WASHINGTON - The woman needed a tracheotomy, which is a surgical procedure performed when you cannot breathe and they cut a hole in your throat to stick a rubber tube in to supply your lungs and heart with oxygen.

By her side in the University of Maryland's Baltimore Washington Medical Centre, 28-year-old nurse Alie Cavey held up an iPad so the Covid-19-stricken woman, in her 60s or 70s, could talk to her daughter. "Just let me die," she repeatedly tried to say.

Eventually, the woman recovered, and was profusely thankful to the staff.

She was one of the lucky ones even though she may have to struggle with the long-term effects of Covid-19.

The United States is in for a grim winter. Nearly 37,000 Americans died of Covid-19 in November, the most in any month since this year's savage spring. Death rates lag hospitalisation, which is soaring again, leading experts to forecast that the country could soon see 2,000 or more fatalities per day.

That would be the equivalent of a major natural disaster like the 2005 Hurricane Katrina (1,800 deaths) - every single day.

On Wednesday (Dec 2), Centers for Disease Control and Prevention (CDC) director Dr Robert Redfield warned: "I actually believe (December, January and February) are going to be the most difficult time in the public health history of this nation."

Hospitals filling up

Hospitalisations from the coronavirus topped 100,000 on Thursday - more than double the number at the beginning of November. The total death toll as at Friday was 276,000.

"If you tell me the hospitalisations are up this week, I'll tell you that several weeks down the road, the deaths will be up," Dr Jeremy Faust, an emergency medicine physician at Brigham and Women's Hospital in Boston, told the New York Times.

And, unlike the spring, when the cases were concentrated in a few states, this time they are nationwide - helped, epidemiologists say, by last weekend's Thanksgiving holiday, which saw millions ignoring pleas not to travel.

California Governor Gavin Newsom has issued new restrictions with hospital intensive care units (ICUs) filling up rapidly.

Bay Area health officials plan to implement stay at home orders as soon as Sunday - and keep them in place until after the Christmas and New Year holiday period.

"There's no reason to wait," said Santa Clara county executive Jeff Smith. "It's sort of like waiting to put the brakes on when you're about to go over the cliff. If you're going to get the public health benefit, you have to do it now."

On the other side of the nation, Washington, DC reported 316 new Covid-19 cases on Friday, the city's second consecutive day with more than 300 - surpassing the springtime peak.

The positivity rate - the number of positive results from total tests - was reportedly at 5.3 per cent, the highest since June when the city had still not moved into phased reopening.

The human tragedy is mounting. The economic crash triggered by the pandemic is biting ever deeper as states move to restrict gatherings again; reports say 26 million Americans do not have enough to eat and long queues can be seen at food banks. Churches are among those supplying food aid.

Millions of Americans face losing support programmes at the end of the month, as Congress has failed to agree on relief and stimulus measures; it has until the end of next week to do so.

Hospitals across the country are near capacity, and making contingencies for mobile refrigerator trucks to function as temporary morgues. Reports are mounting of local authorities, from McLennan county in Texas to Cuyahoga and neighbouring Stark county in Ohio, already ordering or using them.

Mental strain

Healthcare workers (HCWs) also face "aggravated psychological pressure and even mental illness", concluded an October National Institute of Health (NIH) paper after a review of data and reports.

The caseload has relentlessly increased. Deaths have risen. "It is expected of HCWs to work long hours while they are under overwhelming pressure," the NIH said.

"They are at the risk of being infected when treating ill patients. On the other hand, like other individuals, they are exposed to a considerable amount of fake news and rumours, all of which increase their anxiety."

"It's definitely a mental struggle," Ms Cavey, a mother of two boys, aged one and three, told The Straits Times.

"There's really no outlet because we're so overworked during this time. And honestly, we have not addressed our mental health as much as we should at this point because we haven't had rest.

"People are struggling with their mental health. It's a scary thing to say but it's true," she said.

"It's just really hard. We have to be strong for our patients because they don't have family at the bedside because of all the restrictions. But when we're walking a thin line with our own mental health, it's hard to help them cope.

"There's been a lot of nurses that just couldn't take it anymore," Ms Cavey said. "I don't know the exact number, but we've had a significant number of resignations in the hospital because… they can't do it much longer, so they go elsewhere."

Different kind of fear

The fear now is different from back in the spring. Then, there was the fear of the unknown, and HCWs did not have enough personal protection equipment; in the initial phase of the pandemic, 29 per cent of all hospitalised patients were HCWs.

Now, though staff are better equipped and more practised at caring for Covid-19 patients, the fear is of not being able to cope with the flood.

"The spread is just so massive at this point; that it is overwhelming systems everywhere," Mr Bob Atlas, president and CEO of the Maryland Hospital Association told ST.

"The strain is real right now. And we really have to hope that people will pull back, if not voluntarily then, as is happening in some other states, with more restrictions… on movement in public spaces and things like that."

Ms Cavey told ST: "Currently we've been pretty much at capacity or over capacity for the past week or two. It's a struggle getting an ICU bed.

"And it's a scary thing thinking if the spike is going to get worse, where are we going to put all these patients? Who's going to take care of all these patients?"