They were feverish and desperate, confined to their cars in a slow single-file line as they waited for coronavirus tests.
A few rolled down the windows to let the 72-degree breeze from Lake Michigan inside and leaned back on the headrests, eyes closed. One family of five, with three children in the back seat of a minivan, had already driven around for hours, trying to find a testing site that was not full.
The coronavirus is surging out of control across the country, and more than 117,000 cases were reported Thursday US time, more new cases than on any other day of the pandemic. In 43 states, new infections are climbing steadily higher. To many Americans, the pandemic's march feels inexorable.
"We knew it was just a matter of time," said Matt Christensen, sitting in the passenger seat of the minivan alongside his wife.
In a single day across the US, the coronavirus churned through homes, workplaces, hospitals, schools and laboratories. From dawn to nightfall, the worst day of the pandemic in terms of new cases, snapshots offered glimpses of the virus's persistent spread and devastating fallout: In Cleveland, lab workers began another grinding day of processing coronavirus tests. In Minot, North Dakota, a hospital scrambled to find space for the crush of coronavirus patients who came through the doors. In Unionville, Connecticut, grieving relatives finalised plans for the funeral of a family's 98-year-old matriarch, who died from the virus.
And in Missouri, officials interrupted the day with a jarring announcement: A person who tested positive for the coronavirus last week disregarded orders to isolate and worked as an election judge in suburban St. Louis on Tuesday. The person, whom St. Charles County officials did not identify, has since died.
On Thursday morning, governors began what is now a familiar routine, pleading in front of news cameras for Americans to do their part to stop the spread of the coronavirus.
In Iowa, where cases have increased 118 per cent over the past two weeks, Gov. Kim Reynolds urged residents to take action at what she described as a critical period in the state's fight.
"For the next three weeks at least, I am asking Iowans to make every effort to help us stop the spread of Covid-19," said Reynolds, who echoed warnings from hospital leaders that capacity could be stretched if cases continue to surge.
Dr. David Williams, chief clinical officer of UnityPoint Health, put it more bluntly.
"Fellow Iowans, my job is to tell you it's time we have to start listening," Williams said.
That message was echoed hours later by Gov. Mike DeWine of Ohio, after announcing that a record 4,961 people in his state received coronavirus diagnoses in a single 24-hour period and that 541 people were seriously ill in intensive care, the most of the pandemic.
"This virus doesn't care if we voted for Donald Trump, doesn't care if we voted for Joe Biden," DeWine said. "It's coming after all of us."
In his own state, some of the most invisible work in diagnosing and fighting the virus continued in a quiet laboratory around lunchtime.
At the Cleveland Clinic, a giant fridge glowed with rows and rows of coronavirus samples. Technicians in surgical masks and blue plastic gloves shook test tubes and squinted at graphs on computer screens, trying to determine whether yet another patient had tested positive for the virus.
This is the reality across the US, where laboratories — once overlooked in the back rooms of hospitals — have become front and centre in the country's pandemic response as they race to keep up with testing demand.
Nearly every hour, samples from a nearby coronavirus testing site were shuttled over in a cooler and dropped off at the Cleveland Clinic lab. A machine processing samples whirred around the clock. It never seemed to get tired, unlike the people who work in the lab, who have been logging intense hours for months.
"I work; I go home; I come back," one lab supervisor said. Another worker described an ever-mounting sense of pressure and responsibility. "This is not fun and games," she said. "There are people's lives at stake."
Children are feeling the effects of the rising caseload, too, with increasing infections forcing schools to close or to postpone reopening if they had not yet opened.
In southwestern Virginia on Thursday, hundreds of students in the Henry County Public Schools district were at work in their classes. They had returned in mid-October after weeks online. But 22 staff members and students had tested positive for the virus since in-person classes resumed, and hundreds more had been quarantined.
So, Thursday, with holidays approaching and the prospect of more cases tied to family gatherings, the superintendent, Sandy Strayer, went before the school board to recommend that the district revert to virtual learning until January.
The board unanimously adopted her recommendation. Come Monday, the district's schools will close again.
A Heavy Toll
In Minot, North Dakota, patients Thursday crammed an emergency room at Trinity Health, waiting to be admitted. The entire floor dedicated to coronavirus patients, which could hold 35 people, had no more available beds. Half of the patients in the intensive care unit were sick with the virus.
Dr. Jeffrey Sather, the chief of staff, called other large hospitals around the state to see if he could send some patients there — a routine request in normal times. But every hospital was also full. He would have to handle the influx alone.
He said he was thinking about how to dedicate another of the hospital's six floors to coronavirus patients.
The coronavirus test positivity rate in Ward County, home to Minot, a city of roughly 47,000, had reached 25 per cent by Thursday, said Lisa Clute, public health director for First District Health Unit. The virus has spread through the community and recently reached two long-term care facilities, where dozens of staff and residents are now infected.
On Thursday, many on Sather's staff were working overtime to handle the huge demand. He said he was worried about overworked staff members, as well as about all they were seeing every day.
"They are witnessing people suffocate to death on a regular basis," Sather said. "And it's a heavy psychological toll."
Amanda Harper had always imagined her grandmother's funeral as a full celebration of a life that took her from Canada to Connecticut. The viewing and service for Juliette Marie Foley, 98, would have been at a church, followed by family time where loved ones would have pored over old photos and swapped stories.
But that was before the pandemic shattered rituals and traditions of life and death.
In October, Foley, the remaining survivor of 17 children, contracted the coronavirus. An avid baker and seamstress, she died on the last day of the month.
On Thursday afternoon, a day before Foley's small graveside service in Connecticut, there were still many details for Harper and the rest of the family to consider.
Would the Zoom link work for the friends and relatives who could not attend, including Foley's beloved grandson in Australia? For the few attending in person, how could Harper ensure it was both intimate and safe, especially with an uptick of virus cases in Connecticut? Should she bring a large photo of her grandmother, or would that encourage people to assemble too close?
"This pandemic has robbed us of the way we say goodbye," said Harper, 37, a university marketing director in Boston. "My grandmother had this beautiful full life, and it ended matter-of-factly in this catastrophic pandemic."
By nightfall, the nation hurtled past the 100,000-case mark once again.
Written by: Julie Bosman, Audra D.S. Burch and Sarah Mervosh
© 2020 THE NEW YORK TIMES