Citing soaring COVID-19 case rates and the lack of hospital beds, California Gov. Gavin Newsom has widened the state’s stay-at-home order.

Newsom also revealed early details of the state’s vaccine distribution plan with the first recipients planned to include acute care workers, employees in skilled nursing homes, paramedics and employees at dialysis centers. The first 327,000 vaccine doses from Pfizer will be allocated among six regions and will be arriving in mid-December, he said.

The second tier of workers who will get the vaccine include those in intermediate care facilities, home healthcare and community health workers, public health field staff, and those in primary care clinics. The next tier covers specialty clinics, laboratory workers, those with jobs at dental/oral health clinics and pharmacy staff.

The new stay-at-home order is based on a region’s available hospital capacity where ICU capacity falls below 15%. Once a region falls under the intensive care unit threshold, it will have 24 hours to comply with the order and must follow the new rules for at least three weeks. The new stay-at-home order bans nonessential gatherings and requires people to stay at home as much as possible to avoid transmitting the virus.

Newsom also issued an advisory that all non-essential travel would be temporarily restricted statewide.

“The bottom line is if we don’t act now, our hospital system will be overwhelmed,” Newsom said at a news conference announcing the new stay-at-home order. “If we don’t act now, we’ll continue to see our death rate climb, more lives lost.”

Newsom said four out of five regions in the state — greater Sacramento, Northern California, Southern California and San Joaquin Valley — are on track to hit the ICU thresholds shortly.

Newsom announced the pending restrictions Thursday, three days after warning that the state’s hospital system could be overwhelmed by record numbers of COVID-19 patients. The rules will allow people to continue essential activities like going to the doctor, buying groceries and picking up takeout. In addition, the order allows distanced outdoor exercise, like hiking, and outdoor religious ceremonies. Retail businesses will be limited to allowing 20% of their customer capacity inside at any one time.

On Thursday, California reported 18,951 new cases. California set records Wednesday with more than 20,000 new lab-confirmed COVID-19 cases out of 138,000 diagnostic tests and the total number of patients in California hospitals with confirmed COVID-19 surpassing 8,500.

Newsom also said the state restrictions could be lifted in as little as a month due to the arrival of vaccines. “We are seeing light at the end of the tunnel,” he added.

The order takes effect at 12:59 p.m. on Dec. 5. Thereafter, if a region falls below the 15% ICU threshold, it will have 24 hours to implement the order.

“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.

Los Angeles Mayor Eric Garcetti issued an emergency targeted safer-at-home order for the city of L.A. late Wednesday evening, effective immediately. The order mirrors that of L.A. County and requires all residents to remain in their homes, ceases the operation of non-essential businesses that require in-person attendance by workers and prohibits gatherings with those outside of one’s household. However, there is a long list of exemptions, including health care operations, retail stores, grocery stores and restaurants providing takeout or delivery service. Beaches, parks, trails, tennis courts and golf courses will also remain open, though children’s playgrounds will be closed.