With two months to go before a presidential handover from Donald Trump to Joe Biden, the federal government's strategy for containing the virus has experts worried.
Outside of embracing conspiracy theories, Trump administration officials appear to have pinned their hopes on improved testing and eventual vaccine approval.
"The strategy, if you can summarize in one word, is hope," said Dr Carlos del Rio, executive associate dean of the Emory School of Medicine and Grady Health System in Georgia. "And hope is not a strategy."
The swell of autumn Covid-19 cases is already proving to be the most intense period for new infections of the entire pandemic. By various counts, the US broke a world record for new cases – 100,000 in a day – this week. Those new infections will portend new hospitalizations, and eventually deaths. Already, more than 230,000 Americans have died from Covid-19.
"If we don't do anything to stop it, we are in the trajectory going straight up," said Del Rio.
Del Rio predicted the United States could see 200,000 cases a day by Thanksgiving, if Americans do not adopt social distancing and universal masking immediately.
There are other grim signs. The nursing home industry, which cares for America's most medically fragile residents, has warned that Covid-19 cases among the elderly and infirm are growing because of intense spread in surrounding communities.
"It is incredibly frustrating," said Mark Parkinson, president and CEO of the American Health Care Association, an industry group for private nursing homes. "If everybody would wear a mask and social distance to reduce the level of Covid in the community, we know we would dramatically reduce these rates in long-term care facilities."
"Thanksgiving is basically set up to be a chain reaction of super-spreader events across our country. And if this is happening across the country, we're not going to have [traveling health workers] or extra staffers," said Ranney, even as "everyone is needed in their own hospitals or their own communities".
Nationwide hotspots could also bring shortages of personal protective equipment (PPE).
"One of the biggest trends we're seeing is people are really ready to pretend the [pandemic] is over," said Gupta.
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