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For millions of Californians, the COVID-19 pandemic will provide a most unwelcome gift this Christmas: a wide-ranging shutdown imposed as the state grapples with its most massive and dangerous surge in infections and hospitalizations to date.

The restrictions that took hold at 11:59 p.m. Sunday across Southern California and the San Joaquin Valley will remain in place for at least three weeks, meaning those regions will not be able to emerge from the state’s latest stay-at-home order until Dec. 28 at the earliest.

Five counties in the San Francisco Bay Area also announced last week that they were proactively implementing the new restrictions and planned to keep them in place until at least Jan. 4.

Combined, those regions are home to some 33 million Californians, representing 84% of the state’s population.

The timing of the rules is the latest blow, in a year full of them, for many businesses — which have been battered by coronavirus-related restrictions and hoped the holiday shopping season would throw them a desperately needed lifeline — and to the psyche of Californians, who for months have lived with the threat of the coronavirus hanging over their heads.

Officials, though, have said desperate times call for drastic measures. The number of new daily coronavirus cases has skyrocketed to a level that would have been unthinkable just weeks ago. Hospitals are already contending with an unprecedented wave of more than 10,000 COVID-19 patients, and the state is on the brink of recording its 20,000th death from the illness.

As bleak as things are now, the ceiling of the surge may be yet to come, as experts say the ramifications of travel and gathering for the Thanksgiving holiday have yet to be fully realized.

Cases that stem from “dinner tables or activities and plans, travel through Thanksgiving, are going to show up right about now,” said Dr. Mark Ghaly, California’s Health and Human Services secretary, and “we know we’ll be seeing that for many days to come.”

“We believe,” he said at a Monday briefing, “that the levels of transmission that we’ve been reporting so far will likely continue to go up some because of those activities around Thanksgiving.”

Gov. Gavin Newsom announced the new round of restrictions last week, saying stricter intervention was needed to shore up the state’s hospital system and make sure intensive care beds remained available.

The state’s latest strategy carves California into five regions: Southern California, the San Joaquin Valley, the Bay Area, the Greater Sacramento area and rural Northern California.

A region is required to implement a state-defined stay-at-home order — which restricts retail capacity to 20% and shuts down outdoor restaurant dining, hair salons, nail salons, public outdoor playgrounds, cardrooms, museums, zoos, aquariums and wineries — if its available ICU capacity drops below 15%.

Southern California and the San Joaquin Valley are already below that threshold, and as of Monday their ICU availability had tumbled to 10.9% and 6.3%, respectively.

The Southern California region encompasses Imperial, Inyo, Los Angeles, Mono, Orange, Riverside, San Bernardino, San Diego, San Luis Obispo, Santa Barbara and Ventura counties. The area defined as the San Joaquin Valley covers Calaveras, Fresno, Kern, Kings, Madera, Mariposa, Merced, San Benito, San Joaquin, Stanislaus, Tulare and Tuolumne counties.

Both Greater Sacramento (20.3%,) and Northern California (28.2%) remain above the ICU threshold for now.

So does the Bay Area, at 25.7%. Health officials there aren’t waiting, however, and have already decided to apply the order — which went into effect in San Francisco, Santa Clara and Contra Costa counties on Sunday; in Alameda County on Monday; and will do so in Marin County on Tuesday.

“We cannot wait until after we have driven off the cliff to pull the emergency brake,” Dr. Sara Cody, Santa Clara County’s health officer, said in a statement.

Though the additional restrictions are undoubtedly a hardship for many, Ghaly said they were “required to make sure we get through the surge as quickly as possible and saving as many lives and preventing as many infections as we possibly can.”

California has seen a sustained and shocking rise in coronavirus cases and hospitalizations over the last few weeks — with numbers surging to levels far beyond those seen at any other point in the pandemic.

Statewide, average daily coronavirus cases have jumped sixfold since early October, hospitalizations have quadrupled since late October, and average daily deaths have nearly tripled in the last month.

Over the last week, California has averaged 20,414 cases per day, a 78.3% increase from two weeks ago, according to data compiled by The Times.

Roughly 240,000 Californians have tested positive for the coronavirus in the last 14 days. That number is larger than the entire population of the city of San Bernardino.

There are now 10,070 coronavirus-positive patients hospitalized statewide and 2,360 are in intensive care, according to numbers Newsom presented Monday. Both those figures are all-time highs.

An average of 112 Californians have died from COVID-19 every day over the last week.

“I think we have moved from characterizing this as a surge, in my mind, to being basically a viral tsunami in terms of its size,” said Dr. Robert Kim-Farley, a professor at the UCLA Fielding School of Public Health, medical epidemiologist and infectious disease expert.

In Los Angeles County, the state’s most populous, health officials reported more than 10,500 new cases Sunday, an unprecedented number for a single day. Hospitalizations for COVID-19 are nearing 3,000, and county Public Health Director Barbara Ferrer said that number could rise dramatically in the next few weeks as the full toll of the Thanksgiving holiday comes into view.

“I wouldn’t be surprised if we start seeing daily hospitalizations approaching 4,000 in a couple of weeks,” Ferrer said in an interview Sunday. “I am positive that we haven’t seen the full increases in our case numbers associated with the Thanksgiving holiday, just based on the timeline.”

Though the pandemic has reached crisis levels in California, state officials say there is light at the end of the tunnel as companies begin to roll out their initial shipments of COVID-19 vaccines.

Newsom said Monday the state was planning to receive 2.16 million doses of vaccine this month — with delivery expected to start by next week.

“Hope is on the horizon,” he said.

More tools are also coming online. Starting Thursday, Californians will be able to opt into a smartphone-based system, turning on COVID-19 exposure notifications in their iPhone settings or downloading the CA Notify app in the Google Play Store.

Some residents can expect to get a notification by phone alerting them that the program is available.

State officials hope the Bluetooth-based technology — which doesn’t collect location data or people’s identities — will help slow the transmission of the novel coronavirus by quickly notifying people when they’ve been exposed to someone who later tests positive for the disease.

Newsom has also named a new general in the battle against COVID-19. He announced Monday he had appointed Tomás Aragón as director of the California Department of Public Health.

Aragón had been health officer for the city and county of San Francisco.

“We’re very, very enthusiastic to have him now on the team,” Newsome said, “to continue to supplement our efforts as we move into this next and challenging phase.”

The appointment requires confirmation from the state Senate.

Times staff writers Jack Dolan and Sean Greene and the San Diego Union-Tribune contributed to this report.