WASHINGTON (NYTIMES) - As the coronavirus races across the United States, it has reached every corner of a nursing home in Kansas, infecting all 62 residents inside.
There are so few hospital beds available in North Dakota that patients sick with the virus are being ferried by ambulance to facilities 100 miles away. And in Ohio, more people are hospitalised with the virus than at any other time during the pandemic.
After weeks of warnings that cases were again on the rise, a third surge of coronavirus infection has firmly taken hold in the United States. The nation is averaging 59,000 new cases a day, the most since the beginning of August, and the country is on pace to record the most new daily cases of the entire pandemic in the coming days.
But if earlier surges were defined by acute and concentrated outbreaks - in the Northeast this spring, and in the South during the summer - the virus is now simmering at a worrisome level across nearly the entire country.
Illinois, Kentucky, Michigan, Montana, North Dakota, Ohio, South Dakota, Utah, Wisconsin and Wyoming each set seven-day case records on Tuesday (Oct 20). Even New Jersey, once a model for bringing the virus under control, has seen cases double over the past month.
"It is a really dangerous time," said Dr Tom Inglesby, an infectious-disease expert at the Johns Hopkins Bloomberg School of Public Health.
"The majority of states are on the rise," he said. And at the same time, "there are very few places where things are stable and going down."
The latest wave threatens to be the worst of the pandemic yet, coming as cooler weather is forcing people indoors and as many Americans report feeling exhausted by months of restrictions.
Unlike earlier waves, which were met with shutdown orders and mask mandates, the country has shown little appetite for widespread new restrictions.
"We're seeing spread virtually everywhere," said Governor Mike DeWine of Ohio, where 69 of 88 counties are now considered "high incidence," meaning at least 100 virus cases per 100,000 people in the past two weeks.
But at a news conference on Tuesday, DeWine, a Republican who was among the first governors to shut down businesses this spring and who imposed a statewide mask mandate this summer, did not announce new measures to curb the spread.
"The fastest way we can do it is not for me to issue some order that you can't enforce or would be difficult to enforce but rather for every Ohioan to take this seriously," he said, grabbing his cloth mask and holding it up.
The newest surge sets the stage for a grueling winter that will test the discipline of many Americans who have spent warmer months gathering in parks and eating outdoors, where the virus is known to spread less easily. At the current rate of growth, new daily confirmed cases could soon surpass 75,687, the record set on July 16.
The rising case count has so far not translated to increased deaths: About 700 people are dying on average each day, a high but steady rate. So far, more than 220,000 Americans have died from the virus.
The latest developments represent a serious new level of spread. Deaths are considered a lagging indicator of new infection, and experts believe the daily toll is likely to rise in the coming months. Nationwide, hospitalisations, the most accurate gauge of how many people are sick from the virus, are already trending upward, at a pace slightly lower than new infections.
In North Dakota, which is leading the nation in new coronavirus cases per capita, hospitalisations and deaths are at a high, and just 20 intensive care beds were available statewide.
"Is bed capacity an issue? Yes," said Tim Blasl, president of North Dakota Hospital Association, who described patients who have had to drive far out of their way to find an open bed in the rural state. But, he added, "Are people receiving care? Yes."
With no statewide mask mandate, some mayors are resorting to options they had long resisted. On Monday, the mayor of Fargo used his emergency powers to issue a mandatory mask order, the first of its kind in the state. Hours later, the City Council of Minot, the fourth-largest city in North Dakota, issued a similar order.
"We were hoping we had escaped the Covid-19," Mayor Tim Mahoney of Fargo, a practising surgeon, said in an interview. "Now we're just like everybody else in the country. It has hit us with a vengeance.
"We kind of thought we'd outsmart it, and you can't outsmart this virus."
In other parts of the country, officials are also returning to another tried-and-true method of containing the virus: stay-at-home orders. On Tuesday, local health officials ordered students at the University of Michigan in Ann Arbor to stay in their residences except for essential activities effective immediately, in an effort to control an escalating community outbreak.
Since Oct 12, cases associated with the university have made up about 61 per cent of confirmed and probable local infections, said Jimena Loveluck, the health officer for Washtenaw County, who warned that many cases have been tied to parties and other big gatherings.
In a sign of how quickly the virus is spreading in many parts of the Midwest and the Great Plains, infections recently overtook a private nursing home in northern Kansas.
The nursing home, Andbe Home, noticed the first sign of a problem Oct 7, when a single resident tested positive. But within days, the virus had run rampant, sneaking from room to room.
Two weeks later, all 62 residents who live there have been infected, and 10 have died. At least 12 employees have also tested positive.