Worshipers receive communion during a Christmas Eve Mass inside the Cathedral of Our Lady of the Angels Thursday, Dec 24, 2020, in Los Angeles. California became the first state to record 2 million confirmed coronavirus cases, reaching the milestone on Christmas Eve as nearly the entire state was under a strict stay-at-home order and hospitals were flooded with the largest crush of cases since the pandemic began. (AP Photo/Ashley Landis)

LOS ANGELES - California's deadly Christmas was marked by pleas to avoid holiday gatherings outside the home and indoor church services in what could be a make-or-break effort to curb a coronavirus surge that already has filled some hospitals well beyond normal capacity.

Festive gatherings with friends and family might be tempting after a year that has seen the pandemic take nearly 24,000 lives and ravage the economy as much of the state remained under a stay-at-home order that has closed nonessential businesses.

But officials repeated warnings that Thanksgiving gatherings where people didn't wear masks or observe social distancing have resulted in a surge and begged people to forego Yule and New Year's festivities.

In Sonoma County in California's wine country, a Native American casino announced it was cancelling a planned private New Year's Eve indoor event that could have drawn as many as 4,000 people. The Graton Resort and Casino is on sovereign native land that isn't subject to state or county health orders but it had come under scrutiny for the event.

Gov. Gavin Newsom said hospitals are under “unprecedented pressure" and if current trends continue the number of those hospitalized because of the virus could double in 30 days.

“We could have a surge on top of surge on top of a surge in January and February," Newsom said in a social media video posting Thursday. “I fear that but we’re not victims to that if we change our behaviours.”

Coronavirus cases, hospitalizations and deaths have mounted exponentially in recent weeks and are breaking new records. On Christmas Eve, California became the first state in the nation to exceed 2 million confirmed COVID-19 cases.

On Friday, the state reported more than 39,000 new COVID-19 cases as of Thursday, a 2% increase from the previous day but still far below the peak of more than 53,000 cases reported last week. The 14-day daily average was below 40,000 cases.

There were 312 new deaths reported, a 1.3% jump from the previous day but still well below last week's peak of 379. However, the overall death rate has surged by more than 16% over two weeks.

The first coronavirus case in California was confirmed Jan. 25. It took 292 days to get to 1 million infections on Nov. 11. Just 44 days later, the number topped 2 million.

The crisis is straining the state’s medical system well beyond its normal capacity, prompting hospitals to treat patients in tents, offices and auditoriums.

As of Thursday, California had record numbers of COVID-19 patients in the hospital and in ICUs, at nearly 19,000 and nearly 4,000, respectively. Friday figures showed no increase in hospitalizations and there were a few more ICU beds available, for a total of around 1,400 statewide, according to the California Department of Public Health.

However, ICU capacity varied between the five regions of the state. The Northern California region had more than 36% of ICU capacity while the Southern California and San Joaquin Valley regions were technically at 0% capacity, meaning that they had no more regular ICU beds available. Hard-hit hospitals were resorting to surge capacity by putting patients in areas not originally designated for the same level of care, such as post-operative recovery rooms.

“In most hospitals about half of all of the beds are filled with COVID patients and half of all the ICU beds are filled with COVID patients, and two-thirds of these patients are suffocating due to the inflammation that’s in their lungs that’s caused by the virus,” said Dr. Christina Ghaly, director of the Los Angeles County Department of Health Services.

“They’re suffocating to the point that they can no longer breathe on their own, and they have to have someone put a tube down their throat, in order to oxygenate their organs. Many of these people will not live to be in 2021,” she said Thursday.

Hospitals have also hired extra staff and cancelled elective surgeries — all to boost capacity before the cases contracted over Christmas and New Year’s show up in the next few weeks.

“We understand that people are tired, but public health measures are not the enemy — they are the roadmap for a faster and more sustainable recovery," said a statement from the Public Health Alliance of Southern California, which includes 10 neighbouring local health departments covering nearly 60% of the state's population.

Los Angeles County, which has accounted for a third of all coronavirus cases and nearly 40% of deaths, urged people to avoid attending indoor religious services, even though they are permitted with social distancing requirements.

The Roman Catholic Archdiocese of Los Angeles was permitting limited indoor services, although it also urged churches to avoid them in favour of outdoor or online services.

The Cathedral of Our Lady of the Angels held livestreamed Christmas Masses where the priests wore face masks, choirs were replaced by a lone singer and no more than 130 people were permitted in an area that can seat 3,000.

Parishioners kept social distance even when taking communion, receiving it at arms' length from clergy members. An officiating priest urged people “never to lose hope, never to be discouraged" despite the pandemic.

Amid the dire warnings were some rays of hope, which the governor said may indicate people are heeding pleas to social distance.

A statistical model that state officials have been using to project hospitalizations predicts more than 71,000 patients in one month’s time. While still an unsustainable four times the current number of patients, the estimate is roughly 40,000 fewer than what the model had been projecting just days ago.

The transmission rate — the number of people that one infected person will infect — has been slowing for nearly two weeks, and it is nearing the point that would bring fewer infections from each person who contracts the virus.

Newsom urged Californians to celebrate the holidays safely.

“Let’s virtually hug those outside of our immediate family," he said. “Let’s stay close to those folks in our household.”

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Associated Press Writers Don Thompson in Sacramento and Stefanie Dazio in Los Angeles and AP Photographer Ashley Landis in Los Angeles contributed to this story.

News from © The Associated Press, 2020