Once again, the U.S. smashed its record for people hospitalized with COVID-19 — putting enormous strain on the health care system and threatening to reduce care for even those who don't have coronavirus.
At least 83,227 COVID-19 patients were hospitalized Saturday, according to the COVID Tracking Project. That's the 12th straight day that the U.S. has broken its record for COVID-19 hospitalizations.
Nearly a quarter of all COVID-19 cases reported in the U.S. were recorded just in November, according to data from Johns Hopkins University.
And health experts say new infections, hospitalizations and deaths will get worse before they get better, as the upcoming holidays and colder weather trigger more indoor socializing.
More than 12 million people in the U.S. have been infected with coronavirus, and more than 256,000 people have died, according to Johns Hopkins. About 2.8 million of the infections were reported in November.
Testing has increased, but not nearly at the same pace as new infections have increased. As of Friday, the number of daily new cases over the past week was 25% higher than the previous week, according to Johns Hopkins.
By contrast, the number of new tests increased only 14.55%, according to the COVID Tracking Project.
Saturday marked the country's 19th straight day of more than 100,000 new cases reported, according to Johns Hopkins.
And more new infections mean more new hospitalizations and deaths in the weeks ahead.
At least 24 hospital leaders warned the American Hospital Association they're having staffing shortages, said Nancy Foster, the association's vice president for quality and patient safety policy.
States report daunting milestones
The real case count is likely to be "multitudes" higher than the 12 million reported because not enough people are getting tested, said Dr. Esther Choo, professor of emergency medicine at Oregon Health & Science University.
Choo said she is particularly concerned by how quickly new cases are accelerating.
"So many states have test positivity rates above 20%, which means that we are vastly lagging behind in our confirmed cases," she told CNN.
And test positivity is just one of the metrics reaching daunting heights across the U.S.
Mississippi reported a single day record in the state with 1,972 cases on Saturday, according to the Mississippi State Department of Health.
In New Mexico, records were set on Saturday with 825 hospitalizations, a tweet from Governor Michelle Lujan Grisham said.
Thanksgiving travel despite CDC's recommendation against it
Due to swelling numbers, health experts have cautioned those fatigued of social distancing not to let up over the Thanksgiving holiday.
"I would say to those who are homesick ... just hold the line," Dr. Chris Pernell, a public health physician at New Jersey's Newark University Hospital, told CNN on Saturday. "Hold on a little bit longer until we can get to the point in the nation where we know that the pandemic isn't accelerating. Otherwise it could be deadly."
The U.S. Centers for Disease Control and Prevention last week urged against Thanksgiving travel, and against celebrating with anyone outside your own household, because cases are soaring. But health officials suspect many will visit family and friends and further spread the virus -- many times, without knowing it.
The CDC says in new guidance last week that more than 50% of COVID-19 infections are spread by people who exhibit no symptoms.
With people increasingly getting sick, and others without symptoms seeking reassurance ahead of the holiday, long lines are forming outside testing sites around the country, appointments are filling up, and commercial labs are warning that their capacities are being stretched.
Health experts, however, stress a negative test result will not guarantee a person isn't carrying the virus to a Thanksgiving gathering, because a test won't necessarily pick up on fresh infections. An already-infected person could test negative, travel to a dinner days later and then spread the disease.
People who want to attend an indoor Thanksgiving dinner with a different household, experts have told CNN, should have planned to quarantine 14 days beforehand.
"If you do that properly, you don't need a test," Dr. Rochelle Walensky, chief of the infectious diseases division at Massachusetts General Hospital, told CNN.
Holding down the virus
For now, experts urge the public to use measures including wearing masks, social distancing, avoiding crowds and washing hands to curb the spread until promising vaccines and treatments are available.
The U.S. Food and Drug Administration on Saturday issued an emergency use authorization of Regeneron's antibody cocktail to treat COVID-19 in high-risk patients with mild to moderate symptoms. It is one of the treatments President Donald Trump received when he was hospitalized.
A race to develop a vaccine effective against the virus has brought some promising results, with Moderna announcing earlier this month that its vaccine candidate was 94.5% effect against coronavirus.
On Friday, Pfizer and BioNTech submitted an application to the FDA for emergency use authorization for their COVID-19 vaccine candidate. Earlier this week, Pfizer said a final analysis of the Phase 3 trial of the vaccine showed it was 95% effective in preventing infections, even in older adults, and caused no serious safety concerns.
While the application for EUA is "encouraging," the Infectious Diseases Society of America stressed Friday that a transparent review of Pfizer's data is still needed.
And if the vaccine is given the green light, "clinical trials and data collection must continue," Dr. Barbara Alexander, president of IDSA, said in the statement.
"Measures that include wearing masks, frequent hand washing, maintaining physical distance and restricting the size of gatherings will remain crucial," the statement said. "Finally, new federal funding must be provided for widespread, fair and equitable vaccine distribution in addition to campaigns to build vaccine confidence."