Working low on oxygen, emergency employees in Los Angeles County are informed to manage the minimal essential.

California’s daily coronavirus case numbers remain about four times what it was during the state’s summer flood, and officials predict the aftermath of a December wave related to holiday gatherings will worsen over the winter.

After new infections – fueled by Thanksgiving trips and gatherings, then Christmas festivities – led to a surge the state hadn’t seen before, the trend in its new cases flattened somewhat in the early days of 2021.

But there are more than twice as many Covid-19 patients in California hospitals as there were a month ago, and many intensive care units in the state are overcrowded. It has also been found that at least six people in the state are infected with the new, more transmissible variant of the virus first identified in the UK.

The state is also facing a lack of oxygen for patients and has deployed the U.S. Army Corps of Engineers and the California Emergency Medical Services Authority to help with the delivery and refilling of oxygen tanks.

As a sign of how bad the shortage is, Marianne Gausche-Hill, the medical director of the Los Angeles County EMS agency, issued guidelines on Sunday for emergency responders to administer the “minimum amount of oxygen” required keep the patient’s oxygen saturation at a level or just over 90 percent. (Levels in their low 90s or below are an issue for people with Covid-19.)

In the brutal logic of the pandemic, more cases inevitably lead to more suffering and death. As of Monday evening, 4,258 people had died with Covid-19 in the past two weeks, compared to 3,043 in the two weeks prior.

Updated

Jan. 5, 2021, 6:31 p.m. ET

“This is a deadly disease, this is a deadly pandemic,” Governor Gavin Newsom told reporters on Monday. “It remains deadlier today than at any point in the history of the pandemic.”

Some progress has been made. For example, California’s daily average of 38,086 cases per day for the past week is an 11 percent decrease from the average for two weeks earlier. And although hospital stays in Covid-19 have increased 18 percent to 20,618 in the past two weeks, that means a slight flattening of the curve, according to Governor Newsom.

But the state’s last major Covid-19 surge in the summer only caused about 10,000 infections on the worst days. And in Los Angeles County, the recent crisis has made the healthcare system so thin that patients arriving at a hospital were recently ordered to wait in an outdoor tent.

Los Angeles Mayor Eric Garcetti said Sunday that the county’s recent spike infected a new person every six seconds and that many transmissions were in private settings.

“It’s a message for all of America: We may not all have the same density as LA, but what is happening in LA can and will come to many churches in America,” he said.

The state’s worst outbreak is centered in southern California and the San Joaquin Valley, where intensive care units are zero percent. Officials are now working to recruit additional nurses to handle the flood of patients. Governor Newsom said 90 patients were being held in “alternative care locations” outside of hospitals to ease the burden.

More vaccinations would help ease the burden on California, but Governor Newsom said vaccinations were only just increasing after some early challenges. So far, the state has only administered about 35 percent of the coronavirus vaccine doses received.

“That’s not good enough,” he said. “We recognize that.”

In the meantime, says Dr. Mark Ghaly, the secretary of state for health and human services, Californians should be extra careful when meeting with people outside of their household as the virus is so widespread.

“The same activities that you did a month ago today are much riskier today than from a Covid transmission perspective,” he said.

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