The United States has topped 19 million COVID cases as hospital intensive care units remained filled to overflowing across much of California, a major coronavirus hot spot.
Governor Gavin Newsom said mandatory constraints on gatherings and business activities would almost certainly be renewed for at least three more weeks in Southern California - encompassing the state's biggest metropolitan areas - and its agricultural heartland, the San Joaquin Valley.
Hospitals across California, and in many parts of the country, have been strained to the brink all month under a mounting surge of coronavirus cases, fuelled by increased holiday-season travel and socialising by Americans disregarding public health warnings.
The situation has grown particularly dire in Los Angeles and neighbouring counties - home to about half the state's population of 40 million - and in the farming communities of the San Joaquin Valley to the north. Hospitals in both regions have struggled with an alarming influx of COVID patients who have left ICUs with little or no additional bed space.
The San Francisco Bay area and greater Sacramento are also under restriction, with ICU capacities hovering just under 10 per cent and 17 per cent, respectively. They come up for possible renewal of stay-at-home orders early next month.
For now residents are required to remain at home and avoid travel, except as necessary for permitted activities such as grocery shopping, medical appointments, dog walks and individual outdoor exercise.
"This is an anxious period," Newsom told reporters in an online briefing from Sacramento, the state capital, though he cited some hopeful data.
Daily COVID-19 hospitalisations and ICU admissions have begun to plateau over the past two weeks statewide in a sign that more Californians are abiding by social-distancing and mask-wearing mandates, Newsom said. However, the numbers have continued to rise sharply in Los Angeles County and the neighbouring counties of San Bernardino and Riverside, he said.
Dr. Mark Ghaly, California's health secretary, said officials are bracing for a worsening of the situation into mid-to late-January, as heightened virus transmissions anticipated from Christmas and New Year's holiday celebrations translate into more illnesses and deaths.
He and Newsom repeated their pleas for Californians to stay diligent about avoiding crowds and unnecessary travel until the newly arrived COVID vaccines can be made widely available this coming spring.
So far, he said, more than 300,000 vaccine doses have been administered statewide, most of those to frontline healthcare professionals.
The United States as a whole has recorded more than 19 million infections and 333,000 deaths since the pandemic began. Daily case loads are running at more than 180,000 nationwide, with nearly 2,200 Americans dying of COVID every 24 hours during the past week.
Over 118,000 coronavirus patients were being treated in US hospitals across the country as of Sunday night, according to a Reuters tally of state-by-state health data.