(CNN) — The number of patients hospitalized across the US with Covid-19 is the highest it’s ever been — and at this rate health experts warn they may have to ration nurses, respirators and care.

“When you run out of capacity, physicians and bioethicists in these hospitals will need to decide which patients are salvageable — potentially salvageable — and which patients aren’t,” CNN medical analyst Dr. Jonathan Reiner explained.

The US reported 121,235 patients hospitalized with coronavirus Monday, the highest it has been since the start of the pandemic, according to the Covid Tracking Project. ICU coronavirus patients have increased from 16% in September to 40% last week, and health experts anticipate holiday travel could mean a “surge on top of a surge.”

That spike in cases would put Martin Luther King Jr. Community Hospital in Los Angeles in the position of needing to ration care, CEO Dr. Elaine Batchlor said Monday.

“If we continue to see an increase in the number of Covid patients, we may be forced to do something that, as health professionals, we all really just loathe having to even think about,” Batchlor told CNN’s Brooke Baldwin.

At Huntington Memorial Hospital in Pasadena, California, nurses that usually care for one or two patients are now caring for three or four, infectious disease specialist Dr. Kimberly Shriner told CNN on Sunday.

“We have a limited number of ventilators, we have a limited number of ICU beds,” Shriner explained, adding that a team including a bioethicist, a community member, a physician, a nurse and an administrative leader will decide how to divide those resources if it comes down to it.

“If you don’t have respirators, you don’t have nurses to care for patients, you don’t have ICU beds, we will have to have these terrible discussions with families, which is why people need to stay home, and when they go out, they need to wear a mask,” Reiner said.

Battlefield triage techniques

Martin Luther King Jr. Hospital will not turn patients away, Batchlor said, but staff may have to employ techniques that have been used in war.

“We use what in the battlefield is called triage techniques, which is doing an assessment of each person’s needs and prognosis and using scarce resources with patients that are most likely to benefit from them,” she said.

Already, resources are being used in unconventional ways to accommodate the surge.

“Our staff has been incredibly adept and flexible in accommodating increasing numbers of patients, so as you heard, we have five tents outside of the hospital,” Batchlor said. “We have patients in our conference room, in our chapel.”

Many gurneys are taken into the gift shop, she said.

While Batchlor didn’t specify how many new patients have Covid-19, the increase in their numbers is putting stress on all care.

L.A. County Health Services Director Christina Ghaly said some hospitals are seeing patients who are still on ambulances.

“Those patients are being cared for and treated in the ambulance as if it’s part of the emergency room bay,” Ghaly said.

US needs to ramp up vaccines, expert says

So far, about 2.1 million vaccine doses have been administered in the US and more than 11.4 million doses have been distributed as of Monday, according to the US Centers for Disease Control and Prevention.

Another 4.7 million will be distributed by the end of the week, Assistant Secretary for Health at the US Department of Health and Human Services Admiral Brett Giroir said. That would bring the total to more than 15.5 million doses “in the hands of the states.”

With doses making their way to state leaders, New Jersey is expecting to vaccinate about 31,000 long term care residents by the end of the week, Gov. Phil Murphy said in a Monday press conference.

“With each passing day, our vaccination program is growing a little larger and a lot stronger,” Murphy told reporters. “With the New Year, we are looking forward to the opening of our six vaccination mega sites and the further expansion of our vaccine efforts, and the continued movement through each priority group.”

Despite these developments, Dr. Ashish Jha, dean of the Brown University School of Public Health, said Monday that the US is falling behind countries like Israel and Canada in the pace of vaccination efforts.

“We really do have to ramp this up,” he said. “Things are in a crisis.”

Manufacturers like Pfizer have millions of doses that are waiting to be allocated, he said, attributing that problem in part to the federal government not following through with their administration after doses are delivered to states.

“There’s a lot of work of getting the vaccine from the state into people’s arms, and we needed a clearer set of plans than we’ve had on that,” he told CNN’s Jim Acosta.

California restrictions likely to be extended

Already hard hit by the impacts of coronavirus, Los Angeles County reported nearly 100,000 new cases in just the past week, LA County Public Health Director Barbara Ferrer said.

“The sad reality is that all indicators show us that our situation may only get worse as we begin 2021,” said Ferrer.

Southern California and the San Joaquin Valley have been under a regional stay at home order that was set to expire on Monday. But based on current trends and ICU capacity in those regions falling to 0%, California Gov. Gavin Newsom announced the order is likely to be extended.

The state added 33,170 new cases of the coronavirus and 64 additional deaths on Monday. Newsom warned that the slightly lower number of deaths is due to a reporting lag over the weekend.

California Health and Human Services Agency Secretary Dr. Mark Ghaly will use the final data from Monday to announce projections based on a four-week period on Tuesday, Newsom said.

California has reported more than 2.1 million coronavirus cases and more than 24,000 deaths since the pandemic began.

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