California announced its most aggressive steps since March to head off the coronavirus, saying it will impose sweeping stay-at-home orders region by region when hospitals become overburdened.

With cases and hospitalizations rising sharply in the state, Gov. Gavin Newsom portrayed the move as a push to get through a difficult winter before vaccines arrive.

“This is the final surge,” the governor said in a news conference. “This is the most challenging moment since the beginning of this pandemic.”

The new orders will take effect when the intensive care units in a region’s hospitals fill to more than 85 percent of capacity. None of the state’s five regions have reached that threshold yet, but some are expected to this week, officials said.

Residents would be required to stay home except for essential tasks and outdoor exercise. Most businesses would have to shut down, including in-person dining, salons and sports events. Hotels in affected areas would be allowed to operate only “in support of critical infrastructure services.”

Schools that have been allowed to reopen can continue to operate, and religious services could be held outdoors under the order. The state’s restrictions on religious services may not survive in the federal courts, after the Supreme Court on Thursday ordered a federal judge who had upheld them to reconsider the matter.

In a change from the strict stay-at-home orders the state imposed in the spring, Mr. Newsom said parks and beaches would remain open, and he encouraged residents to go outside and use them, and even to take outdoor fitness classes.

Some cities and counties in the state have already imposed new restrictions as cases have exploded. Los Angeles County issued a similar stay-at-home order last week. Though some municipalities within the county balked, like Pasadena and Beverly Hills, the City of Los Angeles followed up with its own strict stay-at-home order earlier on Thursday.

“My message couldn’t be simpler: It’s time to hunker down,” Mayor Eric Garcetti of Los Angeles said. “It’s time to cancel everything. And if it isn’t essential, don’t do it.”

Governor Newsom spoke on Thursday from his home, where he was still under quarantine after three of his children had contact with someone who later tested positive for the virus. His office said on Wednesday that a staff member had also tested positive, but had not been in recent contact with Mr. Newsom.

Californians have been on a kind of emotional roller coaster ride since the pandemic began, careening between relief that the state’s early stay-at-home orders helped rein in the virus and alarm that cases surged again despite a slow reopening tailored to each county’s conditions.

On Monday, leaders said that new restrictions were in the works, and the governor released dire projections showing that without them, the state’s intensive care units would be overloaded by the middle of this month. Hospitals in hard-hit regions like the San Joaquin Valley, where many low-paid essential workers live in crowded conditions, have been filling up rapidly for weeks.

“Everything is on the table, in terms of how we guide the state through this,” Dr. Mark Ghaly, California’s secretary of health and human services, said Monday.

But after months of hearing that businesses can safely operate outdoors and with proper precautions, many Californians are pushing back against new restrictions. And a growing list of elected leaders have been caught flouting the rules they’ve urged their constituents to follow.

As in March, the rollout of new restrictions, particularly in Los Angeles County, has been confusing, and enforcement has been spotty.

Mr. Newsom said on Thursday, as he did repeatedly in the spring, that the state would withhold money from counties that refuse to enforce stay-at-home orders.

“We didn’t want to be punitive, but we wanted to be firm,” he said.

That approach, however, has drawn criticism in the past for leading to piecemeal, inconsistent enforcement.

Advocates and experts have also criticized a lack of enforcement of protections for essential workers, which has added to the vulnerability of the low-paid Californians who were already more heavily affected by the virus than most others.

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