After several weeks of rapidly rising coronavirus cases, hospitals around the United States are once again overwhelmed, forcing local authorities to take new measures to cope with the pandemic.
On Tuesday, a record 61,964 people were admitted to hospitals with Covid-19 across the country, marking the first time the case tally passed the 60,000 mark, according to the Covid Tracking Project.
The situation is particularly worrying in the border city of El Paso in western Texas, a state where coronavirus cases have exceeded 1 million.
More than 1,000 people have been admitted to hospital in El Paso County alone, a substantial portion of the state's 6,170 people currently in wards.
"These are dark times," Ogechika Alozie, chief medical officer at the city's Del Sol Medical Centre, told CNN on Wednesday. "I think the biggest word is just fatigue. And there's frustration."
Cases are so high that Texas Governor Greg Abbott requested a military medical centre be converted for intake of non-Covid patients in order to free up space in hospitals. County officials, meanwhile, have requested additional mobile morgues.
The situation in El Paso is typical of the difficulties local governments are facing in the US, where President Donald Trump has played down the epidemic and left the handling of the health crisis to state, county and city officials.
In late October, an El Paso County judge ordered non-essential businesses to close for two weeks, a measure fought by El Paso's mayor and the state attorney general.
Mr Trump has placed much of his hopes of fighting the coronavirus pandemic on the rapid development of a vaccine.
Positive outcome of Phase 3 trials of a vaccine developed by Pfizer mean inoculations are likely to begin by the end of the year or in early 2021.
But with no vaccine at present, the US is facing troubling circumstances.
The number of deaths each day is still lower than levels reported in the spring. But the US recorded more than 1,500 fatalities in 24 hours on Tuesday.
The death rate has "declined since the spring partly because hospitals and staff were so overstretched back then. As cases take off across the country, we will increasingly start seeing those limitations again," said emergency medicine specialist Craig Spencer on Twitter.
The US contamination curve has undergone three notable waves: a first in the spring with New York as the centre, a second in the summer that hit the US south particularly hard and a third since mid-October with records being set in the Midwest.
In North and South Dakota, more than one in 2,000 residents is currently admitted to hospitals with Covid-19, according to the Covid Tracking Project.
Doug Burgum, the North Dakota Governor, this week authorised health workers who test positive to continue working in Covid units in order to cope with the "enormous pressure" on the state healthcare system.
In Minnesota, Governor Tim Walz ordered bars and restaurants to close at 10pm and placed a 10-person limit on gatherings.
Restrictions are extended beyond the Midwest as well, such as in Utah, where wearing a mask in public is now mandatory statewide. And in New York state, restaurants, bars and gyms will have to close at 10pm starting on Friday.
President-elect Joe Biden this week urged Americans to wear face coverings: "A mask is not a political statement, but it is a good way to start putting the country together."
He has pledged to tackle the health crisis from day one of his administration, which begins on January 20.