A major wave of coronavirus patients flowing into hospitals by early December could force Los Angeles County to return to restrictive Safer-at-Home orders similar to those of the early days of the pandemic, according to public health officials who expressed a new sense of urgency on Wednesday, Nov. 18.

The county reported 3,944 new cases Wednesday, among the highest daily numbers since mid-July. If this rate continues, the county could surpass 4,000 average daily cases and 1,750 hospitalizations by early December, triggering more restrictions such as a complete closure of outdoor dining, health officials said.

“We should each ask ourselves and those we care about to make the changes we know can prevent the spread of cases and deaths from COVID-19,” said Public Health Director Barbara Ferrer.

If the 5-day average of daily cases rises above 4,500 or hospitalizations crest above 2,000, then county officials would enact a 3-week Safer-at-Home order similar to what was imposed in April.

Based on changes to the health order announced Tuesday, by Friday, Nov. 20, restaurants, breweries and wineries will need to reduce outdoor capacity by 50%, and close between the hours of 10 p.m. and 6 a.m., though they can remain open for pickup and delivery. Indoor retail sites, personal care businesses and offices will be limited to 25% capacity. Cardrooms and outdoor entertainment centers will be limited to 50% of maximum outdoor capacity.

The county on Wednesday also reported 36 additional deaths, a considerable increase above the average number of daily deaths over the past week currently at 10, a figure Ferrer called a “silver lining” in the pandemic at the moment. But the fear was that if hospitalizations continued to rise, more deaths would be inevitable. A total of 7,335 people have died in L.A. County since the pandemic began and 348,336 have been infected.

Wednesday’s numbers did not include updated daily totals from Long Beach and Pasadena, which operate their own health departments. Long Beach reported two additional fatalities, increasing its death toll to 268; its total of confirmed cases grew by 160, to 14,647. Pasadena reported 40 additional cases, raising its total to 3,200; its death toll of 130 did not change.

The infection rate in the county rose as of Wednesday to 1.18, up from 1.03 a week ago, meaning that for every one person infected with the coronavirus, on average 1.18 people become sick also. That’s the highest rate of transmission since late June when the rate was measured at 1.26.

With the rate of hospitalizations increasing dramatically in recent weeks — now up to 1,188 from 791 on Nov. 1 — Dr. Christina Ghaly who heads the Department of Health Services said the situation could not be ignored.

“Even if we take decisive action now, we’ll see increases continue for the next two to three weeks,” Ghaly said.

There were currently about 200 people admitted into L.A. County hospitals with COVID-19 daily, up from about 100 in September. That rate was alarming, especially considering that people sick with influenza were expected to occupy a significant number of hospital beds, Ghaly said. The number of available beds for coronavirus patients was set at about 2,500 without using surge capacity. During the summer, the department estimated available COVID beds at around 4,000.

Intensive care unit beds were another concern as demand could outstrip supply, Ghaly said. About 1/4 of hospitalized patients with COVID-19 require intensive care and about 2/3 of those go on ventilators. Experience shows that roughly half of those placed on ventilators don’t make it, Ghaly said.

“This is a serious disease and should not be taken lightly,” Ghaly said.

Despite the surge in cases and hospitalizations, L.A. County and California as a whole is actually fairing much better than in other places around the country. In Utah, case rates were more than 1,200 people per 100,000 residents. In Indiana, they were about 1,100 cases per 100,000. California, meanwhile, was averaging 250 cases per 100,000 people.

“What we did in the past worked, but we need to renew our commitment and diligence in slowing the spread,” Ferrer said. “It’s unfortunate that we’re back to having additional restrictions. We cannot be in the same place that other states are heading. We cannot jeopardize our health care system.”

Limited by what restrictions the county can actually enforce, public health officials were left with making a strong appeal for personal responsibility, strongly urging against non-essential travel and gathering for Thanksgiving with any more than three households and 15 people. For those who do travel outside the region, the state is recommending a 14-day quarantine. But beyond recommending there’s not much else officials are willing to do by way of enforcement.

“This has been a community that’s rallied and done the right thing,” Ferrer said. “If there’s ever been a time to get back to dong the right thing it’s right now.”