What comes next is likely the country's "worst-case scenario in terms of overwhelmed hospitals, in terms of the death count," said emergency medicine physician Dr. Leana Wen.
"There's just so much virus in our communities right now," she said.
Her words echoed a bleak forecast by Centers for Disease Control and Prevention Director Dr. Robert Redfield, who warned Wednesday the next three months are going to be "the most difficult in the public health history of this nation."
It's a grim reality reflected in the latest numbers.
- The US had its highest day of new cases -- 217,664 -- and deaths -- 2,879 -- on Thursday, according to Johns Hopkins University.
- There were a record-setting 100,667 hospitalizations on Thursday, according to the Covid Tracking Project.
- The US has been adding 1 million new cases every six days for three weeks.
- Covid-19 was the leading cause of death this week, with 11,820, an average of 1,660 a day, according to the University of Washington's Institute for Health Metrics and Evaluation (IHME).
More than 14.2 million cases and 277,000 deaths have been recorded in the US, according to Johns Hopkins.
So far for Friday, Johns Hopkins reported there have been 51,094 cases and 655 deaths.
IHME projects 262,000 more people will die over the next four months and daily deaths will peak at more than 2,900 in mid-January.
Vaccinations won't have a big impact on deaths by April 1, but universal mask usage could, the IHME team said in a Friday update.
"Scaling up mask use to 95% can save 66,000 lives by April 1," the team said.
Health care systems under stress
Leading health officials say rising cases will be followed by more hospitalizations that could cripple health care systems across the country. Hospitals and experts all over the US are sounding the alarm.
Marvin O'Quinn, president and chief operating officer of CommonSpirit Health, which runs hospitals in 21 states, told CNN that all its hospitals are getting more patients.
"We are now up to roughly 2,100 positive cases in our hospitals. That's an increase of almost 70% since November 11," O'Quinn said. "We're seeing about 70 to 100 new cases every day."
In Pennsylvania, just under 5,000 people are hospitalized with Covid-19, and two parts of the state are inching closer to staffing shortages, Secretary of Health Dr. Rachel Levine said Thursday.
"It is so important to remember that all of us have to be mindful, that we all have a role to play in what is happening in the hospitals right now," Levine said. "You might not need hospital care right now; you might not have a loved one in the hospital right now. But what is happening in our hospitals has a direct impact on you."
In the past two months, the positivity rate in Miami-Dade County, Florida, has spiked 91%, the county's Chief Medical Officer Peter Paige said Friday. Hospitalizations spiked 139%.
Maryland health officials reported 3,792 new Covid-19 cases Friday, breaking the state's previous record for daily cases, said the Department of Health.
This is the first time Maryland has passed 3,000 cases in a day, CNN's tally shows.
Growing acceptance of masks, vaccine
Most US adults -- 72% -- say it bothers them when people in public do not wear masks, according to a survey from the Pew Research Center. Far fewer adults -- 28% -- say it bothers them at least somewhat when stores require customers to wear masks for service.
Results showed 87% say they have worn a mask or face covering "all or most of the time" in stores and businesses over the past month. That includes 91% of Democrats and 81% of Republicans.
Pew also reported that 60% of respondents now say that if a Covid-19 vaccine were available today, they would take it.
Among those not willing to get the vaccine, about half of them -- or 18% of US adults -- say it's possible they could decide to get vaccinated once more information becomes available, but 21% of US adults are "pretty certain" more information will not change their mind.
The survey was conducted between November 18 and 29 and included 12,648 respondents.
The Department of Health and Human Services launched its national ad campaign promoting awareness about forthcoming vaccines with a modest $150,000 ad buy on YouTube.
Fauci: 'Full brunt' of Thanksgiving not yet felt
"The people who make our health care system work are relying on you to do the right thing," she continued.
And hospitals nationwide have yet to see the impacts that Thanksgiving gatherings and travel could bring, with another surge projected in coming weeks.
On NBC's "Today" on Friday, Dr. Anthony Fauci said the "full brunt" of Thanksgiving coronavirus cases won't be clear for another week or two.
"We'll see more of the surge as we get two to three weeks past (and) it butts right up on the Christmas holiday, as people start to travel and shop and congregate," Fauci said.
Fauci, director of the National Institute of Allergy and Infectious Diseases, said he accepted President-elect Joe Biden's offer to serve as his chief medical adviser "right on the spot."
Fauci said he supports as a "good idea" Biden's plan to suggest all Americans wear a mask for the first 100 days of his presidency.
Dr. Celine Gounder, a member of the Biden-Harris transition Covid-19 advisory board, said the incoming administration doesn't plan a national shutdown.
"Shutdowns, or lockdowns, are really not on the table, at least not from the Biden-Harris team. We really view this as restrictions that you dial up or dial down based on the local epidemiology," Gounder said.
New strict measures
California hospitals are treating more than 9,900 Covid-19 patients, the highest level yet, according to data from the state's Health Department. More than 2,200 of those patients are in intensive care units, which is also the highest number since the pandemic's start.
The figure comes as Gov. Gavin Newsom announced a strict regional stay-at-home order. The order will go into effect 48 hours after ICU capacity drops below 15% in one of five regions, Northern California, the Bay Area, Greater Sacramento, the San Joaquin Valley or Southern California.
But six governments in the Bay Area aren't waiting.
"It takes several weeks for new restrictions to slow rising hospitalizations and waiting until only 15% of a region's ICU beds are available is just too late," said San Francisco Health Officer Dr. Tomás Aragon. "Many heavily impacted parts of our region already have less than 15% of ICU beds available, and the time to act is now."
The order will go into place Sunday in the combined city and county of San Francisco, the city of Berkeley and Contra Costa and Santa Clara counties followed by Alameda County on Monday and Marin County on Tuesday. The orders affect roughly 6 million people.
California added 22,018 new Covid-19 cases Friday, topping the state's all-time high for daily positives that was set earlier this week. The total number of confirmed cases is 1.2 million.
Delaware Gov. John Carney announced Thursday a stay-at-home advisory, telling residents to avoid indoor gatherings with anyone outside their households from December 14 through January 11. The state also will require residents to wear cloth face coverings every time they're indoors with someone who isn't in their households, the governor's office said.
"A vaccine is on the way but, make no mistake, we are facing the most difficult few months of this crisis," the governor said in a statement. "I know we're all tired of COVID-19 -- but it's not tired of us."