Wednesday was the deadliest day yet of the COVID-19 pandemic in California and the U.S., with no signs of slowing down. Paired with a national death toll greater than September 11, 2001, and one statewide that equaled the devastating 2018 Camp Fire five times over, was also another record-breaking day of new cases and hospitalizations.

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By the numbers, there hasn’t been a day that comes close to Wednesday in California: 428 new victims of the virus were added to the state’s death toll, which grew to nearly 21,900, and 51,773 new cases of COVID-19 were reported around the state, according to data compiled by this news organization — each shattering records that had already been broken in the past week. The total cases Wednesday were nearly 50% more than any day prior to this week and the day’s death toll nearly doubled the previous record.

For the first time of the pandemic, California is averaging more than 35,000 new cases and 200 fatalities per day over the past week, figures that dwarf those from the beginning of November, when the state was averaging just over 4,000 cases and about 45 deaths each day. Just in the past two weeks, California’s average daily cases have soared by 137% and its average daily death toll by even more: 205%.

As long as transmission continues to rise and more patients are admitted to hospitals, it’s likely the death toll will continue to follow, health officials and epidemiologists have said. About 12% of infections result in hospitalization within two to three weeks, and about 12% of those eventually end up in an intensive care unit, according to state health officials.

Hospitals around California have admitted a net of approximately 650 COVID-positive patients each of the past two days — the largest single-day increases of the pandemic — with the active total rising to 14,939, as of Tuesday, according to the latest data from the state. Intensive care units are closer to capacity than any other point of the pandemic, with 3,188 patients currently intubated and fewer than 1,400 staffed and licensed beds available statewide.

If state health officials’ estimates are accurate, California’s 245,000 cases over the past week could result in more than 3,500 additional patients with cases of COVID-19 that demand intensive care in the coming weeks. Gov. Gavin Newsom warned on Tuesday that hospitals “in nearly every part of the state” will reach surge capacity “in the next few weeks,” according to the state’s projections.

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On Wednesday, ICUs in the Bay Area fell below 15% capacity for the first time of the pandemic, triggering stay-at-home orders for the locales in the region that hadn’t already enacted the more restrictive orders. More alarmingly, ICUs in all of Southern California had reached 99.5% capacity and in the San Joaquin Valley, ICUs were at full capacity.

The majority of the record-breaking fatalities Wednesday came in Southern California, but casualties were spread widely across the state. Thirty of California’s 58 counties reported new victims of the virus, led by Los Angeles County, where there were a record-smashing 137 deaths and more than 22,000 new infections (fueled in part by a backlog of 7,000 tests, county health officials said).

The Bay Area also set a record for deaths in the region with 68 on Wednesday, led by 32 in Santa Clara County, nearly three times more than any previous day of the pandemic. In Alameda County, there were 12 additional fatalities; in Contra Costa, 11 new deaths; five in San Francisco; four in Santa Cruz; and two each in Solano and Sonoma counties.

San Bernardino County reported the second-largest death toll in the state Wednesday with 63, followed by 38 in Riverside County and 23 each in San Diego and Orange counties. Sacramento and San Joaquin counties also added 12 deaths apiece.

The Greater Sacramento region, as defined by the state’s regional stay-at-home order, is reporting the most fatalities over the past week on a per-capita basis, with more than 6 per day for every million residents. Only the San Joaquin Valley at the height of its summertime surge has reported as many deaths in proportion to its population. The per-capita rate in the Bay Area — about 2 per day for every million residents — is the lowest of all five regions, but rates are rising all over the state.

Average daily deaths have increased by 213% in the past two weeks in Greater Sacramento; 193% in the San Joaquin Valley; 162% in Southern California; 147% in the Bay Area; and 50% in Northern California.

The infection rate in the Bay Area — just under 50 per day for every 100,000 residents — is also the lowest of all five regions but has more than doubled in the past two weeks: a 112% spike. In Southern California, cases have surged by 143% in the past two weeks to nearly 100 daily infections for every 100,000 residents, the highest rate in the state. In the San Joaquin Valley, the per-capita rate is about 78.7/100K, 126% higher than two weeks ago; in Northern California, it’s grown by about 52% to 63.3/100K; and in Greater Sacramento, the rate is about 60.3/100K, 75% higher than two weeks ago.

The infection rate in California — about 88.7 daily cases per 100,000 residents over the past week — is now higher than all but five other states. However, even with its recent record totals, only 10 states reported fewer deaths per-capita over the past week than California.

California has broken its daily death record three times in the past week, with 218 on Friday, followed by 255 four days later, and 428 the day after that.

The U.S. on Wednesday also set a record for daily deaths that it had previously broken last week. More than 3,600 Americans were added to the national death toll, which rose over 307,000, according to the New York Times. More than 17 million Americans have been infected over the course of the pandemic, according to the Times, including a record 245,000 on Wednesday alone. And, just as in California, the number of patients hospitalized continues to rise: up to 113,000 currently being cared for across the nation, according to the COVID Tracking Project, nearly twice as many as were hospitalized during the previous peak this summer.