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It's hard to overstate how much the U.S. coronavirus outbreak has deteriorated this past week, with each day ushering in new, disturbing records. 

. It was only last week that the U.S. reached a record of more than 100,000 infections in a single day for the first time ever.

This is the worst the pandemic has been," says 

 Chief Health Officer in the Divisions of Infectious Diseases and Geriatric Medicine at the University of Michigan.

Daily cases have gone up more than 70 percent nationwide, since the beginning of November. Another way to put it: 

 people in the U.S. tested positive for COVID-19 over the past week. 

"You have the entire country seeing surges and you're seeing it in rural areas and in urban areas. It's a reflection of the fact that COVID is so widespread."

 about a potential vaccine, there are dark months ahead of the country, as people spend more time indoors and travel for the holidays. 

"This is a really dangerous time," says Malani, who is also a fellow with the Infectious Diseases Society of America. "It's not too late. We can still turn things around, but it's going to require a big effort." 

Here are some of the big takeaways from the week in COVID-19: 

 patients are now hospitalized. Compare that to the spring and summer peaks, when hospitalizations leveled off at close to 60,000 patients. Experts say there is no indication that the current trend will slow down. In fact, quite the opposite. Given the record-setting growth of cases, it's likely that hospitalizations will pick up speed in the coming weeks, as some patients end up seriously ill. 

The Midwest and the South (including Texas) account for more than two-thirds of all COVID-19 hospitalizations. Earlier surges were concentrated in a few places, but this fall spike is hitting lots of states all at once. From Utah to Wisconsin to Iowa, hospitals are warning that the situation is not sustainable if the volume of new patients doesn't slow down. An 

 found at least 18 states have crossed into a dangerous zone where their hospitals could be at risk of reaching capacity, which could eventually require extreme measures like rationing care. 

2)  Parts of Midwest and the West are 'at the breaking point' 

 the Midwest. There are no signs that is subsiding. In fact, new daily cases have more than doubled over the past two weeks in that region, which is made up of 12 states. Illinois has added far 

 over the past week than any other state — 80,000, which is almost twice as many as California. 

The Dakotas, Wisconsin, Iowa and Nebraska have the highest rate of infections per capita in the U.S. Wisconsin is now averaging 

a day than New York City did at the height of its outbreak. 

46 deaths; new cases leap, hospitalizations climb Friday

, "We're at the breaking point." Parts of Texas, in particular El Paso, are in crisis and carting in mobile 

 because of rising deaths.  Montana is reeling after months of rising case counts, and doctors are 

 the region is on the "brink of disaster." 

3) States tiptoe toward new restrictions, but gaping holes remain

From Iowa to Connecticut, state leaders have started tightening restrictions and rolling back their reopening plans. Many have begun with the most high-risk activities, like restaurants and large group activities. Parts of California have stopped all indoor dining, including 

 at 10 pm, saying that infections spread the most quickly later in the evening. 

 caps on gathering sizes, limiting them to 25 people in the hardest hit counties (though religious services are exempted). Meanwhile, 

 has put in place a nightly curfew for indoor dining, gyms and bars. In Illinois, state leaders have warned a shutdown could be on the way; Chicago has issued a stay-at-home 

, although it's unclear how that will be enforced. 

Public health experts caution that states need consistent policies, instead of a patchwork of restrictions that only chip away at certain high-risk settings. As Anne Rimoin of UCLA 

NPR recently: "This is a hard moment where we don't necessarily get to have our cake and eat it too. You want to have bars open, then you might not be able to have schools open. You want to not wear a mask, you're going to see more COVID." 

Some state leaders that resisted mandating mask use are starting to bend, but experts say these new measures don't go far enough. 

 a statewide mask mandate.  Iowa's Governor Kim Reynolds has implemented a limited mask requirement, mostly aimed at large gatherings. Nebraska's new mandate also only requires people to wear a mask when they spend an average of 

And there are quite a few states that don't have a 

 statewide mask mandate. And even those that do, compliance and enforcement are issues. 

"We need to make mask-wearing obligatory and put a lot of stress once again on not having group assemblies of any kind," says Dr. William Shaffner, medical director of the National Foundation for Infectious Diseases. 

5) After a long plateau, deaths are now going up 

Since the summer, one of the few hopeful developments has been that fewer people are dying. That trend is shifting now. After averaging below 900 since Sept. 1, average daily deaths broke above 1,000 this week. Daily deaths have 

 about 23 percent over the past week. The current average is still about half of what the U.S recorded during the spring peak, but public health experts caution that deaths lag behind hospitalizations by a few weeks. 

 from the modeling group at the University of Washington predicts that more than 2,000 people will die each day from COVID-19 by mid January, and that the total U.S death toll will reach about 440,000 by March. The modelers say that changes in behavior 

6) Even East and West Coast states, that had kept cases low, are heading into trouble

Parts of the country that kept the virus in check for months are starting to see growth. Look at the Northeast, where daily cases have close to doubled over the past two weeks. New Jersey and Massachusetts are still averaging about half as many cases a day as hard-hit states like Minnesota and Michigan. 

On the opposite side of the country, in Washington state, cases have more than doubled since the beginning of November. Oregon is not far behind. California is a bit more mixed. The 

 remains lower than almost any other state, but there are pockets of alarming growth, particularly in the San Francisco Bay area and around San Diego. 

7) Rural and suburban counties outpace metro counties in per capita infections

The pandemic was slow in reaching rural America, but it's hold hasn't loosened since getting to those communities. The rate of infections in the most rural counties remains 

 than anywhere else and well-above the large urban areas. Much of the stress on hospitals in parts of the Midwest like Michigan, Kansas and Utah comes from rural areas, which rely on transferring patients in need of care to the metro areas. "In Michigan, a lot of the new cases are coming from the west side of the state and from less populated areas

In the Dakotas, the numbers are nothing short of staggering. One in 1,629 residents of South Dakota is 

 for COVID-19, the highest per capita rates in the country. The mortality rate in rural communities is also higher than urban areas. Public health experts say there are similar patterns with other public health crises, like HIV. It can take longer to reach rural America, but once there it's harder to root out the problem. 

8) Long-term care facilities are getting hammered again 

 of all COVID-19 deaths are linked to long-term care facilities. These populations are exceptionally vulnerable because of their age and how easily an outbreak can balloon in congregate living situations. There were

 through nursing homes earlier in the pandemic. Now, the 

 finds that cases are again surging in these facilities, with more than 24,000 cases in these facilities last week. Indiana, Ohio, Pennsylvania and Texas account for about one third of all nursing home deaths this week.   

Health

COVID-19

Will Stone

Author

With record cases and hospitalizations and newly rising deaths, experts wonder, will this surge ever slow down? Find out where the virus is hitting hardest and what is being done to stop it.

The pandemic this week: 8 things to know about the surge

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