LOS ANGELES (AP) — California’s overwhelmed hospitals are setting up makeshift extra beds for coronavirus patients, and a handful of facilities in hard-hit Los Angeles County are drawing up emergency plans in case they have to limit how many people receive live-saving care.

The number of people hospitalized across California with confirmed COVID-19 infections is more than double the state’s previous peak, reached in July, and a state model forecasts the total could hit 75,000 patients by mid-January.

Plans for rationing care are not in place yet, but they need to be established because “the worst is yet to come,” said Los Angeles County’s health services director, Dr. Christina Ghaly.

Medical workers remove a stretcher from an ambulance near medical tents outside the emergency room at UCI Medical Center, in Irvine, Calif., on Thursday.

While shipments of the vaccine are rolling out to many health care workers and nursing homes across the country, it could be months before the shots are available to the general public. Until then, four hospitals run by Los Angeles County are weighing what to do if they cannot treat everyone because of a shortage of beds or staffers.

A document recently circulated among doctors at the four hospitals proposed that instead of trying to save every life, their goal could shift to saving as many patients as possible — meaning those less likely to survive would not get the same kind of care.

“Some compromise of standard of care is unavoidable; it is not that an entity, system or locale chooses to limit resources, it is that the resources are clearly not available to provide care in a regular manner,” said the document obtained by the Los Angeles Times.

Many hospitals in California already have implemented emergency procedures to stretch staff and space.

A medical worker passes a medical tent outside the emergency room at UCI Medical Center in Irvine, Calif. on Thursday. Califo

A medical worker passes a medical tent outside the emergency room at UCI Medical Center in Irvine, Calif. on Thursday. California is desperately searching for nurses, doctors and other medical staff to meet demands.

Corona Regional Medical Center southeast of Los Angeles has converted an old emergency room to handle nearly double the usual number of ICU patients. It’s also using two disaster tents to triage ER patients.

Overall, the state’s ICU capacity was just 2.1% on Sunday. Some hospitals have canceled non-essential elective surgeries, such as hip replacements, that might take up beds that could soon be needed for COVID-19 patients.

Nurses say the crush of cases means they have less time to spend with patients, many of whom are sicker than they have ever been.

“The more patients we have, the more there’s a risk of making a mistake, especially if we’re rushing,” said Wendy Macedo. a nurse at UCLA Health Santa Monica Medical Center. ”Obviously we’re trying to avoid that, but we’re only human.”

California was experiencing “some of the darkest days of our COVID-19 surge,” Gov. Gavin Newsom said, but there was some light Sunday as a group of scientists and experts endorsed a vaccine developed by Moderna. The step clears the way for the drug to be distributed throughout California and other Western states that reviewed it separately from the Food and Drug Administration.

A homeless person sleeps outside the Los Angeles County + USC Medical Center hospital entrance in Los Angeles on Wednesday. H

A homeless person sleeps outside the Los Angeles County + USC Medical Center hospital entrance in Los Angeles on Wednesday. Hospitals across the state are filling up so fast that officials are rolling out mobile field facilities and scrambling to hire more doctors and nurses.

CVS and rival Walgreens started providing shots last week at some long-term care locations in Connecticut and Ohio, and both companies said they would expand their programs in 12 states starting this week. Those states include Florida, Kentucky, Maine, Maryland, Nevada, New Hampshire, New York, Oklahoma, Oregon and Vermont, CVS Health said Monday.

CVS plans to make three visits to each site to give residents and staff their initial shot and then a booster. It expects to complete the program in about three months.

But with vaccinations in limited supply until spring or summer, political leaders are calling on people to stay at home and wear masks.

New York Gov. Andrew Cuomo has asked airlines flying into his state from the United Kingdom to make all passengers take a coronavirus test before they get on board. At least one airline, British Airways, has agreed, the Democrat said.

Cuomo wants the U.S. government to temporarily halt flights from the U.K. because of the emergence of a new strain of the virus in that country.

Tennessee Gov. Bill Lee on Sunday announced new social gathering restrictions while still refusing to implement a mask mandate despite pleas from front-line health care workers. Tennessee, one of a dozen states without a mask mandate, is experiencing the highest new cases per capita in the country.

Instead of a mask mandate, the Republican signed an executive order limiting public gatherings to 10 people. However, places of worship, weddings and funerals are exempt.

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Associated Press writers Tom Murphy in Indianapolis, Kimberlee Kruesi in Nashville, Tennessee, and John Seewer in Toledo, Ohio, contributed to this report.