After several weeks of rapidly rising coronavirus cases, hospitals around the United States are once again overwhelmed, forcing local authorities to take new measures to cope with the pandemic.
On Wednesday a record 65,368 people were in the hospital with Covid-19 across the country, marking the second day in a row and second time ever that the tally passed the 60,000-mark, according to the Covid Tracking Project.
Around the country, officials were scrambling to staunch the spread.
In New York state, Governor Andrew Cuomo announced that any establishment with a liquor license, including bars and restaurants, would have to close at 10:00 pm beginning Friday. The rule will also apply to gyms.
New York City was the early epicentre of the nation's coronavirus pandemic, but hotspots have since popped up across the country, leaving practically no geographical region unaffected.
One such locale is the border city of El Paso in western Texas, a state where coronavirus cases have now exceeded one million.
More than 1,000 people are hospitalised in the county of El Paso alone, a substantial portion of the state's nearly 6,800 hospitalisations.
"These are dark times," Ogechika Alozie, chief medical officer at the city's Del Sol Medical Center, told CNN Wednesday. "I think the biggest word is just fatigue. And there's frustration."
Cases are so high that Texas Governor Greg Abbott has requested a military medical centre be converted for intake of non-Covid patients in order to free up space in hospitals. County officials, meanwhile, have requested additional mobile morgues.
The situation in El Paso is typical of the difficulties local governments are facing in the United States, where President Donald Trump has downplayed the epidemic and left handling of the health crisis to state, county and city officials.
In late October an El Paso County judge ordered non-essential businesses closed for two weeks, a measure fought by El Paso's mayor and the state attorney general.
Trump has placed much of his hopes of fighting the coronavirus pandemic on the rapid development of a vaccine.
Positive Phase 3 trials of a vaccine developed by Pfizer mean inoculations are likely to begin by the end of the year or in early 2021.
But with no vaccine at present, the US is facing troubling circumstances.
The number of deaths each day is still far from levels seen in the spring, however, the US recorded more than 1,300 fatalities in 24 hours on Wednesday.
The coronavirus death rate has "declined since the spring partly because hospitals and staff were so overstretched back then. As cases take off across the country, we will increasingly start seeing those limitations again," said emergency medicine specialist Craig Spencer on Twitter.
The US contamination curve has undergone three notable waves: a first in the spring with an epicentre in New York, a second in the summer that hit the US south particularly hard, and a third since mid-October with records being set in the Midwest.
In North and South Dakota, more than one in 2,000 residents is currently hospitalised with Covid-19, according to the Covid Tracking Project.
North Dakota Governor Doug Burgum this week authorised health workers who test positive to continue working in Covid units in order to cope with the "enormous pressure" on the state healthcare system.
In Minnesota, Governor Tim Walz ordered bars and restaurants to close at 10:00 pm and placed a 10-person limit on gatherings.
Restrictions are popping up beyond the Midwest as well, such as in Utah, where wearing a mask in public is now mandatory statewide.
President-elect Joe Biden pleaded Monday once again for Americans to wear face coverings, telling viewers in a televised speech that "a mask is not a political statement, but it is a good way to start putting the country together."
He has pledged to tackle the health crisis from day one of his administration, which begins January 20.