Los Angeles County public health officials today announced 13,756 new COVID-19 cases and 60 more deaths, as the area crossed a landmark 600,000 cases, but also had to modify the department’s safety policy regarding places of worship to account for recent Supreme Court rulings.

To date, the Los Angeles County Department of Public Health has reported 610,372 positive COVID-19 cases across and a total of 8,817 coronavirus-related deaths.

The county also estimates that one of every 80 residents not hospitalized or in quarantine/isolation is infected with the virus, likely without knowing it or showing any symptoms, yet still capable of infecting others.

On Dec. 11, the county reached 500,000 cases, and since then, more than 100,000 new cases have been reported—the fastest acceleration of new cases during the pandemic.

Nevertheless, the Los Angeles County Health Officer Order was modified Saturday to align with recent Supreme Court rulings for places of worship. The court ruled that such places are permitted to offer faith-based services both indoors and outdoors with mandatory physical distancing and face coverings over both the nose and mouth that must be worn at all times while on site. Attendance is not permitted to exceed the number of people who can be accommodated while maintaining a physical distance of 6 feet between separate households.

Public Health strongly recommended that places of worship continue to hold services outdoors, with physical distancing and face coverings to prevent the spread of COVID-19.

A record 5,424 people were hospitalized with the disease on Saturday—up more than 300 from Friday—and 21% of these people are in the ICU.

Hospital capacity across the county is very limited, and health care workers are hard-pressed to keep up with the need for care.

“I’m not going to sugarcoat this. We are getting crushed,” said Dr. Brad Spellberg, chief medical officer at Los Angeles County-USC Medical Center, which has more than 600 beds and is one of the largest hospitals in the county.

Spellberg said every day at his hospital for the last week has begun with no available intensive care beds and a scramble to find room in spaces that don’t usually handle critical patients, like post-surgery recovery areas.

“And it isn’t just COVID patients,” he said. “It’s car accidents and heart attacks and victims of violence. They need a place to go to receive critical care.”

Spellberg also voiced the frustration felt by health care workers caused by those who deny the severity of the virus and downplay its impact on hospitals.

“The amount of moral courage it takes to run towards the danger makes it very frustrating for our heroes every day to come to our hospitals and care for patients when we see video and hear people not taking the public health strategies seriously,” he said.

His comments came amid a surge of cases that has exploded across the county since November, exacerbated by the Thanksgiving holiday and accompanying gatherings that occurred in spite of warnings against them.

On Thursday, the state announced that the 11-county Southern California region had formally reached zero capacity in intensive-care units. The designation does not mean there are no beds available, since the state adjusts the capacity figure based on the ratio of COVID patients occupying ICU space.

As of Friday, hospitals around Long Beach still had about 10% capacity left in their ICUs, Long Beach Mayor Robert Garcia said, but it’s unclear if that number has changed. Long Beach, which has its own health department, does not report coronavirus statistics over the weekend.

Across California on Saturday, nearly 17,400 people were hospitalized with confirmed or suspected COVID-19 infections—more than double the previous peak reached in July—and a state model that uses current data to forecast future trends shows the number could reach an unfathomable 75,000 by mid-January.

More than 3,600 confirmed or suspected COVID-19 patients were in intensive care units.

Some areas of California are “just right at that cusp of getting overrun,” Dr. Anthony Fauci, the country’s top infectious disease expert, said during an event organized by the California State University system.

Corona Regional Medical Center southeast of Los Angeles has converted an old emergency room to help handle nearly double the usual number of ICU patients. It’s using space in two disaster tents to triage ER patients because the emergency room is filled with patients who need to be hospitalized.

Ambulances can sit for two hours unless they are bringing in patients with critical, life-or-death emergencies.

Yet coronavirus cases have not reached their peak in this third and most devastating wave, and that means more drastic measures are on the horizon.

Many hospitals are preparing for the possibility of rationing care. A document recently circulated among doctors at the four hospitals run by Los Angeles County asking them to shift strategy: instead of trying everything to save a life, their goal during the crisis is to save as many patients as possible.

“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,” the document obtained by the Los Angeles Times reads.

The county’s Health Services director, Dr. Christina Ghaly, said the guidelines were not in place as of Friday night but that they were essential to develop given that the surge has arrived and “the worst is yet to come.”

California has begun receiving new COVID-19 vaccines. But the available doses are too scanty and too late to have any immediate impact on the soaring infection rate.

The latest explosion of cases has been tied to people ignoring social-distancing rules during the Thanksgiving holiday. Health care officials and workers expressed frustration that many people aren’t following state-mandated safety rules designed to slow that rate.

Many emergency rooms already have been using outdoor tents to make more space, said Dr. Marc Futernick, an emergency room physician in Los Angeles who is on the board of the California chapter of the American College of Emergency Physicians. One hospital that has maxed out its outdoor overflow tent is expanding into a nearby gym, he said.

“I am fearful it will be worse than what we saw in New York,” Futernick said. “When New York’s hospitals became overwhelmed, health care providers poured in from around the country.”

“None of that is happening right now, and there’s no way for it to happen because every place is busy,” Futernick said. “There’s no cavalry coming.”

The Associated Press contributed to this report.