LOS ANGELES (NYTIMES) - California surpassed 50,000 known coronavirus deaths Wednesday (Feb 24), the first state to reach that chilling milestone.

The news comes as a bleak reminder that the recent progress the state has made against the pandemic may be fragile. Most of those deaths were recorded recently, during a frightening winter surge that followed a period of relatively low case counts and a spreading hope that the virus could be controlled until vaccines arrived.

According to a New York Times database, California, the country's most populous state, averaged more than 560 deaths a day at its peak in January. By contrast, for much of November, it reported fewer than 50 deaths a day on average.

It took nearly 10 months for Los Angeles County to hit 400,000 cases, but little more than a month to add another 400,000, from Nov 30 to Jan. 2.

Although the state has reported more total deaths than any other in the nation, it is far from the hardest hit relative to the size of its population. At least 30 states have reported more total deaths per capita, and New Jersey has recorded twice as many.

State officials warned in mid-November, before Thanksgiving, that another surge could be on its way. As cases rose again, leaders begged Californians to hunker down and not to ease up on precautions.

When they reimposed restrictions that had been lifted, the move added to a pervasive sense of exhaustion - another disheartening reversal in the pandemic.

Nearly all of California's roughly 40 million residents spent the holidays under strict orders to stay at home. Gatherings with people they did not live with were banned.

Even with those restrictions, though, the virus spread rapidly, and hospitals were overwhelmed.

Scenes like those that played out in New York during the spring - when testing was scarce and deaths were probably undercounted - became commonplace in Southern California, dashing experts' hopes that they could be avoided.

The region was a centre of the pandemic in the United States, just as the first vaccines were beginning to be administered.

Doctors and nurses treated patients in hospital lobbies. Relatives watched remotely as loved ones took their last breaths. Healthcare workers who held the screens for them are still grappling with the lingering effects of sustained trauma.

"It's really hard to put all of it into words," said Ms Helen Cordova, an intensive care unit nurse at Kaiser Permanente Los Angeles Medical Centre, the first person in California to get a vaccine shot outside a clinical trial.Tallying the loss of life across California's vast expanse belies the virus's uneven impact on poorer communities of colour, particularly in the Central Valley and Los Angeles.

Latinos, who are more likely than other Californians to work in essential industries and less likely to have the resources or space to isolate themselves if they get infected, have been sickened and have died at disproportionately high rates. State figures show that Latinos, who make up 39 per cent of the state population, accounted for 46 per cent of California's deaths.

"We've created a separate and unequal hospital system and a separate and unequal funding system for low-income communities," said Dr Elaine Batchlor, CEO of Martin Luther King Jr. Community Hospital in Los Angeles, the hardest-hit hospital for its size in the hardest-hit county in the state.

And so far, California has failed to prevent the same inequities from plaguing the state's vaccination effort, a process that has been criticised as chaotic and confusing.

On top of everything, researchers have confirmed that a coronavirus variant now spreading in California is more contagious than earlier versions of the virus.

Nevertheless, there is hope.

California is now reporting half as many new cases a day, on average, as it did two weeks ago. Some counties have been allowed to lift restrictions. Local officials say more reopenings are on the way. State lawmakers approved a US$7.6 billion (S$10.03 billion) relief package this week.

And as Governor Gavin Newsom - whose political fortunes hinge on getting children back into schools and shots into the arms of a far-flung, diverse populace - has pointed out, California has administered many more vaccine doses than any other state.