The United States set a one-day record for new coronavirus cases on Wednesday with at least 102,591 new infections and as hospitals in several states reported a rising tide of patients, according to a Reuters tally.
Nine states reported record one-day increases in cases on Wednesday: Colorado, Idaho, Indiana, Maine, Michigan, Minnesota, Rhode Island, Washington and Wisconsin.
The pandemic has affected nearly every aspect of American life, including a record number of voters mailing in their ballots in Tuesday's presidential election, the outcome of which has yet to be decided.
In addition to rising cases, hospitalisations on Tuesday topped 50,000 for the first time in three months. North Dakota reported only six free intensive care unit beds in the entire state on Wednesday, when it was one of 14 states that reported record levels of hospitalized Covid-19 patients.
Hospitalisations are a key metric because they are not impacted by the amount of testing done.
The proportion of tests coming back positive is greater than 50 percent in South Dakota and over 40 percent in Iowa and Wyoming. The World Health Organization says rates of more than 5 percent are concerning because they indicate undetected community transmission.
Coronavirus deaths are trending higher but not at the same rate as cases. The United States is averaging 850 deaths a day, up from 700 one month ago.
The outbreak is hitting the Midwest the hardest, based on new cases per capita in recent weeks.
Illinois reported 48,579 cases in the last seven days, more than any other state. Texas, which has twice as many residents, reported 47,932 cases and both California and Florida reported about 30,000 new cases each.
The previous US record for new cases in a day was 100,233 on 30 October - the highest ever reported by any country in the world.