The US continued to report more than 100,000 new coronavirus cases a day over the holiday weekend, as experts warned that widespread Thanksgiving travel could fuel a surge in coming weeks.
In New York, Governor Andrew Cuomo warned of a problem in the hospitals a serious situation, and appealed for retired physicians to return to the frontlines.
The number of new cases reported in the US topped 200,000 for the first time on Friday, according to Johns Hopkins University. Since January, when the first US infections were reported, more than 13m cases have been recorded and more than 265,000 people have died.
There was some good news on Monday, as Moderna said it would apply for US authorisation to use its coronavirus vaccine. The company announced final results from its trial, which it said confirmed 94% efficacy.
Modernas data will be weighed by the Food and Drug Administration (FDA) on 17 December. The company said it expected to have doses for 10 million people ready for the US by the end of December. Pfizer and BioNTech submitted an application for emergency use on 20 November.
The news came as the number of hospitalisations in the US reached a record high. According to the Covid Tracking Project, 93,238 patients were in hospital on Sunday, a steady climb from 47,531 at the start of November, straining workers and resources as winter approaches.
Hospital capacity is the top concern, Cuomo told reporters on Monday, after ordering all elective surgeries to cease in one county and urging hospitals statewide to ready plans to increase capacity by 50% or set up field hospitals.
In Rhode Island, hospitals reached Covid-19 capacity on Monday, the same day a two-week pause meant to control the rise in new cases took effect. A state alert to phones read: Hospitals at capacity due to Covid. Help the front line by staying home as much as possible for the next two weeks.
Under restrictions announced earlier in November by the Democratic governor, Gina Raimondo, some businesses will be required to shut down for two weeks while others are restricted.
Recreational businesses including bowling alleys, theaters and casinos, as well as indoor sporting facilities and gyms, must close. Bars and bar areas in restaurants are also required to close, while restaurants are limited to 33% indoor capacity. Residents are also asked to close their social circles to only people in their own household.
This will not be easy but I am pleading with you to take it seriously, Raimondo said. Choosing to gather with those outside your household will have ripple effects that will increase the strain on our hospitals and put lives at risk.
Raimondo did not rule out another shutdown.
In New Jersey, Governor Phil Murphy said he was re-tightening the limit on outdoor gatherings to 25 people, effective 7 December, with exceptions for funerals, memorials, weddings, religious and political activities such as protests. Murphy also said all indoor youth and adult sports will be put on hold from 5 December to 2 January, also with exemptions.
As you start to make your holiday plans, please recognise that the gathering limits are back to what they were in May and June when we all came together and crushed the curve as much as any state in the nation, the Democrat wrote on Twitter, looking ahead to Christmas. Keep gatherings as small as possible.
In South Dakota, a Republican-run state which has seen surging case numbers, the Rapid City council was set to consider a mask mandate. One ordinance would require face coverings in certain situations but would have no penalties for violators. It also includes exemptions, including young children, law enforcement and religious services.
The Republican governor, Kristi Noem, opposes mask mandates or other interventions. Cities across the state have passed their own mask requirements. State health officials on Sunday reported 700 new cases with 544 hospitalised.
Counties across California have enacted stricter restrictions after the state broke a record with more than 7,700 hospitalisations. With 59% of all hospital beds in use within the states healthcare system, total hospitalisations have increased by 89%, said Gavin Newsom, Californias governor, who is in quarantine after three of his children came in contact with a California highway patrol officer who tested positive for coronavirus. Public health officials project that without any intervention, hospitalisations could increase to 78% by Christmas Eve.
The state is averaging 14,657 cases a day. During the peak of the pandemic in July, California reported a seven-day average of just 9,881 cases a day.
Los Angeles county, the most populous in the US, has asked its 10 million residents to stay home as much as possible. San Francisco and San Mateo counties moved to the most restrictive tier in the states pandemic blueprint, forcing most indoor activities to close and putting residents under curfew from Monday.
Despite dire warnings from authorities including the Centers for Disease Control and Prevention (CDC), millions traveled over the weekend, as Thanksgiving drew to a close. Dr Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said that could cause a spike in cases and warned that the level of infection in the US would not all of a sudden turn around.
What we expect, unfortunately, as we go for the next couple of weeks into December, is that we might see a surge superimposed on the surge we are already in, Fauci told NBC on Sunday.
Fauci said it was not too late for people to help curb the virus by wearing masks, staying distant from others and avoiding large groups.
Between 800,000 and more than a million travelers made their way through US airport checkpoints each day in the past week, according to the Transportation Security Administration, as airports recorded their highest travel numbers since the pandemic began.
Wednesday was the busiest such day since mid-March, with 1,070,967 clearing airport security, the Washington Post reported. In the early days of the pandemic, daily totals fell below 100,000.
The impact of mass travel and Thanksgiving gatherings could mean a flood of new cases just before Christmas.
When you look at people who are hospitalised today, they were infected two weeks ago, maybe more, Dr Jonathan Reiner, a professor of medicine at George Washington University, told CNN. And then it takes usually another week for folks to succumb to the illness.
Vivian Ho contributed reporting
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