FRESNO, Calif. (AP) — The number of available intensive care unit beds in California’s San Joaquin Valley plummeted to zero for the first time Saturday, state officials announced as ICU units fill up statewide amid spiking COVID-19 cases.

Just a day earlier, the region’s ICU capacity was at 4.5%, according to the California Department of Public Health.

The region comprised of 12 counties in central California, along with the enormous Southern California region, contain more than 60% of the state’s 40 million residents. Last week, the two regions were ordered to follow the strictest anti-COVID-19 rules under a new state stay-at-home order that aims to keep hospitals from being overwhelmed by restricting infectious contacts.

Overflowing ICUs has been a major concern.

It wasn’t immediately clear how hospitals in the San Joaquin Valley will respond.

In Imperial County, El Centro Regional Medical Center recently opened a tent in its parking lot with capacity for 50 non-coronavirus patients as it deals with the crush of people with COVID-19.

Public health officials blame the surge on people ignoring safety rules to wear masks and social distance except for people in their own households. They have voiced fears that COVID-19 infection rates and hospitalizations will continue to soar as people ignore stay-at-home orders to gather for the holidays.

The restrictions — the toughest since a spring lockdown — have been met with defiance from some business owners who say it will ruin them after nearly a year of seeing their clientele avoid public places because of COVID-19 fears and on-again, off-again restrictions.

Six counties in the San Francisco Bay Area and the city of Berkeley chose to implement their own voluntary orders independent of the state. Sonoma County joined that group Thursday, implementing its own lockdown beginning Saturday.

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