LOS ANGELES (AP) — California has become the first state to record 2 million confirmed coronavirus cases.

A tally by Johns Hopkins University on Thursday showed the nation’s most populated state has recorded 2,010,157 infections since January. There have been more than 23,000 deaths.

The grim milestone comes as a COVID-19 crisis that health officials say stems from Thanksgiving gatherings strains California’s medical system. More than 18,000 people are hospitalized and many of the state’s intensive care units filled.

Top executives from the state’s largest hospital systems joined public health authorities this week in pleading for people to not gather for Christmas and New Year’s celebrations. The results could overwhelm the medical system, they warned.

Exhausted staff, many pressed into service outside their normal duties, already are attending to virus patients in hallways and conference rooms, said officials from Kaiser Permanente, Dignity Health and Sutter Health, which together cover 15 million Californians.

“We are really making a clarion and desperate call to Californians to not repeat what happened at Thanksgiving,” said Dr. Stephen Parodi, the Permanente Medical Group’s associate executive director.

Dr. Mark Ghaly, California Health and Human Services secretary, reiterated that the state’s modeling shows some hospitals and regions of the state will be overwhelmed in coming weeks if the surge continues. But he said that’s not a given.

“Let’s make some choices over the next 10 days that we will never regret, because our families, our loved ones, our communities will be more intact because of it,” he said.

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Thompson reported from Sacramento. Associated Press reporters Janie Har in San Francisco and Daisy Nguyen in Oakland contributed.