States enact more Covid-19 rules as the US hits 11 million cases

(CNN) -- The United States surpassed 11 million coronavirus cases on Sunday, according to data from Johns Hopkins University, as states across the country moved to enact restrictions aimed at slowing the spread of the virus.

The latest milestone comes just six days after the US recorded 10 million cases, per Johns Hopkins data. It was the fastest the US has added one million new cases since the pandemic began.

At least 45 states have reported more new infections this past week compared to the previous week, according to Johns Hopkins University.

"We have this firestorm of coronavirus all across the country," emergency medicine physician Dr. Leana Wen said. "It's not one or two hotspots, the entire country is a hotspot of coronavirus infection."

Even Wyoming is getting hit hard. On Saturday, the state set new records for Covid-19 hospitalizations and deaths, with 202 hospitalizations and 17 new deaths reported in one day.

Nationwide, more than 246,000 people have died -- including 1,266 new deaths reported on Saturday alone.

And while some officials toughen their restrictions, some say changing behavior is more important than shutting down.

'Don't share your air, and don't do stupid things'

If everyone took precautions and stopped assuming their friends aren't infected, the results could be more effective than a lockdown, Los Angeles Mayor Eric Garcetti said.

"The good thing about where we are now is we're smarter than we were in March. We understand that this blanket kind of lockdown, which did the trick then, may not be the best way now," he said.

"It's not about whether a store is open or not. It's about your and my behavior. It's about whether we think, 'Oh, I know that person, so I'm familiar with them. I can hang out with them ... Those things are what's causing the spread."

So if people don't like shutdowns, the solutions are simple: "Cancel those vacation plans right now. Do not sneak in other households for Thanksgiving," Garcetti said.

"To me, the mantra is two things: Don't share your air, and don't do stupid things."

More states are setting new rules

With the rapid acceleration of new infections, many states are scrambling to curb the virus with new restrictions. Among them:

-- Washington state announced new restrictions on social gatherings, businesses and religious services.

-- Michigan announced high schools and colleges will shift to remote learning for three weeks, among other restrictions on social gatherings and businesses.

-- Utah now has a statewide mask mandate.

-- Ohio is enacting stricter mask mandates for businesses

-- New Mexico is banning in-person services for nonessential businesses.

-- Maryland is scaling back indoor restaurant dining capacity from 75% to 50%.

-- New York says most bars and restaurants must close by 10 p.m.

-- Oregon is closing indoor restaurant dining and limiting social gatherings to no more than six people.

The Navajo Nation will also implement stricter measures starting Monday, including virtual learning for students and the closure of non-essential government services.

"We are in the worst moment of this pandemic to date. The situation has never been more dire," Michigan Gov. Gretchen Whitmer said Sunday in announcing new restrictions, pointing to the approaching winter months when people will gather indoors, raising the risk of spreading the coronavirus. "We are at the precipice and we need to take some action."

"We are inching closer and closer to a major public health crisis in which we could potentially see our hospitals filling up with patients," Navajo Nation President Jonathan Nez said. "Our health care system on the Navajo Nation cannot sustain a long-term surge in COVID-19 cases."

Hospitals are at the worst point ever in this pandemic

Remember those grim scenes from the spring and summer surge, when hospitals were overwhelmed with Covid-19 patients?

The US set a new record-high number of patients hospitalized with Covid-19 on Saturday -- 69,455, according to the Covid Tracking Project.

That's well beyond the spring peak of 59,940, on April 15, and the summer peak of 59,718 on July 23.

In some hospitals, the staffing is so dire that asymptomatic doctors and nurses infected with coronavirus are allowed to keep working in Covid-19 units.

Dr. Megan Ranney, an emergency physician at Brown University, told CNN that health care workers are watching their colleagues get sick, and they're "worn out and tired and scared."

"We are looking at patients who can't see their families to say goodbye," she said. "It's just the beeping of a machine, the sound of a ventilator."

She said the strain on hospitals impacts not just Covid-19 patients, but those dealing with other issues like cancer, heart attacks and strokes.

Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine, said that wearing masks or social distancing would not last "in perpetuity."

"Now's not the time to be defiant of masks," he said. "Now's not the time to be defiant about social distancing."

Fauci: Local shutdowns are more likely than a national lockdown

If hospitals get overwhelmed with Covid-19 patients, local or state officials might order some places to shut down again, said Dr. Anthony Fauci, director of the National Institute for Allergy and Infectious Diseases.

"We're not going to get a national lockdown," Fauci said.

"But I think what we are going to start seeing in the local levels, be they governors or mayors or people at the local level, will do ... very surgical type of restrictions which are the functional equivalent of a local lockdown."

"If things really get bad," Fauci said, "you may need to take the extra step you're talking about."

Two former commissioners of the Food and Drug Administration say it's up to governors to slow the virus's spread.

"The latest US Covid surge isn't confined to certain regions like the ones in the spring and summer. It's hitting the whole nation hard," Dr. Scott Gottlieb and Dr. Mark McClellan wrote in an opinion article in the Wall Street Journal.

"In previous waves, health-care workers from less-affected areas were deployed to New York and the South. It isn't possible to send an army of health-care personnel into hot zones when the entire country is a hot zone."

They said the Covid response had been a joint effort between the federal government and states.

"But the White House is changing hands during the most critical point of the pandemic, and it's a particularly important time for leadership from governors, mayors and county administrators," they wrote.

"Governors and local leaders should first reinforce steps known to be effective: wearing a quality mask, avoiding gatherings and maintaining social distance, especially indoors. Halloween gatherings contributed to the current spread, and Thanksgiving will be no different without more vigilance," Gottlieb and McClellan warned.

The flu season collides with the pandemic

Hospitals aren't just grappling with coronavirus. They're also dealing with the flu, which caused an estimated 400,000 hospitalizations and 22,000 deaths in the US during the last flu season, according to the Centers for Disease Control and Prevention.

Both flu and coronavirus can cause many of the same symptoms, US Surgeon General Dr. Jerome Adams said.

But "the one symptom that I would alert people to that really differentiates flu from Covid is loss of taste or smell," Adams said on NPR's "All Things Considered."

"If you get that symptom, then you need to be reaching out to your health provider right away and going in and getting a Covid test."

Adams encouraged the public to get a flu shot this year and warned not to self-diagnose. A health care provider can give better answers so patients can respond appropriately to their symptoms.

"Covid seems to spread much more easily than the flu, and it causes much more serious illnesses in some people," he said.

Dr. Jonathan Reiner, a professor of medicine at George Washington University, said the symptoms between the flu and Covid-19 will be "indistinguishable."

"You should not go to work, you should not go to school, if you develop what feels like (the flu)," because that could be Covid," he said.

"You should quarantine and get a test."

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