California builds field hospitals and considers rationing care as virus spreads unabated.

LOS ANGELES — As California’s new coronavirus cases, hospitalizations and deaths continue to soar, the nation’s most populous state has emerged as the epicenter of the pandemic heading into a dangerous holiday week.

With just 2.5 percent of the state’s overall intensive care capacity available, officials have been rushing to get more so-called field hospitals up and running. And discussions are underway about how to implement the state’s plans to ration care.

While Gov. Gavin Newsom did not officially extend what were supposed to be three-week stay-at-home orders affecting most of the state’s 40 million residents, he said on Monday that it was “self-evident” the orders would need to be in effect well into January, in light of projections that more than 90,000 people in California could be hospitalized with the virus in coming weeks.

The state added 295,000 cases over the past week, according to a New York Times database, and is likely to reach 300,000 new cases this week, given the virus’s trajectory. No other state has added even 150,000 cases in a week.

Mr. Newsom urged Californians to view their sacrifices as part of a massive effort to mitigate the worst surge the state has seen, even as hundreds of thousands of vaccine doses are rushed to health care providers.

“We have agency,” he said, repeating a point he has made at various times throughout the pandemic. “The future is not something to experience — it’s something to manifest.”

The governor spoke during a Monday news conference from his home, where he is in quarantine for the second time because of exposure to a state employee who tested positive.

Mr. Newsom has tested negative, but he said that he, like tens of thousands of other Californians, would spend Christmas isolated even from his family.

The governor and other state leaders have in recent days painted an increasingly dark picture of the fate of those who fail to heed guidelines.

Dr. Mark Ghaly, the state’s secretary of health and human services, said in a news conference that health care providers and state and local leaders were working frantically to prevent the state from tipping into what he and the governor described as crisis mode.

“We continue to build up our capacity,” he said. “When we look forward to that forecast of quite a few patients towards the end of January — that’s not a story that’s already been written.”

But as has been the case in the last couple of months, making sure health care facilities are sufficiently staffed has been the biggest hurdle. Nurses, doctors, janitors and so many others are exhausted. Aid from other states and the federal government is scarce.

In the next week or so, more Californians could hear that hospitals are simply full. Patients who are unable to avoid going to the hospital will wait in hallways for hours.

The mere possibility that California’s caseload could overwhelm even the state’s emergency surge capacity is likely to harm workers, said Joanne Spetz, a professor at the Philip R. Lee Institute for Health Policy Studies at the University of California, San Francisco.

“The term psychologists use is moral distress,” she said. “And that is a huge, looming and developing issue among health professionals.”

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