The US hit a record number of coronavirus hospital admissions on Tuesday and surpassed one million new confirmed cases for just the first 10 days of November amid a surge that shows no signs of slowing.
The new wave appears bigger and more widespread than the surges of the spring and summer - and threatens to be worse.
But experts say there are also reasons to think the nation is better able to deal with the virus this time around.
William Hanage, a Harvard University infectious-disease researcher, said the country was "definitely in a better place" in terms of improved medical tools and knowledge.
Newly confirmed infections in the US were running at all-time highs of well over 100,000 per day, pushing the total to more than 10 million and eclipsing one million since October 31. There are now 61,964 people in hospital with the disease, according to the Covid Tracking Project.
Several states posted records on Tuesday, including more than 12,600 new cases in Illinois, 10,800 in Texas and 7,000 in Wisconsin.
Deaths - a lagging indicator, since it takes time for people to fall sick and die - are climbing again, reaching an average of more than 930 a day.
Hospitals are under pressure, and unlike previously, this upswing is not confined to one or two regions.
"The virus is spreading in a largely uncontrolled fashion across the vast majority of the country," said Dr William Schaffner, an infectious-disease expert at Vanderbilt University.
Governors made increasingly desperate pleas for people to take the fight against the virus more seriously.
In an unusual prime-time speech hours after Wisconsin set new records for infections and deaths, Democratic governor Tony Evers announced he was advising people to stay in their homes, and businesses to allow people to work remotely, require masks and limit the number of people in stores and offices.
Minnesota's Democrat governor Tim Walz ordered bars and restaurants to close at 10pm, and Iowa's Republican governor Kim Reynolds said she would require masks at indoor gatherings of 25 or more people, inching toward more stringent measures after months of holding out.
While deaths are still well below the US peak of some 2,200 per day back in April, some researchers estimate the nation's overall toll will hit around 400,000 by February 1, up from about 240,000 now.
But there was also good news.
Doctors now better know how to treat severe cases, meaning higher percentages of Covid patients who go into intensive care units are coming out alive. Patients have the benefit of new treatments, namely remdesivir, the steroid dexamethasone and an antibody drug that won emergency-use approval from the Food and Drug Administration on Monday. Also, testing is more widely available.
In addition, a vaccine appears to be on the horizon, perhaps around the end of the year, with Pfizer this week reporting early results showing its experimental shots are a surprising 90% effective at preventing the disease.
And there's a change pending in the White House, with President-elect Joe Biden vowing to rely on a highly respected set of medical advisers and carry out a detailed coronavirus plan that experts say includes the kind of measures that will be necessary to bring the surge under control.
Mr Biden pledged during the campaign to be guided by science, make testing free and widely available, hire thousands of health workers to undertake contact-tracing, and instruct the Centres for Disease Control and Prevention to provide clear, expert advice.
"We are already seeing encouraging signs from President-elect Biden with regard to his handling of Covid-19," said Dr. Kelly Henning, a veteran epidemiologist who heads the Bloomberg Philanthropies' public health programs.
"I am relieved to see he's already put some of the smartest scientific minds on his new coronavirus task force and that they are acting urgently to try and get the pandemic under control as quickly as possible."
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