The US hit a record number of new coronavirus cases on Friday (Oct 30) for the second day in a row, topping 94,000 infections in 24 hours, according to a tally from Johns Hopkins University.
The country, which has seen a resurgence of its Covid-19 outbreak since mid-October, recorded 94,125 new cases in the 24 hours up to 8.30pm Friday (0030 GMT Saturday), according to a real-time count by the Baltimore-based school, reports AFP.
That broke the record of more than 91,000 cases set just one day earlier.
Case numbers in the US also passed nine million reported infections on Friday, as Covid-19 surges days before the country chooses its next president.
With the virus spreading most rampantly in the Midwest and the South, hospitals are also filling up again, stretching the health care system just as the nation heads in to flu season.
"We are not ready for this wave,"Dr Ashish Jha, dean of the Brown University school of public health, warned on ABC's Good Morning America on Thursday.
Authorities in El Paso, Texas, imposed a curfew this week to protect "overwhelmed" health care workers and began setting up field hospitals.
But a judge's attempt to shut down non-essential businesses in the city has been challenged by the mayor and the state's attorney general, the Washington Post reported.
Midwestern state Wisconsin has also set up a field hospital in recent weeks, and hospital workers in Missouri were sounding warning bells as cases there rise.
Hospitals in the western state of Utah were preparing to ration care by as early as next week as patients flood their ICUs, according to local media.
Utterly disqualifying
The pattern of the pandemic so far shows that hospitalisations usually begin to rise several weeks after infections, and deaths a few weeks after that.
More than 229,000 people have died of the virus in the US since the pandemic began, the Hopkins tally showed as of Friday, with the daily number of deaths creeping steadily upwards in recent weeks also - though at present it remains below peak levels.
For months public health officials have been warning of a surge in cases as cooler fall weather settles over the US, driving more people indoors.
As the weather changes, New York and other parts of the northeast, which were the epicentre of the US outbreak in the spring but largely controlled the virus over the summer, were reporting a worrying rise.
Some epidemiologists believe that Covid-19 spreads more easily in drier, cool air.
Rural areas, which in the spring appeared to be getting off lightly compared to crowded cities, were also facing spikes with states like North Dakota charting one of the steepest rises in recent weeks.
The state is so overwhelmed that earlier this month it told residents they have to do their own contact tracing, local media reported.
With four days to go until the election, Donald Trump was battling to hold on to the White House against challenger Joe Biden, who has slammed the president's virus response.
"It is as severe an indictment of a president's record as one can possibly imagine, and it is utterly disqualifying," Mr Biden said Friday as the toll passed nine million.
Mr Trump downplays the virus even as the toll has been accelerating once more, holding a slew of rallies with little social distancing or mask use.
He has repeatedly told supporters that the country is "rounding the curve" on Covid infections.
But Americans, wary of crowded polling booths on Election Day as the virus spreads, are voting early in record numbers.