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  • A person wears a mask as he checks his mobile...

    A person wears a mask as he checks his mobile phone outside the temporary closed “HVY Industry,” an inclusive training gym, under a mural reading ” We Got this LA,” in Los Angeles Thursday, Jan. 7, 2021. A surge following Halloween and Thanksgiving produced record hospitalizations and now the most seriously ill of those patients are dying in unprecedented numbers. California health authorities reported Thursday 583 new deaths and a record two-day total of 1,042. (AP Photo/Damian Dovarganes)

  • A person wears a mask as he checks his mobile...

    A person wears a mask as he checks his mobile phone outside the temporary closed "HVY Industry" personal training gym under a mural reading " We Got this LA," in Los Angeles Thursday, Jan. 7, 2021. A surge following Halloween and Thanksgiving produced record hospitalizations and now the most seriously ill of those patients are dying in unprecedented numbers. California health authorities reported Thursday 583 new deaths and a record two-day total of 1,042. (AP Photo/Damian Dovarganes)

  • A sign posted outside the Cedars-Sinai Medical Center reads: "Wash...

    A sign posted outside the Cedars-Sinai Medical Center reads: "Wash your hands, Take care of each other," as maintenance workers dig a trench in Los Angeles Thursday, Jan. 7, 2021. California health authorities reported Thursday 583 new deaths and a record two-day total of 1,042. The state has deployed 88 refrigerated trailers, up from 60 a few weeks ago, for use as makeshift morgues, mostly in hard-hit Southern California. (AP Photo/Damian Dovarganes)

  • A medical worker walks past a refrigerated trailer parked outside...

    A medical worker walks past a refrigerated trailer parked outside the Cedars-Sinai Medical Center in Los Angeles Thursday, Jan. 7, 2021. California health authorities reported Thursday 583 new deaths and a record two-day total of 1,042. The state has deployed 88 refrigerated trailers, up from 60 a few weeks ago, for use as makeshift morgues, mostly in hard-hit Southern California. (AP Photo/Damian Dovarganes)

  • A woman wears a mask as she takes two small...

    A woman wears a mask as she takes two small dogs in a stroller for a walk in Los Angeles Thursday, Jan. 7, 2021. California health authorities reported Thursday a record two-day total of 1,042 virus deaths, with many people infected during the surge after Halloween and Thanksgiving. The California Hospital Association says the state is moving too slowly to find ways to handle so many cases. (AP Photo/Damian Dovarganes)

  • A caution sign is placed on the floor of a...

    A caution sign is placed on the floor of a COVID-19 unit at St. Joseph Hospital in Orange, Calif., Thursday, Jan. 7, 2021. (AP Photo/Jae C. Hong)

  • Christie Aiello, left and Denise Gomez prepare the Pfizer-BioNTech COVID-19...

    Christie Aiello, left and Denise Gomez prepare the Pfizer-BioNTech COVID-19 vaccine for medical workers at St. Joseph Hospital in Orange, Calif. Thursday, Jan. 7, 2021. (AP Photo/Jae C. Hong)

  • Registered nurse Anita Grohmann puts on her PPE next to...

    Registered nurse Anita Grohmann puts on her PPE next to a balloon delivered to a patient in a COVID-19 unit at St. Joseph Hospital in Orange, Calif. Thursday, Jan. 7, 2021. The virus is surging in virtually every state. California is particularly hard hit, with skyrocketing deaths and infections threatening to force hospitals to ration care. (AP Photo/Jae C. Hong)

  • Medical workers wait in the holding area after getting the...

    Medical workers wait in the holding area after getting the Pfizer-BioNTech COVID-19 vaccine at St. Joseph Hospital in Orange, Calif. Thursday, Jan. 7, 2021. (AP Photo/Jae C. Hong)

  • Registered nurse Kyanna Barboza tends to her COVID-19 patient at...

    Registered nurse Kyanna Barboza tends to her COVID-19 patient at St. Joseph Hospital in Orange, Calif., Thursday, Jan. 7, 2021. The virus is surging in virtually every state. California is particularly hard hit, with skyrocketing deaths and infections threatening to force hospitals to ration care. (AP Photo/Jae C. Hong)

  • Syringes containing the Pfizer-BioNTech COVID-19 vaccine sit in a tray...

    Syringes containing the Pfizer-BioNTech COVID-19 vaccine sit in a tray in a vaccination room at St. Joseph Hospital in Orange, Calif., Thursday, Jan. 7, 2021. (AP Photo/Jae C. Hong)

  • Dr. Michael Forino, right, gets the Pfizer-BioNTech COVID-19 vaccine at...

    Dr. Michael Forino, right, gets the Pfizer-BioNTech COVID-19 vaccine at St. Joseph Hospital in Orange, Calif., Thursday, Jan. 7, 2021. (AP Photo/Jae C. Hong)

  • Thank you letters are posted on the wall in the...

    Thank you letters are posted on the wall in the lobby area of St. Joseph Hospital in Orange, Calif., Thursday, Jan. 7, 2021. California health authorities reported Thursday a record two-day total of 1,042 coronavirus deaths as many hospitals strain under unprecedented caseloads. The state's hospitals are trying to prepare for the possibility that they may have to ration care for lack of staff and beds — and hoping they don't have to make that choice. (AP Photo/Jae C. Hong)

  • An EMT disinfects a gurney after transporting a patient at...

    An EMT disinfects a gurney after transporting a patient at St. Joseph Hospital in Orange, Calif., Thursday, Jan. 7, 2021. California health authorities reported Thursday a record two-day total of 1,042 coronavirus deaths as many hospitals strain under unprecedented caseloads (AP Photo/Jae C. Hong)

  • Registered nurse Kyanna Barboza adjusts the ventilator on her COVID-19...

    Registered nurse Kyanna Barboza adjusts the ventilator on her COVID-19 patient at St. Joseph Hospital in Orange, Calif., Thursday, Jan. 7, 2021. California health authorities reported Thursday a record two-day total of 1,042 coronavirus deaths as many hospitals strain under unprecedented caseloads. (AP Photo/Jae C. Hong)

  • Registered nurse Merri Lynn Anderson, right, tends to her patient...

    Registered nurse Merri Lynn Anderson, right, tends to her patient in a COVID-19 unit at St. Joseph Hospital in Orange, Calif., Thursday, Jan. 7, 2021. The state's hospitals are trying to prepare for the possibility that they may have to ration care for lack of staff and beds — and hoping they don't have to make that choice as many hospitals strain under unprecedented caseloads. (AP Photo/Jae C. Hong)

  • Registered nurse Keran Li looks at a monitor while checking...

    Registered nurse Keran Li looks at a monitor while checking on her patient in a COVID-19 unit at St. Joseph Hospital in Orange, Calif. Thursday, Jan. 7, 2021. California health authorities reported Thursday a record two-day total of 1,042 coronavirus deaths as many hospitals strain under unprecedented caseloads. (AP Photo/Jae C. Hong)

  • Registered nurse Merri Lynn Anderson talks to her patient with...

    Registered nurse Merri Lynn Anderson talks to her patient with a curtain drawn between them to give the patient privacy in a COVID-19 unit at St. Joseph Hospital in Orange, Calif., Thursday, Jan. 7, 2021. California health authorities reported Thursday a record two-day total of 1,042 coronavirus deaths as many hospitals strain under unprecedented caseloads. The state's hospitals are trying to prepare for the possibility that they may have to ration care for lack of staff and beds — and hoping they don't have to make that choice. (AP Photo/Jae C. Hong)

  • A motorists gets tested inside his Porsche sports car at...

    A motorists gets tested inside his Porsche sports car at Good Life Medical Services COVID-19 drive thru site in Los Angeles Thursday, Jan. 7, 2021. California health authorities reported Thursday a record two-day total of 1,042 coronavirus deaths as many hospitals strain under unprecedented caseloads. (AP Photo/Damian Dovarganes)

  • Registered nurse Merri Lynn Anderson puts on her PPE to...

    Registered nurse Merri Lynn Anderson puts on her PPE to check on her patient in a COVID-19 unit at St. Joseph Hospital in Orange, Calif., Thursday, Jan. 7, 2021. California health authorities reported Thursday a record two-day total of 1,042 coronavirus deaths as many hospitals strain under unprecedented caseloads. The state's hospitals are trying to prepare for the possibility that they may have to ration care for lack of staff and beds — and hoping they don't have to make that choice. (AP Photo/Jae C. Hong)

  • A COVID-19 patient, placed on a ventilator, rests at St....

    A COVID-19 patient, placed on a ventilator, rests at St. Joseph Hospital in Orange, Calif. Thursday, Jan. 7, 2021. California health authorities reported Thursday a record two-day total of 1,042 coronavirus deaths as many hospitals strain under unprecedented caseloads. (AP Photo/Jae C. Hong)

  • A COVID-19 patient eats his breakfast at St. Joseph Hospital...

    A COVID-19 patient eats his breakfast at St. Joseph Hospital in Orange, Calif., Thursday, Jan. 7, 2021. The state's hospitals are trying to prepare for the possibility that they may have to ration care for lack of staff and beds — and hoping they don't have to make that choice as many hospitals strain under unprecedented caseloads. (AP Photo/Jae C. Hong)

  • A COVID-19 patient lies in his bed as registered nurse...

    A COVID-19 patient lies in his bed as registered nurse Keran Li, foreground, works on her computer at St. Joseph Hospital in Orange, Calif. Thursday, Jan. 7, 2021. The state's hospitals are trying to prepare for the possibility that they may have to ration care for lack of staff and beds — and hoping they don't have to make that choice as many hospitals strain under unprecedented caseloads. (AP Photo/Jae C. Hong)

  • Physical therapist Daniel Lumbera helps a COVID-19 patient sit up...

    Physical therapist Daniel Lumbera helps a COVID-19 patient sit up on his bed at St. Joseph Hospital in Orange, Calif. Thursday, Jan. 7, 2021. The state's hospitals are trying to prepare for the possibility that they may have to ration care for lack of staff and beds — and hoping they don't have to make that choice, as many hospitals strain under unprecedented caseloads. (AP Photo/Jae C. Hong)

  • Registered nurse Kobie Walsh, left, checks on a COVID-19 patient...

    Registered nurse Kobie Walsh, left, checks on a COVID-19 patient at St. Joseph Hospital in Orange, Calif. Thursday, Jan. 7, 2021. The state's hospitals are trying to prepare for the possibility that they may have to ration care for lack of staff and beds — and hoping they don't have to make that choice, as many hospitals strain under unprecedented caseloads. (AP Photo/Jae C. Hong)

  • Registered nurses Kyanna Barboza, right, tends to a COVID-19 patient...

    Registered nurses Kyanna Barboza, right, tends to a COVID-19 patient as Kobie Walsh puts on her PPE at St. Joseph Hospital in Orange, Calif. Thursday, Jan. 7, 2021. California health authorities reported Thursday a record two-day total of 1,042 coronavirus deaths as many hospitals strain under unprecedented caseloads. The state's hospitals are trying to prepare for the possibility that they may have to ration care for lack of staff and beds — and hoping they don't have to make that choice. (AP Photo/Jae C. Hong)

  • Two nurses put a ventilator on a patient in a...

    Two nurses put a ventilator on a patient in a COVID-19 unit at St. Joseph Hospital in Orange, Calif. Thursday, Jan. 7, 2021. California health authorities reported Thursday a record two-day total of 1,042 coronavirus deaths as many hospitals strain under unprecedented caseloads. (AP Photo/Jae C. Hong)

  • A technician distributes a test kit at a COVID-19 walk-up...

    A technician distributes a test kit at a COVID-19 walk-up testing site on the Martin Luther King Jr. Medical Campus Thursday, Jan. 7, 2021, in Los Angeles. (AP Photo/Marcio Jose Sanchez)

  • People take a COVID-19 test on the Martin Luther King...

    People take a COVID-19 test on the Martin Luther King Jr. Medical Campus, Thursday, Jan. 7, 2021, in Los Angeles. (AP Photo/Marcio Jose Sanchez)

  • Masked pedestrians walk past a COVID-19 testing site on the...

    Masked pedestrians walk past a COVID-19 testing site on the Martin Luther King Jr. Medical Campus Thursday, Jan. 7, 2021, in Los Angeles. (AP Photo/Marcio Jose Sanchez)

  • People line up at a COVID-19 walk-up testing site on...

    People line up at a COVID-19 walk-up testing site on the Martin Luther King Jr. Medical Campus Thursday, Jan. 7, 2021, in Los Angeles. (AP Photo/Marcio Jose Sanchez)

  • People walk past a covered tent at a COVID-19 walk-up...

    People walk past a covered tent at a COVID-19 walk-up testing site on the Martin Luther King Jr. Medical Campus Thursday, Jan. 7, 2021, in Los Angeles. (AP Photo/Marcio Jose Sanchez)

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PUBLISHED: | UPDATED:

By DON THOMPSON | The Associated Press

SACRAMENTO  — For Caroline Brandenburger, the coronavirus outbreak that has overwhelmed California hospitals comes with a very personal toll.

“Just today we had two deaths on this unit. And that’s pretty much the norm,” said Brandenburger, who works on the COVID-19 unit at St. Joseph Hospital in Orange, south of Los Angeles. “I usually see one to two every shift. Super sad.”

“They fight every day, and they struggle to breathe every day even with tons of oxygen. And then you just see them die,” Brandenburger said. “They just die.”

California avoided surging cases for months, but now the virus is raging out of control there, as it has done in many other states. Only Arizona tops California in cases per resident and, with 40 million residents, the huge state is seeing staggering caseloads: more than 2.5 million confirmed infections.

A surge following Halloween and Thanksgiving produced record hospitalizations, and now the most seriously ill of those patients are dying in unprecedented numbers. California health authorities reported Thursday 583 new deaths and a record two-day total of 1,042.

There have been more than 28,000 COVID-19 deaths in the state since the start of the pandemic.

Hospitalizations are nearing 22,000, and state models project the number could reach 30,000 by Feb 1. Already, many hospitals in Los Angeles and other hard-hit areas are struggling to keep up and warned they may need to ration care as intensive care beds dwindle.

Lawmakers and public health officials have repeatedly praised medical workers as heroes as they struggle to treat the infected. Many nurses already stretched thin are now caring for more patients than typically allowed under state law after the state began issuing waivers that allow hospitals to temporarily bypass a strict nurse-to-patient ratios law.

The nurses at St. Joseph Hospital illustrate the toll that comes with the work.

“This past week has been probably the hardest week for me physically and emotionally,” said Donna Rottschafer, a nurse in the COVID-19 unit. “I’ve been here 21 years, and I’ve seen more people pass away in the last week — in the past couple weeks really — then almost like combined in all of my career as a nurse.”

“We’re seeing patients who are maxed out on oxygen, who are basically just suffering,” she said.

To the north in Los Angeles County, figures released Thursday showed a new daily caseload of nearly 20,000, a 66.5% increase over the previous day, Los Angeles Mayor Eric Garcetti said.

The more than 8,000 people hospitalized was the largest number since the pandemic began early last year, Garcetti said.

The county has a fourth of the state’s population but accounts for about 40% of COVID-19 deaths.

Garcetti said federal authorities should step in to send the region vaccines, money, doctors and personal protective equipment, noting that medical workers and PPE flooded into New York when it hit its peak early in the pandemic.

“This is our peak, and we need you,” Garcetti said. “We need national leadership, we need vaccines and we need resources to pay for them. Give us those and we know how to get the job done.”

Los Angeles is one of 14 counties in the two hardest-hit regions — Southern California and the agricultural San Joaquin Valley — that for about two weeks have essentially run out of intensive care unit beds for COVID-19 patients.

Intensive care availability at Bay Area hospitals fell to the lowest levels yet, dropping from 7.4% to just 3.5% as of Wednesday, according to state data. The Northern California region, which includes 11 mainly smaller and rural counties, had the best capacity at around 25%.

Earlier this week, state health officials caught hospitals off guard and left them scrambling with new orders limiting nonessential surgeries and requiring hospitals that have scarce ICU space to accept patients from those that have run out, an order that may require transferring patients hundreds of miles.

During an earlier surge, patients in Imperial County along the border with Mexico were sent to hospitals as far away as the San Francisco Bay Area. But the current outbreak is so widespread that only 11 mostly rural counties north of Sacramento and San Francisco are above the state’s threshold of having at least 15% capacity for coronavirus patients in ICU beds. Those below that level are under stricter restrictions for business operations.

The biggest fear is that hospitals will be tipped into rationing care in a few weeks when people who ignored social distancing rules to gather with friends and relatives for Christmas and New Year’s Eve start showing up for medical care.

Officials urged people to avoid mixing households or travelling in hopes of slowing the infection spread and preventing what has been called a surge on top of a surge.

In an effort to keep people closer to home, the Newsom administration issued a more strident travel advisory that says people from out of state are “strongly discouraged” from entering California, and Californians should avoid non-essential travel more than 120 miles from home.

“This next two or three weeks will define everything for us,” said Garcetti, the Los Angeles mayor. “Our own behavior will dictate everything that we do.”

___

Associated Press writer Kathleen Ronayne in Sacramento, John Antczak and Christopher Weber in Los Angeles and Janie Har in San Francisco contributed to this story.