How bad will the next few weeks be for California as coronavirus cases surge?

Looking east, California can envision its coronavirus future in the overflowing hospital wards of New York City. Looking west, it can draw hope from the disease’s swift decline in Asian nations that quickly imposed strict physical-isolation measures on infected people.

Two months after its first confirmed case of the deadly respiratory illness in California, the state is preparing to confront what public health authorities agree will be the cruelest month — an April that portends a peak in sickness and death.

How cruel remains to be seen. Officials hope that sharp limitations on work and public activity, imposed by Gov. Gavin Newsom on March 19, and subsequently ratcheted up in some cities and counties, will hobble the COVID-19‘s racehorse spread.

The enormous social reengineering of recent days has closed businesses and emptied public places. But its ultimate effectiveness remains one of multiple unknowns — dependent on innumerable actions by millions of Californians.

Preparing for the worst, hospital administrators across the state continued Friday to clear all available beds for an influx of patients. San Francisco ordered priority testing for doctors and nurses to try to prevent sick health practitioners from becoming super-spreaders of the disease. Los Angeles County shut all of its beaches to limit social interaction. And the Navy hospital ship Mercy cruised into the Port of Los Angeles, with 1,000 beds and 800 staffers ready to help ease the county’s healthcare system.

Tracking the coronavirus in California

The latest maps and charts on the spread of COVID-19 in California.

The number of confirmed coronavirus cases in California jumped from 1,468 on Sunday to 4,598 Friday, while deaths climbed from 27 to 93. But because the case count remains reliant on testing, which is being expanded but still lags behind other states, the actual incidence of the disease is certainly much more widespread.

“The numbers can get huge, which means the implications for the healthcare system are equally dramatic,” said Barbara Ferrer, Los Angeles County’s public health director. “Without slowing the spread, we could easily overwhelm our system here in L.A. County and the entire healthcare system in California.”

Although a system overload remained the fear, one projection from University of Washington epidemiologists suggested that California’s 9-day-old stay-at-home order might keep the hospital overload below catastrophic levels. And Dr. Robert Kim-Farley, a UCLA epidemiologist, said Friday that after a considerable uptick in cases, “I think we should be able to see some leveling off of those numbers in a couple of weeks, because of the physical distancing measures.”

While the U.S. now stands to have the worst outbreak of any developed country in the world, UC Berkeley biostatistics professor Nicholas Jewell said California will soon learn whether its limits on work and public movement have paid dividends.

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Socially distanced bikers and walkers, against a backdrop of the Queen Mary, make their way along pedestrian and beach bike path on the first day that Long Beach reopened the path on Monday May 11, 2020. The city of Long Beach eased a few of its public health restrictions, allowing under certain guidelines the reopening of pedestrian and beach bike paths, tennis centers and courts. Beach bathrooms are also reopening, but the parking lots and beaches still remain closed.   (Genaro Molina/Los Angeles Times)

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Traffic remains light on the southbound 110 Freeway headed toward downtown Los Angeles on April 28.  (Robert Gauthier / Los Angeles Times)

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Dominique Barrett, center, known as “King Vader” to his 2.4 million TikTok followers, prepares to shoot a video on April 30 in Glendora.  (Dania Maxwell / Los Angeles Times)

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Cody Purcell of Redondo Beach rides a wave, glowing from the bioluminescence, in Hermosa Beach, CA, after midnight Friday morning, May 8.  (Jay L. Clendenin/Los Angeles Times)

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Friends play spikeball, a game perfect for social distancing on an open but restricted San Buenaventura State Beach.  (Brian van der Brug / Los Angeles Times)

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The majority of golfers are wearing masks while hitting balls on the driving range at Van Buren Executive Golf Course in Riverside.  (Gina Ferazzi / Los Angeles Times)

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Beaches including Harbor Cove Beach were open but beachgoers were not supposed to be sitting on the sand.  (Brian van der Brug / Los Angeles Times)

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Tango instructor Yelizaveta Nersesova leads a Zoom tango event from her Los Angeles home April 27 that brought together hundreds of dancers from around the world.  (Jason Armond / Los Angeles Times)

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Grocery store workers, joined by United Food and Commercial Workers International Union Local 770 representatives and community members, hold a rally in support of strict social distancing on May 1 at a Ralphs store in Hollywood where 19 employees have tested positive for COVID-19.  (Kent Nishimura / Los Angeles Times)

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Mostly masked commuters keep their distance from one another on a Metro bus in downtown Los Angeles on April 29.  (Gabriella Angotti-Jones / Los Angeles Times)

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Gregory Kuhl, 69, heads home after a shopping trip in Hollywood on April 28. Big cracks in the street, cars parked in driveways blocking sidewalks and uneven pavement levels make navigating his route difficult.  (Dania Maxwell / Los Angeles Times)

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Tenants and their supporters from across Los Angeles gather at city hall to call on L.A. Mayor Eric Garcetti, the L.A. City Council and California Gov. Gavin Newsom to cancel rent and mortgage payments during the COVID-19 crisis.   (Luis Sinco / Los Angeles Times)

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Aerial view of over 100 vehicles lined up at the West Valley COVID-19 testing center at Warner Center in Woodland Hills.  (Brian van der Brug / Los Angeles Times)

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Senior Mason Wise, left, helps his sister, Mackenzie, a sophomore, clean out her PE locker at El Camino Real Charter High School in Woodland Hills. School officials were allowing no more than five students at a time on campus to take home their belongings.   (Brian van der Brug / Los Angeles Times)

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Shuttered storefront businesses in the garment district of Los Angeles. California’s unemployment rate has skyrocketed since the statewide coronavirus shutdown took effect.  (Luis Sinco / Los Angeles Times)

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Healthcare workers celebrate as Claudia Martinez is discharged from the ICU after she recovered from COVID-19 at Scripps Mercy Hospital in Chula Vista.  (Marcus Yam / Los Angeles Times)

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Carson residents Kaeli Burks, 3, left, and her cousin Bailey Watson, 5, look out the window of their car after their mothers helped them with self-testing at a new drive-up testing site for COVID-19 in Carson. Free COVID-19 testing is available to all city residents thanks to a partnership between the city and US Health Fairs.   (Genaro Molina / Los Angeles Times)

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Norm and Tracy Kahn enjoy eating dinner outside on a small cafe table sitting in blue chairs on their side yard during the coronavirus pandemic on April 27 in Riverside. “During this pandemic, eating outside offers us an opportunity to change surrounding and appreciate the calmness of being outdoors among trees, scents from nature and the sounds of birds,” she said. Also adding, “Mixing up where we eat puts variety into our days and takes away the sameness of feeling trapped at home.”   (Gina Ferazzi / Los Angeles Times)

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Ronald Reagan UCLA Medical Center nurses carry supplies outside the hospital.   (Robert Gauthier / Los Angeles Times)

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Tom Sean Foley pauses on a walk with his kids, Cathelen Claire, “C.C.,” 3, and Timothy Joseph, 4, to take a photo in front of the “Love Wall,” mural by artist Curtis Kulig, outside of Smashbox Studios in Culver City.  (Jay L. Clendenin / Los Angeles Times)

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Protesters stand along Mission Blvd. in Pacific Beach during A Day of Liberty rally on April 26. The protesters were against the government shutdown due to the coronavirus.  (K.C. Alfred / San Diego Union-Tribune)

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People make orders at a food truck along Shoreline Avenue in Long Beach.  (Luis Sinco / Los Angeles Times)

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Medical staff, wearing protective gear, work inside a COVID-19 isolation area inside the emergency department at Los Angeles County-USC Medical Center in Los Angeles, where patients with the virus are being treated.   (Mel Melcon / Los Angeles Times)

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Neighbors practice social distancing while enjoying the nice weather near The Strand in Hermosa Beach.  (Gabriella Angotti-Jones / Los Angeles Times)

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Counter-protesters attend a protest to call on state and local officials to reopen the economy in downtown Los Angeles.  (Christina House / Los Angeles Times)

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A group of protesters cheer on cars during a vehicle caravan protest to call on state and local officials to reopen the economy in downtown Los Angeles.  (Christina House / Los Angeles Times)

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Cedar Mountain Post Acute Rehabilitation staff member Navi Cavaltera waters a flower pot put up by the community to show their support for the nursing staff of the facility in Yucaipa. Eighteen of 20 coronavirus-related deaths in Yucaipa were residents of the skilled nursing facility.  (Irfan Khan / Los Angeles Times)

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A pedestrian wearing a protective mask passes a mural on a store on Melrose Avenue in the Fairfax district of Los Angeles.  (Allen J. Schaben / Los Angeles Times)

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Jonte Florence, a freestyle dancer, does a handstand on a mostly empty Hollywood Walk of Fame. Florence said he normally performs for hundreds of tourists along the busy street.  (Allen J. Schaben / Los Angeles Times)

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The Tyrannosaurus rex overlooking the intersection of Hollywood Boulevard and Highland Avenue wears a protective mask while practicing social distancing.  (Allen J. Schaben / Los Angeles Times)

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Businesses are shuttered and pedestrians are few and far between on Hollywood Boulevard.  (Allen J. Schaben / Los Angeles Times)

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Daniel Rogerson wears a vintage military gas mask while riding a bike along the beach path in Santa Monica, which is closed to enforce social distancing because of the coronavirus pandemic.   (Luis Sinco / Los Angeles Times)

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A face mask seller in colorful dress appears to be part of a mural behind a bus stop on Soto Street in Los Angeles.   (Irfan Khan / Los Angeles Times)

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Life around Cesar E. Chavez Boulevard and Soto Street has slowed down as California officials extended stay-at-home orders into May and residents entered Easter weekend with unprecedented limits on their movements.   (Irfan Khan / Los Angeles Times)

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UC Irvine Medical Center health care workers return their gratitude as about 25 Orange County first responder vehicles participate in a drive-by parade of gratitude as they battle COVID-19 at the hospital.  (Allen J. Schaben / Los Angeles Times)

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Billy Budd, 55, of Hollywood, walks along Hollywood Boulevard with a protective face covering. Budd is a scenic artist for movies and television who is currently out of work due to the coronavirus outbreak.   (Mel Melcon / Los Angeles Times)

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Stuart Reyes and his sister, Stephanie, sell masks for $5 each on the 3000 block of West Century Boulevard in Inglewood. Stuart Reyes said he is selling masks to support his mother.   (Irfan Khan / Los Angeles Times)

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A jogger runs on a closed trail past dozens of pieces of caution tape, torn off by hikers and mountain bikers at El Escorpion Canyon Park in West Hills.   (Brian van der Brug / Los Angeles Times)

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Alex Herron and nurse Mercy Pineda at a blood drive sponsored by USC athletics and the American Red Cross at USC’s Galen Center.   (Genaro Molina / Los Angeles Times)

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Los Angeles City Hall displays blue lights to show support for healthcare workers and first responders.  (Gary Coronado / Los Angeles Times)

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After being indoors for several days because of rainy weather and coronavirus stay-at-home orders, Olivia Jacobs, 4, and her mom, Cia Jacobs, enjoy a warm and sunny afternoon making chalk drawings on the sidewalk in front of their home in West Hills.  (Brian van der Brug / Los Angeles Times)

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An Oceanview Plaza security guard sports a whimsical mask while on patrol.   (Robert Gauthier / Los Angeles Times)

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Jacob De Wilde, left, and Lesli Lytle load a car with food during a food distribution organized to mark Good Friday.  (Irfan Khan / Los Angeles Times)

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As a late season storm continues to make its way across the Southland, a young basketball player dribbles along an alley through an Elysian Park neighborhood in Los Angeles.  (Kent Nishimura / Los Angeles Times)

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People are silhouetted in a window of an apartment building in Hollywood, where a stay-at-home order remains in effect to help curb the spread of the coronavirus.   (Luis Sinco / Los Angeles Times)

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The Wilshire Grand Center display blue lights and a heart to show support for healthcare workers and first responders.  (Gary Coronado / Los Angeles Times)

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Women wear masks as they stroll along Highland Avenue in Hollywood. Wearing masks while outdoors is mandatory in the city of Los Angeles.   (Luis Sinco / Los Angeles Times)

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Patients are removed from Magnolia Rehabilitation and Nursing Center after 39 tested positive for the coronavirus and nursing staff was not showing up to work.  (Gina Ferazzi / Los Angeles Times)

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A specimen is turned in at the new mobile testing site for people with symptoms of the coronavirus at Charles R. Drew University of Medicine and Science in South Los Angeles.  (Christina House / Los Angeles Times)

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Hippie Kitchen in Los Angeles hands out food, water and toiletries to homeless people and residents of skid row. Additionally, masks were offered to help reduce the spread of the coronavirus.  (Myung J. Chun / Los Angeles Times)

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Nurses pose for a fun photo during a break in drive-through public testing for the coronavirus at Arrowhead Regional Medical Center in Colton.  (Irfan Khan / Los Angeles Times)

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A woman shows a notice from her doctor that allows her to obtain a test for coronavirus at a new drive-up testing site in a parking lot at the South Bay Galleria in Redondo Beach.  (Genaro Molina / Los Angeles Times)

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A person who wishes to remain anonymous strikes from her car to support McDonald’s employees who are demanding the company cover healthcare costs of any worker or immediate family member who gets sick from COVID-19 in Los Angeles.  (Dania Maxwell / Los Angeles Times)

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Cassidy Roosen, with Beach Cities Health District, holds up a sign that says, “We’re All in This Together,” while waiting to direct cars at a drive-through, appointment-only coronavirus testing location at the South Bay Galleria in Redondo Beach.  (Jay L. Clendenin / Los Angeles Times)

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Grace Carter, 15, of Riverside, practices a dance routine at home after dance classes and school were canceled. She has to use the Zoom app on her iPhone to practice with her dance group. “It’s hard,” she said. “My bedroom is a smaller space. I miss all my friends at the studio.”  (Gina Ferazzi / Los Angeles Times)

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A man works from his home in Long Beach.  (Marcus Yam / Los Angeles Times)

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A San Bernardino County healthcare worker takes a sample at a coronavirus drive-through testing site at the county fairgrounds in Victorville.  (Irfan Khan / Los Angeles Times)

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A Metro general service employee disinfects a bench in Boyle Heights.  (Gary Coronado / Los Angeles Times)

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A runner jogs past the Pottery Barn in Pasadena. Some businesses in the area have boarded up their stores.  (Al Seib / Los Angeles Times)

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Raquel Lezama and daughter Monica Ramos collect meals for their family at Manual Arts High School. Lezama was laid off from her $17.76-an-hour job at a Beverly Hills hotel.  (Al Seib / Los Angeles Times)

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The Iron City Tavern in San Pedro tries an incentive to lure takeout customers.  (Carolyn Cole / Los Angeles Times)

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Healthcare workers gather outside UCLA Ronald Reagan Medical Center to call for further action from the federal government in response to the COVID-19 outbreak.   (Robert Gauthier / Los Angeles Times)

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Kristen Edgerle, of Victorville, collects information from a blood donor before drawing blood at The Richard Nixon Presidential Library blood drive during the coronavirus pandemic in Yorba Linda.  (Jason Armond / Los Angeles Times)

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Shauna Jin, of Los Angeles, with her dog, Bodhi, practices social distancing with John Kiss, of Los Angeles, at the entrance of Runyon Canyon Park in Los Angeles.  (Gary Coronado / Los Angeles Times)

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A lending library had some additional useful items, including a roll of toilet paper and cans of beans and corn, in a Hermosa Beach neighborhood.  (Jay L. Clendenin / Los Angeles Times)

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Protesters drive by the Getty House, the home of L.A. Mayor Eric Garcetti, in Hancock Park. Tenant advocates are demanding a total moratorium on evictions during the coronavirus crisis.   (Wally Skalij / Los Angeles Times)

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Venice residents Emily Berry and Gavin Kelley take a break at Venice Beach. Berry, a cocktail waitress at Enterprise Fish Co., lost her job due to the coronavirus outbreak. Kelley, a manager at a performing arts school with a focus on music, said that he still has a job and that classes at the school will resume online this coming Monday.  (Mel Melcon / Los Angeles Times)

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The JW Marriott at L.A. Live is sharing a message of hope with red lights in 34 windows, creating a 19-story display on the hotel’s north side.  (Gary Coronado / Los Angeles Times)

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Juan Diaz Jr., a lifelong Dodgers fan, prays that the season will start by May in front of Dodger Stadium on what would have been opening day.  (Mel Melcon / Los Angeles Times)

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Hayley, CEO and founder of Love My Neighbor Foundation, right, dances with Crystal Armster, 51, while she and her colleagues continue to feed the homeless on skid row amid the pandemic.  (Genaro Molina / Los Angeles Times)

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A masked passenger on a Metro bus in downtown Los Angeles.   (Wally Skalij / Los Angeles Times)

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Dede Oneal waits for a coronavirus test at the Crenshaw Christian Center in South Los Angeles.  (Genaro Molina / Los Angeles Times)

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A man in a mask passes a closed restaurant along Spring Street in downtown Los Angeles.   (Wally Skalij / Los Angeles Times)

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Artist Corie Mattie paints a mural on the side of a pop-up store as a man takes a picture in West Hollywood.  (Wally Skalij / Los Angeles Times)

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Medical assistant Zoila Villalta works with Rosie Boston, 32, of Glendale, who is donating blood for her first time at L.A. Care Health Plan downtown.   (Al Seib / Los Angeles Times)

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A couple wait for a bus outside the Petersen Automotive Museum in Los Angeles.  (Luis Sinco / Los Angeles Times)

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With all Los Angeles schools closed until further notice, LAUSD buses sit idle in Gardena.  (Brian van der Brug / Los Angeles Times)

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A lone traveler makes his way to catch a flight in Tom Bradley International Terminal.  (Genaro Molina / Los Angeles Times)

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Denise Young looks on as her daughter, Allison, 9, a fourth-grader at EARThS (Environmental Academy of Research Technology and Earth Sciences) Magnet School in Newbury Park, receives a Chromebook.  (Mel Melcon / Los Angeles Times)

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Hollywood Boulevard is devoid of the usual crowds.  (Brian van der Brug / Los Angeles Times)

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Michael Ray, 11, plays before a movie at the Paramount Drive-In.  (Wally Skalij / Los Angeles Times)

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Isabella Leader, 15, counts how many flags have been left for World War II veteran Lt. Col. Sam Sachs who was celebrating his 105th birthday at the Mom & Dad’s House, an assisted living facility, in Lakewood. Lt. Col. Sachs appealed to the public for birthday cards after the coronavirus pandemic forced the cancellation of a big celebration and wound up receiving thousands, including a letter and photo from President Trump.  (Genaro Molina / Los Angeles Times)

Because of a lag time of as much as two weeks between transmission of the illness and the onset of symptoms, gauging the benefits of physical distancing takes time. With California’s stay-at-home order eight days old on Friday, people reporting the illness might have been infected prior to the limitations.

“We need another week or two to really tell if California’s fairly quick shelter in place did make a difference,” Jewell said. “It has the potential to make a huge difference. I know that mathematically … But I don’t know that with any degree of certainty.”

Some experts remain fearful that the disease curve will flatten, but at a dangerous level that sends too many patients to hospitals for months. “The problem is not the peak of the epidemic wave,” said Stanford University infectious disease expert John Ioannidis. “The problem is: How long are we above the point of saturation for the medical system?”

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But projections from the University of Washington’s Institute for Health Metrics and Evaluation show California could end up with a milder peak of cases than New York state is projected to have.
While New York state could see its worst daily death toll of roughly 550 fatalities from the coronavirus by the second or third week of April — with a range that includes as few as 124 deaths daily to a maximum of 1,357 on the possible worst day — California could see its worst daily death toll in late April, perhaps around 150 deaths in a single day, the computer simulation found.

A best-case scenario puts the California toll at two deaths a day and a worst-case projection envisions as many 370 deaths daily at the peak in late April.

The study acknowledges a number of possible outcomes. In all, it suggests California could see 6,109 deaths, but there’s a wide variation — as few as 898 deaths and as many as 13,650 deaths. New York would see 10,243 deaths, with as few as 5,167 deaths and as many as 26,444 deaths. And the death toll for the U.S., for instance, could range from 38,000 to 162,000.

The University of Washington researchers cautioned that their projections are freighted with considerable uncertainty, gleaned from thousands of computer simulation runs to come up with a single, most-likely outcome.

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Unlike other models of the trajectory of the new coronavirus, the study relies on death counts from the United States and around the world. The scientists believe those numbers are more reliable than counting the confirmed number of infections, which vary greatly because of disparate testing rates around the U.S. and the world.

And the variations on the number of hospital beds that will be needed in California also diverged wildly, from as few as 1,200 to nearly 36,000. The ICU bed demand also got a broad projection, from a low of 90 to a high of 5,700.

“What we think we’ll see is a quite late peak in the epidemic in California, and that’s because there’s been a very slow trajectory of growth — of deaths and cases in California,” said Dr. Chris Murray, the author of the study and of the institute. “And that may be because of earlier social distancing. We don’t know. But certainly it is not the trajectory we’re seeing in New York, or Louisiana, or Georgia, for example.”

The debate over possible outcomes was put into clear view in the Silicon Valley, where the city of San Jose projected the number of possible deaths for the region, only to promptly have its estimate called into question by officials in Santa Clara County.

City officials said during a discussion with the San Jose City Council on Thursday that they projected a death toll from the illness of at least 2,000 for Silicon Valley and as high as 16,000, by the end of May. A day later, Santa Clara County released a statement saying it had not “produced, reviewed, or vetted” the San Jose projections.

The lessons from overseas seem to be that physical-isolation measures can work, said Kim-Farley, the UCLA epidemiologist.

Italy imposed strict orders to stay in the home, but it’s likely they went into place only after the coronavirus had spread widely. “I would be expecting that within another week or two … the number of cases or deaths will slow down and ultimately will become less and less, like we saw in China,” Kim-Farley said.

American experts will also be looking overseas to see what happens when social separation rules are loosened, as they will be when the Chinese begin to return to work in the coming weeks. “It’s hopeful they would not see a major second wave,” Kim-Farley said. “That is the $64,000 question: What will happen?”

The uncertainty did not sit easily with nurses, doctors and other hospital workers who are preparing for an onslaught of cases.

An emergency room nurse at one large hospital in Los Angeles said anxiety is rising among staff as the number of COVID-19 patients grows, with fears exacerbated by a global shortage of protective gear.

“A lot of us are really scared to go to work,” said the nurse, who was not authorized by her institution to speak to the media. “Our families are literally afraid when we come home from work.” When she sees people outside the hospital failing to abide by physical-distancing rules, she gets mad.

“We wish we could stay home too,” said the nurse, who declined to be named. “But we can’t.”

An operating room nurse at a Kaiser Permanente hospital in Los Angeles County shared that sense of foreboding, saying guidance on how workers should best protect themselves changes daily, with the guidelines steadily becoming less rigorous.

“We’re all just kind of like, ‘What in the world did we get ourselves into?’ This is not what we signed up for,” said the nurse, who also asked not to be named. “We didn’t think we would ever be in the position of healthcare workers working in a Third World country, in the middle of the woods … It’s been chaos.”

Another unknown is how California’s homeless population will affect the crisis.

California has more than 150,000 people living in unstable housing conditions, with 108,000 living outdoors. The tens of thousands of people living on the street represent a risk to hospitals because they are especially susceptible to severe cases of the novel coronavirus — they are aging, often have underlying health conditions and live in environments where sanitation is difficult.

Boston researcher Thomas Byrne compares the homeless population to those in nursing homes, and points out that those living on the street often have the medical conditions similar to housed people 20 years older.

Byrne released a study this week that predicts up to 2,600 homeless people in Los Angeles alone could wind up in hospitals with the coronavirus, and about 900 could need intensive care, tying up crucial resources.

Gov. Gavin Newsom last week set in motion an ambitious plan to move tens of thousands of homeless people into hotels and motels. But so far, only a few thousand unsheltered people across the state have been relocated to shelters and a few hundred of the first available rooms — though Newsom said more than 4,000 have been leased or purchased.

Kim-Farley urged Californians to remain hopeful, saying: “There is life after COVID-19. It is not an existential threat to all of mankind. We will overcome this.”