CLEVELAND (NYTIMES) - They voted from cars and at outdoor tables. They stood in lines spaced far apart. They strapped on masks and pumped sanitiser into their palms.

All across America on Tuesday (Nov 3), voters cast ballots in a presidential election in which the uncontrolled coronavirus pandemic was both a top issue and a threat.

As millions of Americans turned out to vote, the nation was facing a rapidly escalating pandemic that is concentrated in some of the very states seen as critical in determining the outcome of the presidential race.

From Wisconsin to North Carolina, infections were on the rise as the nation barrelled toward 10 million total cases.

The virus that has left millions of people out of work and killed more than 230,000 people in the United States will be one of the most significant challenges for the winner of the presidential race, and it loomed over every chapter of the election, down to the final ballots.

In the last hours of campaigning, President Donald Trump - who, regardless of the election outcome, will be in charge of the nation's response to the pandemic for the next 2 1/2 critical months - was at odds with his own coronavirus advisers and suggested that he might fire Dr Anthony Fauci, the nation's top infectious-disease expert.

Former vice-president Joe Biden told voters in a final pitch that "the first step to beating the virus is beating Donald Trump".

In Virginia, voters' temperatures were taken at some polling sites.

In Wisconsin, the mayor of Wausau, a small city where cases are spiking and tensions are high, issued an order banning guns at polling places.

And in Texas, an election judge did not wear a face covering, prompting accusations of voter intimidation and such intense heckling that the judge called the local sheriff to report that she felt unsafe.

The pandemic, which drove record numbers of Americans to cast ballots early or by mail, rarely strayed far from voters' minds.

"I just don't want another shutdown," said Ms Rachel Ausperk, 29, a first-time voter who said she chose Mr Trump in Ohio, a highly contested state that reported more new coronavirus cases on Tuesday than on any day since the nation's outbreak began more than eight months ago.

In Miami, Mr Eddie Gil, 50, said that he, too, had been guided by concerns about the coronavirus and how it was being handled.

He said he voted for Mr Trump in 2016 but chose Mr Biden this year, in part because of the President's handling of the pandemic.

"The government has failed all the small businesses," said Mr Gil, who opened a gym in January but said the pandemic forced him to close.

"I'm very disappointed," he added. "I thought putting a real estate businessman in office would drain the swamp."

The coronavirus outbreak shaped nearly every aspect of the 2020 election and only intensified as voters went to the polls.

The United States shattered records in recent days, reporting more than 85,000 new cases a day, nearly double the caseload at the start of October.

Deaths have increased slowly to more than 800 daily, more than in early July but far fewer than in the spring.

Though the country is conducting more testing, that does not fully account for the increase in cases.

In a collision of two powerful forces shaping 2020, the virus was raging most ominously across political battlegrounds around the Great Lakes.

Several swing states recorded records or near highs on Tuesday, including Minnesota, Pennsylvania and Wisconsin, which have all announced more cases over the past seven days than in any other week-long period during the pandemic.

In Wisconsin, a prize eyed by both parties, more than 100,000 virus cases have been reported in the past month, and deaths and hospitalisations have spiked, leaving many to fear that worse news could be ahead.

Voters who entered a polling location in Kenosha, Wisconsin, first passed a hand-washing station outside the front doors.

Then there was a kiosk of free masks, wipes and hand sanitiser just inside the lobby.

The room where they voted was a large, airy gymnasium with tables spaced at least 4.5 metres apart.

Mr David Sconzert, a poll worker, said he carefully considered whether to show up on Election Day at all.

A cancer survivor, he said he tested positive for the coronavirus in early October yet feared he did not have the immunity that would prevent him from catching it again.

"I almost called it off," he said. "But then I just thought, 'No. I'm taking a chance.' "

Inside a community basketball gym in Cleveland, poll workers fastened on masks and sat down behind cardboard and plastic shields that encased them on three sides.

Looking more like a row of bank tellers, they greeted voters, who were expected to give an electronic signature by slipping on disposable plastic finger shields and then guiding their hands under a narrow opening.

Voter booths, spaced out around the gym, had been meticulously measured with a 1.8m rope.

Ms Raven Payne, a 25-year-old first-time poll worker, had one job all day: sanitation.

Dressed in a bright yellow vest, plastic gloves, a face mask and a face shield, she had a distinctly buglike appearance as she hovered around the room, swooping in to clean, wipe and scrub each booth in between voters.

A little over a kilometre away, about 40 people sick with the coronavirus were lying in beds at the main campus of the Cleveland Clinic.

Across Ohio, more people are hospitalised with the virus than at any other time during the pandemic; around the country, more than 50,000 people were in a hospital with the coronavirus on Tuesday, up 67 per cent from a month ago.

When Americans found themselves voting in the middle of the 1918 flu pandemic, infections also surged in October, peaking around Election Day.

After voters turned out for the midterm elections that year, deaths continued at a fairly high rate throughout November and into December.

At the same time, some places were lifting restrictions on public gatherings, and people were flocking to the streets to celebrate the armistice ending World War I, two factors that contributed to new infections.

This year, experts are hopeful that the flood of mail-in voting and precautions at the polls will protect Election Day gatherings from becoming superspreader events.

But with cases soaring nationwide and health officials overwhelmed, it may be difficult to determine in the coming weeks what effect voting may have had.

The next few weeks are seen as crucial for controlling the pandemic, as colder weather forces people indoors and families gather around the table at Thanksgiving.

No matter the outcome of the election, one person will be in charge of the nation's Covid-19 response through the next critical period: Mr Trump.

The President, who was hospitalised for the virus in October, has largely shut down the White House Coronavirus Task Force and in recent days downplayed the country's spiralling cases, saying that the nation is "rounding the corner".

Dr Deborah Birx, the White House's coronavirus response coordinator, issued an urgent plea on Monday for an "aggressive balanced approach that is not being implemented", in a private memo that was earlier reported by The Washington Post.

In many places, voters and poll workers took extraordinary measures on Tuesday to try to protect themselves.

They wore American flag-themed masks, used napkins to drop off votes in ballot boxes and even passed ballots with the help of salad tongs.

"People just love the tongs," said Mr Tommy Nickerson, a ballot worker in Oakland, California, where workers in face masks used tongs to collect ballots from drive-thru motorists.

Across the street, people cast ballots at tables set up outside.

Some thought the virus - and all the precautions - was overhyped.

"I don't think it's as big as they say," said Ms Ann Roth, a 57-year-old voter from Papillion in suburban Omaha, Nebraska, who cast her ballot for Mr Trump.

"People are going to do what they're going to do."

In Michigan, another key swing state that Mr Trump carried by a razor-thin margin four years ago, Democrats were focused on driving up turnout in Detroit. The pandemic was especially devastating for the city.

"It hit us like an atomic bomb," said Mr Ronald Lockett, t executive director of the Northwest Activities Centre, where there was a line out the door to vote on Tuesday.

Mr Lockett said he had the coronavirus this year, had to cut his staff during the pandemic, and had lost hundreds of thousands of dollars because he had not been able to hold events.

He cast his vote for Mr Biden, he said, in large part because he hoped the former vice-president would guide America out of the pandemic.

"This election," he said, "is going to determine the future of Covid."

For live updates and results, follow our US election live coverage.