Regions of California where hospitals are in danger of overload will be subject to a new stay-at-home order, with some parts of the state projected to reach that point later this week, Gov. Gavin Newsom announced Thursday.

The new order will apply in regions where available intensive care unit capacity drops below 15%, according to the Newsom administration.

Newsom said four out of five regions in the state, including the Greater Sacramento Region, are on track to hit that threshold early this month. The fifth region, the Bay Area, is on track to meet that threshold by the middle of the month.

“The bottom line is if we don’t act now, our hospital system will be overwhelmed,” Newsom said at a press conference announcing the new stay-at-home order.

▪ Greater Sacramento (currently has 22% ICU capacity available): Alpine, Amador, Butte, Colusa, El Dorado, Nevada, Placer, Plumas, Sacramento, Sierra, Sutter, Yolo, Yuba

▪ San Joaquin Valley (19.7% capacity): Calaveras, Fresno, Kern, Kings, Madera, Mariposa, Merced, San Benito, San Joaquin, Stanislaus, Tulare, Tuolumne

▪ Northern California (18.6% capacity): Del Norte, Glenn, Humboldt, Lake, Lassen, Mendocino, Modoc, Shasta, Siskiyou, Tehama, Trinity

▪ Bay Area (25.4% capacity): Alameda, Contra Costa, Marin, Monterey, Napa, San Francisco, San Mateo, Santa Clara, Santa Cruz, Solano, Sonoma

▪ Southern California (20.6% capacity): Imperial, Inyo, Los Angeles, Mono, Orange, Riverside, San Bernardino, San Diego, San Luis Obispo, Santa Barbara, Ventura

In regions where intensive care unit capacity falls below the threshold, the new stay-at-home order will bar nonessential gatherings and require people to stay at home as much as possible to avoid transmitting the virus. It will allow people to continue with essential activities like going to the doctor, buying groceries and picking up takeout. It also allows distanced outdoor exercise, like hiking, and outdoor religious ceremonies.

Retail will be allowed to operate in those areas at 20% capacity. Schools that have already reopened for in-person classes can remain open.

Non-essential travel, including traveling for family gatherings over the holidays, will be prohibited. All playgrounds, indoor recreation, salons, museums, zoos, aquariums, movie theaters, wineries, bars, casinos, live-audience sports and amusement parks must close in regions subject to the order. Restaurants must stop both indoor and outdoor dining.

Once a region falls under the intensive care unit threshold, it will have two days to comply with the order and must follow the new rules for at least three weeks.

The new order represents a return for many Californians to the isolation they experienced in March, when California was the first state to impose a stay-at-home order. That order directed all Californians to avoid nonessential social contact.

“We are at a tipping point in our fight against the virus and we need to take decisive action now to prevent California’s hospital system from being overwhelmed in the coming weeks,” Newsom said in a written statement. “I’m clear-eyed that this is hard on all of us – especially our small businesses who are struggling to get by.”

Local business owners in the Sacramento region bemoaned yet another set of restrictions that they say change so often they are hard to follow. Senate Republican Leader Shannon Grove accused Newsom of announcing the new order without giving enough public health data to justify his actions.

“Governor Newsom continues to disrupt life as we know it without releasing the full data behind his decisions or showing the impact his actions are having on our lives,” the Bakersfield Republican said in a statement. “To be clear, it’s not just about the numbers of COVID-19 cases and hospitalizations he runs through in his almost-daily press conferences, but the data and facts about the toll his shutdown orders are taking on Californians’ mental health, on our children’s education, including the achievement gap, on domestic violence and child abuse rates.”

On Monday, Newsom warned that a new stay-at-home order would be necessary if case rates didn’t decelerate. At the time, he said the state’s modeling showed intensive care units would be overrun by mid-December if viral transmission wasn’t curbed.

The next day, the state’s average number of daily new cases over a two-week period shot past 14,000, a new record representing a worse spike than the state saw over the summer.

The current surge isn’t due to Thanksgiving, Newsom said. The effect of the holiday, when many people gathered with family and friends, won’t be felt for a couple of weeks, he says.

With Hanukkah and Christmas around the corner, California Health and Human Services Secretary Dr. Mark Ghaly urged people to cancel their holiday travel plans if their region falls under the stay-at-home order.

“We know what a struggle this pandemic has been for so many California families, but our actions have saved countless lives,” Dr. Mark Ghaly, California Health and Human Services Secretary, said in a written statement. “This targeted action will preserve vital ICU beds for people who need them – whether they’re COVID-19 patients or someone who has suffered a heart attack or a stroke.”

Regions will stay under the stay-at-home order for a minimum of three weeks. At that point, Ghaly said state regulators will look at transmission rates in those areas to project intensive care unit capacity for the next month. If available capacity is projected to be over the 15% threshold, counties will be released from the stay-at-home order and return to the regular color-coded tier system, Ghaly said.

Newsom said he’s relying on local governments to help enforce the new rules, and said he will withhold money from counties that don’t follow the new stay-at home rrequirements. The state’s Department of Alcohol and Beverage Control is also working to ensure the businesses it regulates comply, he said.

Late last week, Los Angeles and Santa Clara counties imposed their own new restrictions as their hospitals filled with COVID-19 patients. Los Angeles’ new order prohibited most gatherings, even distanced ones held outside, except for outdoor religious services or political protests. Santa Clara’s new orders include a requirement that anyone traveling to the county from more than 150 miles away quarantine for two weeks upon arrival, avoiding going outside and having food delivered them.

Despite the grim announcement, Newsom during his press conference called the current spike in infections “the final surge” of the pandemic, as pharmaceutical companies race to bring promising vaccine candidates to market.

“Help is on the way. There is light at the end of the tunnel,” he said. “This is the most challenging moment of the pandemic. Lives are in the balance. Lives will be lost unless we do more than we have ever done.”