The coronavirus pandemic reached a dire milestone Wednesday when the number of new U.S. infections topped 100,000 a day for the first time, continuing a resurgence that showed no sign of slowing.
The pandemic is roaring across the Midwest and Plains states. Seven states set records for hospitalizations for covid-19, the disease caused by the virus. And Connecticut, Iowa, Maine, Michigan, Minnesota, Nebraska and North Dakota saw jumps of more than 45% in their seven-day rolling average of new infections, considered the best measure of the spread of the virus.
The country recorded 104,004 new cases Wednesday.
"It's clear we're heading into a period where we're going to see increasing hospitalization and deaths in the U.S. And it worries me how little we're doing about it," said Tom Frieden, director of the Centers for Disease Control and Prevention during the Obama administration. "We know by now how fast this virus can move. You have to get ahead of it."
After more than nine months of restrictions, some state leaders are hesitant to risk further pandemic fatigue, Frieden said.
But if case counts continue rising at the current rate and strong action isn't taken, viral transmission may soon reach a point in some areas where nothing will stop it except another shutdown, he said.
"The numbers keep going up, and we're only getting closer and closer to Thanksgiving and Christmas," when some families are expected to congregate indoors and risk spreading the virus further, said Eleanor Murray, an assistant professor of epidemiology at Boston University. "For so many reasons, the next few weeks are going to be bad for us and good for covid."
For many people, the virus is not as daunting as the prospect of being unable to pay their bills or send their children to school.
"I got news for you, pal. Covid-19 is over. It's done," said Nick Arnone, owner of HLSM, a software company for the power sports industry, in Plains, Pa. "We have therapeutics, so deaths are way down; we are very close to a vaccine. We've got to ride it out now.
"But if we don't have a strong economy, there is no way we can do anything. [President Donald] Trump is correct. Without a good economy, there is no way to dig our way out of this."
Those more concerned with the virus broke heavily for former Vice President Joe Biden in Tuesday's election. But they were matched by the proportion of Trump voters who supported his call for a return to normalcy and a revived economy.
In El Paso, Texas, where the pandemic is surging, James Clark said he voted for Biden because of the uncontrolled outbreak.
"Covid was the main reason ... and the things he was saying specifically about it," Clark said. "I mean there were some things Trump was doing well, too, but overall it was covid."
On the campaign trail, Biden warned voters of a "dark winter" and invoked empty chairs in homes where families grieved the death of a loved one. He suggested he would follow science and tighten restrictions where that was necessary.
Trump repeatedly declared that the country was "rounding the turn" on the pandemic and said a vaccine was almost ready to be distributed. "You know what we want? We want normal," Trump said this past weekend in Butler, Pa.
The two political messages were consistent with the viewpoints of each candidate's base, said Kathleen Hall Jamieson, director of the Annenberg Public Policy Center at the University of Pennsylvania.
Stefan Baral, a physician and epidemiologist at Johns Hopkins School of Public Health, on Wednesday faulted Democrats' pandemic messaging, saying Biden did not adequately express empathy for the economic hardships caused by the pandemic-related shutdowns.
"This is a terrible virus. But empathy for all the folks who have lost their jobs and lost their opportunities and kids who are out of school -- I just never felt that message of empathy come across at all," Baral said.
When some people heard Biden talk about the dark winter ahead, they thought, "The first thing he's going to do is close my business," Baral said.
In Chandler, Ariz., a suburb southeast of Phoenix, Al Fandick last week said he considers the pandemic wildly overblown and masks largely pointless. Fandick, 53, who runs a transport company, said he found it absurd that he was required to don a mask to enter a restaurant but could remove the face covering once he sat down.
"Having a face mask on while I walk into that restaurant, but then I can take that face mask off, that's like having a peeing section in a pool," Fandick said.
Aside from trips to visit people in the hospital, he never wore a mask until Maricopa County began mandating it for public spaces, a policy he opposes, he said.
On the other side of the gulf are those who see the accelerating pandemic and a possibly very deadly period ahead.
"It is demoralizing to feel like: Here we are in November. A third surge is not just underway, but has already surpassed past surges. And people still don't understand what's happening and what's at stake," said Murray of Boston University.
"We are in the middle of an emergency. We have cases higher than they have ever been since this pandemic started, and yet you will have people paying less attention than ever to covid," Murray said. "We as a country are not in a place right now where it's safe to do that."
The U.S. death toll is already more than 233,600, and the seven-day rolling average for new daily deaths is rising. Total confirmed U.S. cases have surpassed 9.4 million and new daily infections are increasing in nearly every state.
"Where we are is in an extremely dire place as a country. Every metric that we have is trending in the wrong direction. This is a virus that will continue to escalate at an accelerated speed and that is not going to stop on its own," said Dr. Leana Wen, a public health expert at George Washington University.
Dr. Susan Bailey, president of the American Medical Association, said there are things Americans can do now to help change the trajectory.
"Regardless of the outcome of the election, everyone in America needs to buckle down, Bailey said.
"A lot of us have gotten kind of relaxed about physically distancing, not washing our hands quite as often as we used to, maybe not wearing our masks quite as faithfully. We all need to realize that things are escalating and we've got to be more careful than ever," she said.
El Paso hospitals are near a "breaking point" as 3,100 new cases of the coronavirus were reported there Wednesday, an official said.
"Hospitalizations continue to rise sharply and unfortunately more people we know will continue to succumb to the complications of this disease," said Dr. Hector Ocaranza, El Paso's city and county health authority.
"Our hospitals are near breaking point, we need everyone to do their part to stop this virus," he said.
There were 1,041 hospitalizations in El Paso on Wednesday, health officials said.
Texas recently surpassed California in recording the highest number of positive tests for the virus, according to Johns Hopkins University's data. The latest numbers show more than 952,000 reported Texas cases.
Federal health officials have said they believe a vaccine could get emergency use authorization before the end of the year. The first limited supplies of doses would then be immediately distributed to the most vulnerable populations, which is likely to include front-line health care workers. Doses would then gradually become more widely available.
The timeline hinges on having a vaccine that's shown to be safe and effective, which experts note is not yet a certainty. "The vaccine has to move at the speed of science," said Dr. Joshua Sharfstein, vice dean for public health practice at Johns Hopkins University and former Maryland state health department chief.
On the treatment front, the makers of two experimental antibody drugs have asked the Food and Drug Administration to allow emergency use of them for people with mild to moderate covid-19, and Trump, who received one when he was sickened last month, has said he wanted them available right away.
So far, the FDA has granted full approval to only one drug -- the antiviral remdesivir -- for hospitalized patients. Dexamethasone or similar steroids are recommended for certain severely ill patients under federal treatment guidelines.
The government continues to sponsor many studies testing other treatments alone and in combination with remdesivir.
Meanwhile, one of the first states to receive rapid, low-cost coronavirus tests from the U.S. government is cautioning against their use in asymptomatic people, a group that was hoped to benefit most from the technology.
Antigen tests like one from Abbott Laboratories that look for telltale viral proteins may miss some infections that can be picked up by costlier gold-standard assays, and can incorrectly return positive results. The rapid tests aren't recommended for people without symptoms who haven't been exposed to a covid-19 patient, and those who undergo one should be informed of the limitations, the Louisiana Department of Health said in guidance issued last week.
Information for this article was contributed by Lenny Bernstein, Joel Achenbach, Frances Stead Sellers, William Wan, Jeremy Duda, Alexandra Hinojosa, Jacqueline Dupree and Karin Brulliard of The Washington Post; by Lindsey Tanner, Marilynn Marchione and Candice Choi of The Associated Press; and by Emma Court of Bloomberg News.