Hospitals in Los Angeles County are deep in the trenches struggling to care for a rapidly growing number of coronavirus patients. Now some hospitals are reporting they are low on oxygen, a tool doctors have increasingly relied on for treating COVID-19 patients in place of ventilators. “Everything we’ve worried about and talked about and warned people about since February is coming to fruition—we’re at that point now,” a doctor who is having to decide how he will ration medical treatment told the Los Angeles Times. People are waiting outside hospitals for up to eight hours to be seen at emergency rooms. Officials are asking residents to avoid calling 911 or visiting the emergency room unless it is absolutely necessary.

These dire circumstances are coming about as the state of California is experiencing a surge in cases due in part to Thanksgiving gatherings that flouted the recommendations of health officials. Los Angeles County saw 140 residents die from the coronavirus on Thursday, the highest toll the county has had in the pandemic.