People wear protective face coverings against the coronavirus while walking on the Santa Monica Pier on June 29, 2020. L.A. County has surged past 100,000 cases of coronavirus. (Mel Melcon/Los Angeles Times/TNS)

LOS ANGELES – For a brief moment, California returned to bars, beaches and Botox. But after a few days, much of the state is reversing course as hospitals see an alarming spike in people sick with COVID-19, raising the specter of an overwhelmed medical system.

“It’s scary,” said Peter Chin-Hong, an infectious disease expert at UC San Francisco. “We still haven’t recovered from the first phase, and now we have to get ready for the next one.”

While Chin-Hong and other medical experts said California currently has the capacity it needs to treat patients, the future is uncertain. Coronavirus cases jumped to more than 220,000 Monday, creeping steadily upward in some places, skyrocketing in others and prompting health officials in multiple counties to demand the closure of bars, hair salons and other businesses opened only days ago.

Gov. Gavin Newsom said hospitalizations have increased 43% in the last two weeks while admissions to ICU units have increased 37%. He hinted at stricter statewide action if counties were unable to contain outbreaks.

“We don’t like the trend line,” Newsom said. “Let me be forthright with you: We are considering a number of other things to advance, and we will be making those public as conditions change.”

Some of the worst outbreaks are in Imperial and Riverside counties, where ICU beds are nearly full and nurses at one hospital have gone on strike to protest what they say is understaffing and a lack of protective gear.

“When you deliberately don’t staff someone to relieve me, I have to stay on duty,” said Erik Andrews, a nurse at Riverside Community Hospital. “Our professionalism is being exploited.”

Hospital officials denied that they were low on staff or protective gear, but the overwhelming case load in the area prompted Rep. Raul Ruiz, D-Calif., an emergency room physician, to call for a reinstatement of restrictions and mask wearing.

California officials have said that hospitalizations should not increase by more than 10% over any three days, but more than a dozen counties across the state are missing the mark. California has about 7,880 ICU beds, and about 38% currently are in use by non-COVID patients, according to Covid Act Now, a collaboration between Stanford and Georgetown universities.

As government officials struggled to regain control of residents weary of restrictions and eager to celebrate the upcoming Fourth of July holiday, numerous health officials are frustrated and fearful. Many said that while hospital capacity has increased, and more is known about how to treat the disease, those on the front lines still face shortages, stress and chagrin that the public is not taking precautions.

One emergency room physician in Los Angeles County contacted a Times reporter on Monday by sending a two-word text message: “Deja vu.”

“I’m not sure why everyone is so surprised that we’re surging again. It never went away, and we opened up” while mask-wearing was being “politicized,” the physician said, calling it “very frustrating.”

Erin McIntosh, 37, a rapid response nurse in the Inland Empire said the last few months had been the “worst of the worst.”

“It leaves us feeling in like we’re not enough,” McIntosh said. “I feel like this is all setting us up to fail.”

But public resistance to restrictions also remains strong, making it difficult to re-institute public health protections, said some experts.

“Every single one of those county health officers faces an impossible set of circumstances,” said David Relman, a Stanford doctor.

Unlike with the first days of the epidemic, when much of the virus was concentrated in urban areas, infections are now rising in California’s northern and inland counties, putting pressure on medical systems with fewer resources. It has left some medical experts to warn the state is not experiencing a second wave, but a failure to maintain the flattened curve of the first one.

And the virus continues to take an uneven toll, hitting communities of color and the elderly hardest, and often leaving the young and more affluent with milder cases that are diagnosed and treated earlier.

A study by Sutter Health in May found that Black COVID-19 patients in Northern California were nearly three times more likely to be hospitalized than non-Hispanic white patients and arrived at the hospital with more severe symptoms. Black patients also die of COVID-19 at higher rates, according to the study and state data.

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