much more they can handle.

'Are we going to have the resources to take care of our community?' he said.

The first COVID-19 case in California was confirmed Jan. 25. It took 292 days to get to 1 million infections on Nov. 11.

Just 44 days later, the number hit 2 million.

On Tuesday, Holy Cross had 147 coronavirus patients across its 377 beds, more than double the record seen at the hospital in the first wave of the pandemic earlier this year.

'If you had told us in April that we'd have 147 patients?' said Elizabeth Chow, Holy Cross' executive director of critical care and a nurse leader. 'Never in my wildest dreams.'

And the nightmare is expected to get worse.

Despite health officials' pleas that people stay home, millions of Americans are traveling ahead of Christmas and New Year's, much like they did last month for Thanksgiving.

Engineers and volunteers stand outside a mobile field hospital at UCI Medical Center in Orange, California

Hospitals in California — and elsewhere — already have been pushed to the brink. They have hired extra staff, canceled elective surgeries and set up outdoor tents to treat patients, all to boost capacity before the cases contracted over Christmas and New Year's show up in the next few weeks.

Holy Cross and Mission Hospital have sprinkled holiday decorations throughout the hallways: poinsettias perched on counters, scraggly miniature trees in patients' rooms, caricatures of the Grinch doodled at nurses' stations.  

But the bright colors don't distract from the constant cacophony: ventilators belching like foghorns, monitors beeping, machines whirring — all trying to keep even one more person from adding to the death toll.

Still, there are hopeful moments.

On Monday, Mission Hospital celebrated a milestone: 100 patients who had been in the isolation intensive care unit — reserved for the sickest of the sick — have survived and gone home.

In Holy Cross, 'Here Comes the Sun' by the Beatles plays throughout the hospital when a COVID-19 patient is discharged.

The new pandemic tradition has happier roots — hospitals often sound a lullaby each time a baby is born.

It's a few seconds of respite, but it's not enough. For every patient who goes home, more are admitted. 

Holy Cross charge nurse Melanie LaMadrid tends to her patients in 12-hour shifts, holding their hands in her purple gloves.

'It's all we can do,' she said. 'Watching them suffer is hard.'

These nurses are not only exhausted, they are angry with those who flout pleas to stay home, stay safe.

'I wish they could just walk down our unit for a day and look at the faces of some of these patients,' Carillo said.

You can be our messengers, nurse Genyza Dawson tells her patients when — or if — they get discharged. Dawson, who has a scar forming on her nose from the tight masks, begs them to spread the word.

'Now you know how it is,' she tells them. 'You were one of the lucky ones.'