Average daily COVID-19 cases and hospitalizations are continuing to fall in the U.S., an indicator that the omicron variant’s hold is weakening across the country.

Total confirmed cases reported Saturday barely exceeded 100,000, a sharp downturn from around 800,850 five weeks ago on Jan. 16, according to Johns Hopkins University data.

In New York, the number of cases went down by more than 50% over the last two weeks.

“I think what’s influencing the decline, of course, is that omicron is starting to run out of people to infect,” said Dr. Thomas Russo, professor and infectious disease chief at the University of Buffalo’s Jacobs School of Medicine and Biomedical Sciences.

COVID-19 hospitalizations are down from a national seven-day average of 146,534 on Jan. 20 to 80,185 the week ending in Feb 13, according to the Centers for Disease Control and Prevention COVID data tracker.

Public health experts say they are feeling hopeful that more declines are ahead and that the country is shifting from being in a pandemic to an ‘endemic’ that is more consistent and predictable. However, many expressed concern that vaccine uptick in the U.S. has still been below expectations, concerns that are exacerbated by the lifting of COVID-19 restrictions.

Dr. William Schaffner of Vanderbilt University’s School of Medicine said Sunday that the downturn in case numbers and hospitalizations is encouraging. He agreed that it likely has a lot to do with herd immunity.

“There are two sides to omicron’s coin,” he said. “The bad thing is that it can spread to a lot of people and make them mildly ill. The good thing is it can spread to a lot of people and make them mildly ill, because in doing so, it has created a lot of natural immunity.”

However, Schaffner said it’s much too early to “raise the banner of mission accomplished.” As a public health expert, he said he’ll be more comfortable if the decline sustains itself for another month or two.

“If I have a concern, it’s that taking off the interventions, the restrictions, may be happening with a bit more enthusiasm and speed than makes me comfortable,” he said. “My own little adage is, better to wear the mask for a month too long, than to take the mask off a month too soon and all of a sudden get another surge.”

Officials in many states are cutting back on restrictions, saying they are moving away from treating the coronavirus pandemic as a public health crisis and instead shifting to policy focused on prevention.

During a Friday news conference, Utah Gov. Spencer Cox announced that the state would be transitioning into what he called a “steady state” model starting in April in which Utah will close mass testing sites, report COVID-19 case counts on a more infrequent basis and advise residents to make personal choices to manage the risk of contracting the virus.

“Now, let me be clear, this is not the end of COVID, but it is the end — or rather the beginning — of treating COVID as we do other seasonal respiratory viruses,” the Republican said.

Also on Friday, Boston lifted the city’s proof of vaccine policy, which required patrons and staff of indoor spaces to show proof of vaccination.

“This news highlights the progress we’ve made in our fight against Covid-19 thanks to vaccines & boosters,” Boston Mayor Michelle Wu said via Twitter.

Dr. Amy Gordon Bono, a Nashville primary care physician, said now is not the time to lessen vaccination efforts, but to double down on them. In the spring of 2021 when vaccines were becoming more readily available, the U.S. was “eager to declare COVID independence,” she said. Then came the delta and omicron surges.

Bono, who attended medical school at Tulane University in New Orleans, said the U.S. should approach COVID like hurricane season.

“You have to learn to live with COVID and you have to learn from it,” she said.

One challenge is that each region has a unique landscape, she said. In the American South, for example, many restrictions have been lifted for a while or never existed in the first place. Yet it’s also a region with relatively lower vaccination rates.

“We’ve suffered so much and if there’s a way to help appease future suffering, it’s having a more vaccinated community,” she said.

In Buffalo, Russo said he sees two possible future outcomes. In one, the U.S. experiences a fairly quiet spring and summer while immunity is still strong. He said in that scenario, it’s likely immunity will wane and there will be a bump of new cases in the cooler months during flu season, but hopefully not a severe surge.

In the second — the one concerning public health experts — a new variant evolves and evades the immunity wall that was built up from both omicron infections and vaccinations.

“Whether such a variant can evolve is the big question, right?” he said. “That is the concern that we’ll have to see through. Omicron was the first version of that, and there is this sort of adage that ‘well, over time, viruses evolve to be less virulent,’ but that’s not really true. Viruses evolve to be able to infect us.”

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SACRAMENTO, Calif. (AP) — California Gov. Gavin Newsom rolled up his sleeve Wednesday and received a coronavirus vaccine booster shot, a move he encouraged others to take as the state heads into the time of year that in 2020 ushered in the deadliest spike of COVID-19 cases.

Much has changed since then — 88% of those 18 and older in California have received at least one dose of a vaccine that didn’t exist last fall and millions have survived contracting the virus and have a level of natural immunity, though it’s unclear for how long.

Still, millions are not vaccinated and new cases and hospitalizations have flattened after a steady two-month decline that saw California boast the nation’s lowest infection rate. State models show a gradual increase in hospitalizations in the next month.

Newsom got his shot at a health clinic in Oakland from Dr. Mark Ghaly, secretary of the California Health and Human Services Agency. He said it was painless and then flexed in celebration. After a 15-minute break to ensure no immediate side effects, he issued a warning about the dangers of the upcoming holiday season.

“This is an incredibly important time because what tends to happen this time — it happened last year — is our attention wanes,” Newsom said. “We start focusing on other things. And as a consequence, we can let our guard down.”

The state seems to have reached what Ghaly called a plateau after its steady decline in cases and hospitalizations since the summer surge of the delta variant of the virus.

Models show coronavirus hospitalizations increasing slightly over the next month, from about 3,800 in hospitals now to about 4,460 by Thanksgiving.

The models forecast a gradual drop in intensive care patients but with a troubling upward curve starting in about two weeks. Deaths are expected to continue their inexorable climb, adding nearly 3,000 to reach a pandemic total of 74,000 by Thanksgiving week.

The rate at which each infected person spreads the disease, known as the R-effective, remains below 1 statewide but had been creeping up since mid-September until another recent dip. Anything below 1 means the number of infected persons will decrease.

That pattern is mirrored in most regions of the state, but the rate in the Greater Sacramento area has edged back above 1, meaning the virus will start to spread.

Still the numbers are a far cry from what the state experienced less than a year ago.

At the end of last year and into January, there were single days when more than 50,000 new cases were recorded, compared to the state’s average of about 5,900 new cases per day in the last two weeks. Nearly 21,000 Californians were hospitalized at the peak and more than 18,500 people died in January alone.

Other experts are not expecting anything like last winter’s deadliest surge, even as people spend more time inside together given the approaching chill, poor weather and holidays.

“I’m not as pessimistic as the state or the governor,” said Dr. Lee Riley, chairman of the Division of Infectious Disease and Vaccinology at the University of California, Berkeley, School of Public Health. “The name of the game really is vaccination.”

Other places where winter conditions have already set in are not seeing significant jumps, he said. He does expect testing systems to be strapped as doctors and patients sort out the difference between the coronavirus and other respiratory diseases.

“Certainly the most mitigating factor is the immunity in the population,” agreed Dr. Jeffrey Klausner, a professor of epidemiology at the University of Southern California.

Counterintuitively, he expects the hardest-hit and most vulnerable populations last time to enjoy the best protection now because they have built up a natural immunity. So areas like Los Angeles, which had disproportionate levels of infections, hospitalizations and deaths, are likely to be protected from a surge.

By contrast, Klausner expects the San Francisco Bay Area, with higher levels of vaccinations but fewer illnesses, is “going to be potentially the most susceptible to a surge because their immunity … is mostly derived from vaccination, which we have learned is actually not as strong and durable as immunity that is acquired after infection.”

California is prepositioning millions of small-dose Pfizer vaccines in anticipation that the federal government will give final approval to administer the shots to children aged 5-11 as early as the end of next week. About 3.5 million children would be eligible, or 9% of California residents, state epidemiologist Dr. Erica Pan said.

The state plans to mandate vaccinations for school children but that’s not expected to kick in until the 2022-23 school year. Meantime, California will wait until after this winter to review its school masking requirement and then will look at typical indicators like the number of people who are vaccinated and the rate of transmissions and hospitalizations, Ghaly said.

Despite the governor’s appeal for more people to be vaccinated or receive booster shots, the state government has a done poor job of policing its own rules.

Newsom was the first governor in the nation to mandate all state workers either get the coronavirus vaccine or submit to weekly testing. The policy went into effect Aug. 2, but the Los Angeles Times reported this week many state agencies ignored the deadline without consequences.

Data from the California Department of Human Resources showed about half of the 59,000 unvaccinated state workers were tested during the first week of October. In the Department of Motor Vehicles, where about 3,600 unvaccinated staffers are required to be tested, just 411 of them have been, the newspaper reported.

Critics said the state’s blasé approach undermines the point of the mandate, which is to make sure state workers who interact with the public are protected and protect others.

Newsom said after the mandate the number of state workers vaccinated increased from 62% to 67%.

“We’re doing something at scale that’s never been done,” Newsom said Wednesday. “So I like the progress we’re making.”

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TOKYO (AP) — Japan’s capital, Tokyo, reported its highest number of new coronavirus infections on Tuesday, days after the Olympics began. Prime Minister Yoshihide Suga urged people to avoid non-essential outings, but said there was no need to consider a suspension of the Games.

Tokyo reported 2,848 new COVID-19 cases, exceeding its earlier record of 2,520 daily cases on Jan. 7. That brings its total to more than 200,000 since the pandemic began last year.

Tokyo is under its fourth coronavirus state of emergency, which is to continue through the Olympics until just before the Paralympics start in late August.

Experts have warned that the more contagious delta variant could cause a surge during the Olympics, which started Friday.

Still, Japan has kept its cases and deaths lower than many other countries. Nationwide, it reported 5,020 daily cases Monday for a total of 870,445 and 15,129 deaths. Its 7-day rolling average of cases is about 3.57 per 100,000 people, compared to 2.76 in India, 17.3 in the United States and 53.1 in Britain, according to data from Johns Hopkins University.

Asked if he is considering an option of suspending the Games, Suga replied, “There is no worry about that,” adding that people have been moving about less since the Games started because of traffic controls and the government’s request that they work remotely.

Suga again urged that people avoid non-essential outings. “Please watch the Olympic Games on TV at home,(asterisk) he said.

Suga’s government has been criticized for what some say is prioritizing the Olympics over the nation’s health. His public support ratings have fallen to around 30% in recent media surveys, and there is little festivity surrounding the Games.

Health Minister Norihisa Tamura, asked about the jump in cases, said it was not a surprise. “Taking into consideration the global acceleration of infections because of the delta strain, which is taking over earlier variants, it was quite possible,” he said.

Tamura blamed bars and restaurants that are still serving alcohol despite a ban under the state of emergency as a possible cause, instead of the Olympics.

The continuing upsurge despite two weeks of emergency measures, which focus on shortened hours for eateries and an alcohol ban, mean they are ineffective, said Kazuhiro Tateda, a Toho University infectious diseases expert who is on a government panel. With the Olympics and summer holidays prompting the movement of people, infections could escalate in coming weeks, Tateda told NHK public television.

Experts noted that cases among younger, unvaccinated people are rising sharply as Japan’s inoculation drive loses steam due to supply uncertainty. Many serious cases involve those in their 50s. They now dominate Tokyo’s nearly 3,000 hospitalized patients and are gradually filling up available beds. Authorities reportedly plan to ask medical institutions to increase their capacity to about 6,000 beds for COVID-19 patients.

Tokyo Gov. Yuriko Koike said elderly people are now more than 60% fully vaccinated and account for just 2% of new cases. “It is crucial to promptly vaccinate younger people,” she said.

Japan’s vaccination drive began late and slowly, but picked up dramatically in May for several weeks as the supply of imported vaccines stabilized and the government pushed to inoculate more people before the Olympics.

The government says 25.5% of Japanese have been fully vaccinated, still way short of the level believed to have any meaningful impact on reducing the risk for the general population.

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India’s official count of coronavirus cases surpassed 20 million Tuesday, nearly doubling in the past three months, while deaths officially have passed 220,000. Staggering as those numbers are, the true figures are believed to be far higher, the undercount an apparent reflection of the troubles in the health care system.

The country has witnessed scenes of people dying outside overwhelmed hospitals and funeral pyres lighting up the night sky.

Infections have surged in India since February in a disastrous turn blamed on more contagious variants of the virus as well as government decisions to allow massive crowds to gather for Hindu religious festivals and political rallies before state elections.

The reported caseload is second only to that of the U.S., which has one-fourth the population of India but has recorded over 32 million confirmed infections. The U.S. has also reported more than 2 1/2 times as many deaths as India, at close to 580,000.

India’s top health official, Rajesh Bhushan, refused to speculate last month as to why authorities weren’t better prepared. But the cost is clear: Many people are dying because of shortages of bottled oxygen and hospital beds or because they couldn’t get a COVID-19 test.

India’s official average of newly confirmed cases per day has soared from over 65,000 on April 1 to about 370,000, and deaths per day have officially gone from over 300 to more than 3,000.

On Tuesday, the health ministry reported 357,229 new cases in the past 24 hours and 3,449 deaths from COVID-19.

Dr. Ashish Jha, dean of Brown University’s School of Public Health in the U.S., said he is concerned that Indian policymakers he has been in contact with believe things will improve in the next few days.

“I’ve been … trying to say to them, `If everything goes very well, things will be horrible for the next several weeks. And it may be much longer,’” he said.

Jha said the focus needs to be on “classic” public health measures: targeted shutdowns, more testing, universal mask-wearing and avoiding large gatherings.

“That is what’s going to break the back of this surge,” he said.

The death and infection figures are considered unreliable because testing is patchy and reporting incomplete. For example, government guidelines ask Indian states to include suspected COVID-19 cases when recording deaths from the outbreak, but many do not do so.

Municipal records for this past Sunday show 1,680 dead in the Indian capital were treated according to the procedures for handing the bodies of those infected with COVID-19. But in the same 24-hour period, only 407 deaths were added to the official toll from New Delhi.

The New Delhi High Court announced it will start punishing government officials if supplies of oxygen allocated to hospitals are not delivered. “Enough is enough,” it said.

The deaths reflect the fragility of India’s health system. Prime Minister Narendra Modi’s party has countered criticism by pointing out that the underfunding of health care has been chronic.

But this was all the more reason for authorities to use the several months when cases in India declined to shore up the system, said Dr. Vineeta Bal of the Indian Institute of Science Education and Research.

“Only a patchwork improvement would’ve been possible,” she said. But the country “didn’t even do that.”

Now authorities are scrambling to make up for lost time. Beds are being added in hospitals, more tests are being done, oxygen is being sent from one corner of the country to another, and manufacturing of the few drugs effective against COVID-19 is being scaled up.

The challenges are steep in states where elections were held and unmasked crowds probably worsened the spread of the virus. The average number of daily infections in West Bengal state has increased by a multiple of 32 to over 17,000 since the balloting began.

“It’s a terrifying crisis,” said Dr. Punyabrata Goon, convener of the West Bengal Doctors’ Forum.

Goon added that the state also needs to hasten immunizations. But the world’s largest maker of vaccines is short of shots, the result of lagging manufacturing and raw material shortages.

Experts are also worried the prices being charged for shots will make it harder for the poor to get vaccinated. On Monday, opposition parties urged the government make vaccinations free to all Indians.

India is vaccinating about 2.1 million people daily, or around 0.15% of its population.

“This is not going to end very soon,” said Dr. Ravi Gupta, a virus expert at the University of Cambridge in England. “And really … the soul of the country is at risk in a way.”

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Associated Press writer Danica Kirka in London contributed to this report.

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.

ANIRUDDHA GHOSAL • AP News

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For weeks after Cindy Pollock began planting tiny flags across her yard — one for each of the more than 1,800 Idahoans killed by COVID-19 — the toll was mostly a number. Until two women she had never met rang her doorbell in tears, seeking a place to mourn the husband and father they had just lost.

Then Pollock knew her tribute, however heartfelt, would never begin to convey the grief of a pandemic that has now claimed 500,000 lives in the U.S. and counting.

“I just wanted to hug them,” she said. “Because that was all I could do.”

After a year that has darkened doorways across the U.S., the pandemic surpassed a milestone Monday that once seemed unimaginable, a stark confirmation of the virus’s reach into all corners of the country and communities of every size and makeup.

“It’s very hard for me to imagine an American who doesn’t know someone who has died or have a family member who has died,” said Ali Mokdad, a professor of health metrics at the University of Washington in Seattle. “We haven’t really fully understood how bad it is, how devastating it is, for all of us.”

Experts warn that about 90,000 more deaths are likely in the next few months, despite a massive campaign to vaccinate people. Meanwhile, the nation’s trauma continues to accrue in a way unparalleled in recent American life, said Donna Schuurman of the Dougy Center for Grieving Children & Families in Portland, Oregon.

At other moments of epic loss, like the 9/11 terrorist attacks, Americans have pulled together to confront crisis and console survivors. But this time, the nation is deeply divided. Staggering numbers of families are dealing with death, serious illness and financial hardship. And many are left to cope in isolation, unable even to hold funerals.

“In a way, we’re all grieving,” said Schuurman, who has counseled the families of those killed in terrorist attacks, natural disasters and school shootings.

In recent weeks, virus deaths have fallen from more than 4,000 reported on some days in January to an average of fewer than 1,900 per day.

Still, at half a million, the toll recorded by Johns Hopkins University is already greater than the population of Miami or Kansas City, Missouri. It is roughly equal to the number of Americans killed in World War II, the Korean War and the Vietnam War combined. It is akin to a 9/11 every day for nearly six months.

“The people we lost were extraordinary,” President Joe Biden said Monday, urging Americans to remember the individual lives claimed by the virus, rather than be numbed by the enormity of the toll.

“Just like that,” he said, “so many of them took their final breath alone in America.”

The toll, accounting for 1 in 5 deaths reported worldwide, has far exceeded early projections, which assumed that federal and state governments would marshal a comprehensive and sustained response and individual Americans would heed warnings.

Instead, a push to reopen the economy last spring and the refusal by many to maintain social distancing and wear face masks fueled the spread.

The figures alone do not come close to capturing the heartbreak.

“I never once doubted that he was not going to make it. … I so believed in him and my faith,” said Nancy Espinoza, whose husband, Antonio, was hospitalized with COVID-19 last month.

The couple from Riverside County, California, had been together since high school. They pursued parallel nursing careers and started a family. Then, on Jan. 25, Nancy was called to Antonio’s bedside just before his heart beat its last. He was 36 and left behind a 3-year-old son.

“Today it’s us. And tomorrow it could be anybody,” Nancy Espinoza said.

By late last fall, 54 percent of Americans reported knowing someone who had died of COVID-19 or had been hospitalized with it, according to a Pew Research Center poll. The grieving was even more widespread among Black Americans, Hispanics and other minorities.

Deaths have nearly doubled since then, with the scourge spreading far beyond the Northeast and Northwest metropolitan areas slammed by the virus last spring and the Sun Belt cities hit hard last summer.

In some places, the seriousness of the threat was slow to sink in.

When a beloved professor at a community college in Petoskey, Michigan, died last spring, residents mourned, but many remained doubtful of the threat’s severity, Mayor John Murphy said. That changed over the summer after a local family hosted a party in a barn. Of the 50 who attended, 33 became infected. Three died, he said.

“I think at a distance people felt ‘This isn’t going to get me,’” Murphy said. “But over time, the attitude has totally changed from ‘Not me. Not our area. I’m not old enough,’ to where it became the real deal.”

For Anthony Hernandez, whose Emmerson-Bartlett Memorial Chapel in Redlands, California, has been overwhelmed handling burial of COVID-19 victims, the most difficult conversations have been the ones without answers, as he sought to comfort mothers, fathers and children who lost loved ones.

His chapel, which arranges 25 to 30 services in an ordinary month, handled 80 in January. He had to explain to some families that they would need to wait weeks for a burial.

“At one point, we had every gurney, every dressing table, every embalming table had somebody on it,” he said.

In Boise, Idaho, Pollock started the memorial in her yard last fall to counter what she saw as widespread denial of the threat. When deaths spiked in December, she was planting 25 to 30 new flags at a time. But her frustration has been eased somewhat by those who slow or stop to pay respect or to mourn.

“I think that is part of what I was wanting, to get people talking,” she said, “Not just like, ‘Look at how many flags are in the yard today compared to last month,’ but trying to help people who have lost loved ones talk to other people.”

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LOS ANGELES (AP) — California on Monday became the first state to record more than 3 million known coronavirus infections.

The grim milestone, as tallied by Johns Hopkins University, wasn’t entirely unexpected in a state with 40 million residents but its speed stunning. The state only reached 2 million reported cases on Dec. 24.

The first coronavirus case in California was confirmed last Jan. 25. It took 292 days to get to 1 million infections on Nov. 11 and 44 days to top 2 million.

California’s caseload is also far ahead of other large states. Texas had more than 2 million and Florida topped 1.5 million.

The state has recorded more than 33,600 deaths related to COVID-19.

A caseload surge that began last fall has strained hospitals and especially intensive care units as a percentage of the infected — typically estimated to be around 12% by public health officials — become sick enough weeks later to need medical care.

On average, California has seen about 500 deaths and 40,000 new cases daily for the past two weeks.

Officials warn that a recent slight downward trend in hospitalizations could reverse when the full impact of New Year’s Eve gathering transmissions is felt.

The state is placing its hopes on mass vaccinations to reduce the number of infections but there have been snags in the immunization drive. On Sunday, Dr. Erica S. Pan, the state epidemiologist, urged that providers stop using one lot of a Moderna vaccine because some people needed medical treatment for possible severe allergic reactions.

More than 330,000 doses from lot 41L20A arrived in California between Jan. 5 and Jan. 12 and were distributed to 287 providers, she said.

In Northern California, Stanislaus County health officials responded by announcing they wouldn’t be holding vaccination clinics until further notice.

“Out of an extreme abundance of caution and also recognizing the extremely limited supply of vaccine, we are recommending that providers use other available vaccine inventory” pending completion of an investigation by state officials, Moderna, the U.S. Centers for Disease Control and the federal Food and Drug Administration, Pan said in a statement.

Fewer than 10 people, who all received the vaccine at the same community site, needed medical attention over a 24-hour period, Pan said. No other similar clusters were found.

Pan did not specify the number of cases involved or where they occurred.

Six San Diego health care workers had allergic reactions to vaccines they received at a mass vaccination center on Jan. 14. The site was temporarily closed and is now using other vaccines, KTGV-TV reported.

Moderna in a statement said the company “is unaware of comparable adverse events from other vaccination centers which may have administered vaccines from the same lot.”

The CDC has said COVID-19 vaccines can cause side effects for a few days that include fever, chills, headache, swelling or tiredness, “which are normal signs that your body is building protection.”

However, severe reactions are extremely rare. Pan said in a vaccine similar to Moderna’s, the rate of anaphylaxis — in which an immune system reaction can block breathing and cause blood pressure to drop — was about 1 in 100,000.

The announcement came as California counties continue to plead for more COVID-19 vaccine as the state tries to tamp down its rate of infection, which has resulted in record numbers of hospitalizations and deaths.

California has shipped about about 3.2 million doses of the vaccine — which requires two doses for full immunization — to local health departments and health care systems, the state’s Department of Public Health reported Monday.

Only about 1.4 million of those doses, or around 40%, have been administered.

So far, the state has vaccinated fewer than 2,500 people per 100,000 residents, a rate that falls well below the national average, according to federal data.

Although Gov. Gavin Newsom announced last week that anyone age 65 and older would be eligible to start receiving the vaccine, Los Angeles County and some others have said they do not have enough doses to vaccinate that many people and are first concentrating on inoculating health care workers and the most vulnerable elderly living in care homes.

The death rate from COVID-19 in Los Angeles County — the nation’s most populous and an epicenter of the state pandemic — works out to about one person every six minutes.

On Sunday, the South Coast Air Quality Management District suspended some pollution-control limits on the number of cremations for at least 10 days in order to deal with a backlog of bodies at hospitals and funeral homes.

“The current rate of death is more than double that of pre-pandemic years,” the agency said.

Adding to concerns, California is experiencing new, possibly more transmissible forms of COVID-19.

The state health department announced Sunday that an L452R variant of the virus is increasingly showing up in genetic sequencing of COVID-19 test samples from several counties.

The variant was first identified last year in California and in other states and countries but has been identified more frequently since November and in several large outbreaks in Northern California’s Santa Clara County, the department said.

Overall, the variant has been found in at least a dozen counties. In some places, testing has found the variant in a quarter of the samples sequenced, said Dr. Charles Chiu, a virologist and professor of laboratory medicine at the University of California San Francisco.

However, not all test samples receive genetic sequencing to identify variants so its frequency wasn’t immediately clear.

Health officials said it was linked to a Christmas-time outbreak at Kaiser Permanente San Jose that infected at least 89 staff members and patients, killing a receptionist. The outbreak has been blamed on an employee who visited the hospital emergency room wearing an air-powered inflatable Christmas tree costume.

The variant is different from another mutation, B117, that was first reported in the United Kingdom and appears to spread much more easily, although it doesn’t appear to make people sicker.

That variant has already shown up in San Diego County and Los Angeles County announced over the weekend that it had detected its first case.

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At the current rate, that means 2,640 hospitalizations from each day’s new case total. “We know that we can expect in the upcoming weeks alarming increases in hospitalizations and deaths,” said Barbara Ferrer, health director for Los Angeles County, the state’s largest with 10 million residents. For some, “the respiratory infection becomes unbearable — they have difficulty breathing and it’s very frightening,” said California Hospital Association president and CEO Carmela Coyle.

What starts with a spike in emergency room visits can cascade into jammed hospital beds and ultimately intensive care units. California’s hospitalizations already are at record levels, and the state has seen a roughly 70% increase in ICU admissions in just two weeks, leaving just 1,700 of the state’s 7,800 ICU beds available. “That fragile but important system may be overwhelmed,” Dr. Mark Ghaly, the state’s top public health officer, said Tuesday. “And the goal of saving lives becomes threatened when that system isn’t as robust and as strong as it can be.” Several hospitals in Los Angeles County and others in San Diego, Imperial and Fresno counties are among those close to running out of intensive care beds that are needed for the sickest patients.

In response, California has requested nearly 600 health care workers to help in ICUs through a contracting agency and the federal government. It’s starting a two-day program to train registered nurses to care for ICU patients and setting up links for doctors to consult remotely on ICU patients. Some hospitals are postponing elective surgeries to free up staff and beds. “Without some major change in our overall behavior … we will see hospitals continue to feel that pressure and get overwhelmed,” Ghaly warned. With that tragic scene in mind, Gov. Gavin Newsom recently imposed an overnight curfew, a ban on nonessential travel, and issued stay-home orders in regions where open ICU beds have dipped below 15%. Similar concerns about patient overload and staffing shortages faded during the initial months of the pandemic, leaving most of the state’s auxiliary surge hospitals barely used.

But now capacity is dwindling even before the impact of infections spread by those who ignored entreaties to stay home for Thanksgiving. County health officials point to a spike in health care workers themselves becoming infected and a dearth of traveling nurses who are busy in other states dealing with their own unprecedented spikes. When specially trained critical care nurses become overwhelmed, hospitals will likely first draft post-surgery nurses to fill the void. And if they too are swamped, hospitals will shift to a team approach, where a critical care nurse oversees others with less training who can still perform many duties.

That would require waiving strict nurse-to-patient ratios that are uniquely written into law in California, something the California Nurses Association argues would inevitably endanger patients’ care. Riverside University Health System Medical Center, for instance, has opened an ICU in a former storage room, chief executive Jennifer Cruikshank told Riverside County supervisors on Tuesday. An ICU nurse who typically cares for two patients is now taking care of three, she said, and doctors and housekeepers are taking extra shifts. In another attempt to help, the state is activating the first two of 11 alternative care sites that have a total capacity of 1,862 beds. A site in hard-hit Imperial County, on the border with Mexico, already has 19 of its 25 available beds in use, though it can expand to handle 115 patients. The second site is at the former home of the Sacramento Kings professional basketball team.

The goal is to have the first 20 beds ready by Wednesday in a practice gymnasium, then prepare another 224 beds in the main arena — some in luxury suites where well-heeled fans once watched games. It’s still unclear what patients will be placed there, Office of Emergency Services spokesman Brian Ferguson said. Last spring the state spent $12 million initially setting up the arena and hiring roughly 250 medical workers who were told to expect 30 to 60 patients within days. But only nine arrived over the next 10 weeks, leaving doctors frustrated before the site was put back into mothballs. It will be staffed this time with California Medical Assistance Teams, which usually respond to disasters like wildfires, and members of Newsom’s California Health Corps — paid volunteers who are often recently retired medical professionals.

The state also is seeking workers from contract medical providers and the federal government. Newsom wants more volunteers after his corps dwindled to fewer than 900 members, less than 1% of the 93,000 who originally signed up. Only 10 corps members were recently assisting at hospitals and nursing homes. But program spokesman Rodger Butler said some have previously assisted in intensive care units and Newsom on Monday said the program “has been incredibly effective, particularly in our skilled nursing facilities,” with members helping at more than 100 facilities statewide. Coyle said the corps isn’t a major help for hospitals “because the patients we are caring for are among the most acutely ill and very few of the Health Corps volunteers were trained at that highest level.”

Fresno County has been pleading for state help to staff three area hospitals for several weeks, but was sent just one or two workers for each amid the nationwide shortage, county Emergency Medical Services Director Daniel Lynch said. “We’re fulfilling what we can, but it is getting harder,” Ghaly said. Fresno officials urged the state to open 123 alternative care beds ready for use at Porterville Development Center in Tulare County, but Lynch said they were told the state’s priority is the Sacramento arena. Now county officials are considering putting overflow beds in the Fresno Convention Center.

Ferguson defended the state’s approach of having “flexible” alternative care sites that could serve residents displaced from nursing homes or skilled nursing facilities, or absorb some of hospitals’ less serious patients. “This is kind of what the next stage of this looks like, if things go back to really bad,” Ferguson said.

Associated Press writers Brian Melley contributed from Los Angeles, Amy Taxin from Orange County and Daisy Nguyen from Oakland.

-DON THOMPSON Associated Press

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Overwhelmed hospitals are converting chapels, cafeterias, waiting rooms, hallways, even a parking garage into patient treatment areas. Staff members are desperately calling around to other medical centers in search of open beds. Fatigue and frustration are setting in among front-line workers.

Conditions inside the nation’s hospitals are deteriorating by the day as the coronavirus rages across the U.S. at an unrelenting pace and the confirmed death toll surpasses 250,000.

“We are depressed, disheartened and tired to the bone,” said Alison Johnson, director of critical care at Johnson City Medical Center in Tennessee, adding that she drives to and from work some days in tears.

The number of people in the hospital with COVID-19 in the U.S. has doubled in the past month and set new records every day this week. As of Tuesday, nearly 77,000 were hospitalized with the virus.

Newly confirmed infections per day in the U.S. have exploded more than 80% over the past two weeks to the highest levels on record, with the daily count running at close to 160,000 on average. Cases are on the rise in all 50 states. Deaths are averaging more than 1,155 per day, the highest in months.

The out-of-control surge is leading governors and mayors across the U.S. to grudgingly issue mask mandates, limit the size of private and public gatherings ahead of Thanksgiving, ban indoor restaurant dining, close gyms or restrict the hours and capacity of bars, stores and other businesses.

New York City’s school system — the nation’s largest, with more than 1 million students — suspended in-person classes Wednesday amid a mounting infection rate, a painful setback in a corner of the country that suffered mightily in the spring but had seemingly beaten back the virus months ago.

Texas is rushing thousands of additional medical staff to overworked hospitals as the number of hospitalized COVID-19 patients statewide accelerates toward 8,000 for the first time since a deadly summer outbreak.

In the worsening rural Panhandle, roughly half of the admitted patients in Lubbock’s two main hospitals had COVID-19, and a dozen people with the virus were waiting in the emergency room for beds to open up Tuesday night, said Dr. Ron Cook, the Lubbock County health authority.

“We’re in trouble,” Cook said.

In the Texas border city of El Paso, overwhelmed morgues have begun paying jail inmates $2 an hour to help transport the bodies of virus victims. The crush of patients is forcing the city to send its non-COVID-19 cases to hospitals elsewhere in the state.

More than 5,400 extra medical personnel have been deployed around Texas by the state alone, said Lara Anton, a spokeswoman for the Texas Department of State Health Services. And that doesn’t include the help surging into Texas from the military and volunteer organizations.

“There are only so many medical personnel to go around. And I think what we’re seeing in places like El Paso is not sustainable in all or a large part of the state,” said Dr. Mark McClellan, a former head of the Food and Drug Administration.

Ballad Health system, which is located in the Appalachian mountains and includes the Tennessee hospital where Alison Johnson works, has warned that it and its workers are stretched so thin that without a change in course, its hospitals might have to turn patients away. Ballad reported having just 16 available ICU beds Wednesday and about 250 team members in isolation or quarantine. It is trying to recruit hundreds more nurses.

In Idaho, doctors warned that hospitals have almost reached the point where they need to ration care, unable to treat everyone because there aren’t enough beds or staffers to go around.

“Never in my career did I think we would even contemplate the idea of rationing care in the United States of America,” said Dr. Jim Souza, chief medical officer for St. Luke’s Health System.

In Reno, Nevada, Renown Regional Medical Center began moving some coronavirus patients into its parking garage.

Video of the converted garage before it opened to patients showed rows and rows of beds separated by moveable white screens set up on one level of the stark, cavernous garage, each section designated by letters and each bed space marked by a number on the ground. The garage unit currently houses 27 patients but at peak capacity will have enough beds to accommodate more than 1,400, said Dr. Paul Sierzenski, Renown’s chief medical officer for acute care.

The garage is heated, pressurized to ensure adequate airflow and set up for patients who don’t require long-term hospital care, Sierzenski said.

In Kansas, hospitals are converting spaces such as chapels and cafeterias for use by COVID-19 patients, said Cindy Samuelson, spokeswoman for the Kansas Hospital Association.

Stormont Vail Health in Topeka, Kansas, devoted an entire hospital floor to COVID-19 patients as their numbers swelled, hitting 90 on Wednesday. The hospital also converted two surgery waiting rooms for use by non-infected patients, spokesman Matt Lara said.

Kansas health chief Dr. Lee Norman said a system that he likened to air traffic control for coronavirus patients is being put in place so nurses from rural hospitals can make a single call to find a larger hospital that can take their sickest patients.

In some cases, nurses and doctors in Kansas have been spending up to eight hours looking for a large hospital with an opening.

Maryland health officials similarly set up a centralized clearinghouse with information on available ICU beds so that hospitals need only make a single phone call. State authorities also issued an emergency order prohibiting most hospital visitors until further notice.

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California is showing signs of a new surge of coronavirus cases, Gov. Gavin Newsom said Monday, warning of a potential third shutdown of businesses and more delays in school reopenings “if we’re not vigilant.”

Coronavirus-related hospitalizations have fallen more than 20% in the past two weeks and just 2.8% of people tested each day in California were positive for the disease, the lowest rate since the pandemic began.

The improving numbers have prompted state officials to loosen restrictions in 13 more counties over the last few weeks, allowing more businesses to reopen while granting hundreds of waivers for elementary schools — mostly private — to resume in-person classes.

But the “reproduction number,” a measure of how quickly the virus is spreading, is creeping up in the state’s most populated areas. An “R number” greater than 1.0 indicates an infected person is spreading the disease to more than one other person, which translates to an increasing case rate.

In the nine-county San Francisco Bay Area, the number increased to 0.95 in the first two weeks of September. In the lower portion of Southern California, which includes Orange, San Diego, San Bernardino, Riverside and Imperial counties, the R number rose to 0.97.

And in upper Southern California — the coastal area from Los Angeles to San Luis Obispo counties and inland Kern County — the number reached .02.

“This is, again, what science had predicted,” Newsom said. “If we go back to our original form, if we’re not cautious, if we’re not vigilant, if we’re not wearing our masks, if we’re not practicing social distancing, physical distancing and hand washing and hygiene, these numbers can start to tick back up.”

Dr. Jeffrey Klausner, a professor in the Division of Infectious Diseases at the University of California, Los Angeles, said the reproduction number is “fraught with uncertainty” because it is an estimate based on a model that includes many factors.

“We have to be cautious and not overinterpret that,” Klausner said.

Plus, Klausner said it’s difficult to know for sure how the coronavirus is progressing in California because of a lack of localized data. He said the state does not provide zip-code level data of the virus, as they do in New York City. He said it’s like “operating with a blindfold on.”

Still, the Newsom administration plans to lift restrictions in more counties on Tuesday as part of its weekly update of the state’s four-tier reopening plan. The state bases those decisions on county-level data that is a week old. The two factors considered are the rate of positive tests and per capita new cases. The R number is not part of the equation.

County governments don’t have to loosen virus restrictions, but they face enormous pressure to do so once the state says they can.

In Los Angeles County, whose 10 million residents make it the nation’s most populous county, local officials don’t expect the state will loosen their restrictions Tuesday because its number of new cases per day still is too high. Los Angeles County Public Health Director Barbara Ferrer said Monday it’s important to remember there is “a lot of community transmission still going on.”

Among the latest is an outbreak at Long Beach State University that prompted officials at the commuter school to quarantine the several hundred students living on campus and halt in-person instruction for two weeks. University officials say five students tested positive so far after violating school rules and attending an off-campus event social gathering.

“We’re in control of our destiny,” Ferrer said. “So I will say we need to be super cautious going into the fall and into the winter.”

A slow-down of business reopenings could not come at a worse time, especially for retailers who depend on the holiday shopping season for a majority of their annual sales, said Rex Hime, president and CEO of the California Business Properties Association, a group representing owners of commercial properties. He said the consequences of a third shutdown “will be devastating.”

“Business people have just been clobbered left and right, up and down, constantly,” he said. “I’m surprised we have businesses left in California.”

Newsom said his message to the business community and parents of school-aged children is to “abide by these mask mandates” as the state moves into the fall “and hopefully in the spring, where we have a vaccine, we can turn the page on COVID-19.”

State health officials are worried the surge of new coronavirus cases could coincide with the traditional flu season, which could strain the health care system since both have similar symptoms.

Newsom got a flu shot Monday during a news conference, urging others to do the same. Ferrer, the Los Angeles County public health director, said she had “no idea what flu season will look like.” She said countries like Australia and Brazil — nations in the Southern Hemisphere that both had large numbers of virus infections — had a mild flu season, presumably because more people are following hygiene protocols to protect themselves from COVID-19.

-Adam Beam Associated Press

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