California has recorded a half-million coronavirus cases in the last two weeks and in a month could be facing a once-unthinkable caseload of nearly 100,000 hospitalizations, Governor Gavin Newsom and the state’s top health official said Monday.

Newsom, himself quarantined for the second time in two months, acknowledged that a state projection model shows hospitalizations in that range and said he’s likely to extend his stay-at-home order for much of the state next week.

Dr. Mark Ghaly, California’s secretary of Health and Human Services, said it’s feared entire areas of the state may run out of room even in their makeshift “surge” capacity units “by the end of the month and early in January.” In response, the state is updating its planning guide for how hospitals would ration care if everyone can’t get the treatment they need, he said.

“Our goal is to make sure those plans are in place, but work hard to make sure no one has to put them into place anywhere in California,” Ghaly said.

It hopes to accomplish that by beefing up temporary staffing, opening makeshift hospitals in places like gymnasiums, tents and a vacant NBA arenas, and by sending patients to regions of the state that might have precious remaining beds. Officials said residents can still play perhaps the biggest role by skipping holiday gatherings and practicing precautions to slow the spread.

California is enduring by far its worst spike in cases and hospitalizations. All of Southern California and the 12-county San Joaquin Valley to the north have been out of regular ICU capacity for days. Those two regions are the ones Newsom said are likely to have stay-at-home orders extended, meaning many business must remain closed, restaurants can only serve takeout and virtually all retail is limited to 20% capacity.

California is averaging almost 44,000 newly confirmed cases a day and has recorded 525,000 in the last two weeks. It’s estimated 12% those who test positive end up in the hospital. That means 63,000 hospitalizations from the last 14 days of cases. The current figure is 17,190.

Los Angeles County is among the hardest hit areas of the state, but its hospitals aren’t there yet, Los Angeles County Department of Health Services Director Dr. Christina Ghaly said Monday. They are in the contingency stage, which means shifting around staff and equipment.

“You’re … doing things that you wouldn’t otherwise do — canceling surgeries, redeploying staff, things of that nature,” said Ghaly, the wife of the state health director. “It causes intense strain. It’s exhausting for staff, but hospitals are able to do this by redeploying the resources that they have to the greatest extent possible.”

But without rapid changes in people’s behavior to stop the spread, she warned, “that’s where we will be headed in the future.”

The explosion of cases in the last six weeks has California’s death toll climbing. Another 83 fatalities reported Sunday raised the total to 22,676, though Newsom cautioned the daily figure was likely too low because of a normal weekend reporting lag.

The state has averaged 233 deaths each day for the last 14 days.