(CNN)State and local leaders have been left to manage the spread of Covid-19 as infections increase at unprecedented speed — and as things get worse, their participation will likely be more important, experts say.

For much of the pandemic, health experts have lamented the lack of a strong national response from the United States while state leadership has implemented measures and restrictions. And now, on the heels of the country adding 1 million cases in less than a week (the fastest it ever has), two former Food and Drug Administration commissioners said Sunday slowing the spread is “now up to governors.”States enact more Covid-19 rules as the US hits 11 million casesStates enact more Covid-19 rules as the US hits 11 million casesStates enact more Covid-19 rules as the US hits 11 million cases“State and local actions, supported by improved treatments, can help build a bridge to vaccinations and more widespread immunity in 2021,” Dr. Scott Gottlieb and Dr. Mark McClellan wrote in a Wall Street Journal op-ed. “Americans are understandably tired of Covid, but accepting temporary restrictions now will help prevent even more painful personal and economic disruptions.”They called on leaders to enforce measures like wearing masks, avoiding gatherings and maintaining social distancing as the winter holidays threaten to drive cases even higher. Already, more than 11 million people have been infected in the US and 246,217 people have died, according to data from Johns Hopkins University. And with more than 2,000 Americans predicted to die every day by January, according to the Institute for Health Metrics and Evaluation at the University of Washington, coronavirus could become the single leading cause of death in the US on a daily basis, the dean of tropical medicine at the Baylor College of Medicine said.Read More”It’s more than just heading in the wrong direction,” Dr. Peter Hotez said while speaking Sunday with CNN’s Ana Cabrera. “We are on the verge of a humanitarian catastrophe.”States take actionOn Sunday, Washington and Michigan joined a growing number of states adding new restrictions.Michigan announced high schools and colleges will shift to remote learning for three weeks, closed movie theaters and casinos, halted exercise classes and stopped indoor dining at restaurants — allowing outdoor and carryout only. And months after suffering the first major outbreak in the US, Washington state announced on Sunday that it was reinstating restrictions statewide. Under the restrictions, indoor social gatherings with people from outside the home are prohibited, unless participants quarantine for 14 days prior, or quarantine for seven days before the gathering and receive a negative Covid-19 test result no more than 48 hours prior. Outdoor gatherings will be limited to five people.Restaurants and bars will be limited to outdoor service with capacity limits and to-go service, Gov. Jay Inslee said. In-store retail stores, including grocery stores, are limited to 25% capacity.Elsewhere, Oregon is set to begin a two-week “social freeze” on Wednesday, which includes a series of measures to limit social gatherings, close restaurants and bars to in-person dining, and impose limits on the number of people that can gather for faith-based organizations, according to Gov. Kate Brown.The state of Utah has enacted a statewide mask mandate, while Ohio is enacting stricter mask mandates for businesses.Washington state enacts new restrictions, months after it was first in the US to confront Covid-19Washington state enacts new restrictions, months after it was first in the US to confront Covid-19Washington state enacts new restrictions, months after it was first in the US to confront Covid-19Just in the city of Los Angeles, more than 1,000 people are in the hospital with the virus.”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,” Los Angeles Mayor Eric Garcetti 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.”Hospitalization rates impact staff and patients of every illnessThe spike in cases has been followed by climbing hospitalizations, a metric that can put a strain on medical resources and signal danger for many patients. According to the Covid Tracking Project, nearly 70,000 people were hospitalized with the virus on Sunday. That number far exceeds the spring peak of 59,940, on April 15, and the summer peak of 59,718 on July 23.And many states set hospitalization records over the weekend. Wyoming reported its record in both hospitalizations and deaths with 202 and 17, respectively. The same day, Dallas County, Texas, said it saw a “potential for record high hospitalizations.”Physician predicts 'unprecedented surge' in US Covid-19 cases after ThanksgivingPhysician predicts 'unprecedented surge' in US Covid-19 cases after ThanksgivingPhysician predicts 'unprecedented surge' in US Covid-19 cases after ThanksgivingAbout 20% of all emergency room visits in the county were for coronavirus symptoms for the week ending November 7, the Dallas County Health and Human Services said.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.’This winter will be hard’A candidate vaccine from US pharmaceutical giant Pfizer and its partner BioNTech is said to be more than 90% effective in preventing infection in volunteers, but that doesn’t mean the year will return to normal, BioNTech CEO Ugur Sahin said on Sunday.States waiting for answers from feds on coronavirus vaccine distributionStates waiting for answers from feds on coronavirus vaccine distributionStates waiting for answers from feds on coronavirus vaccine distribution“This winter will be hard. We will not have a big impact on the infection numbers with our vaccine this winter,” he said.Sahin said that if all goes well, his company would start delivering the vaccine at the end of this year at the earliest, with the goal of delivering more than 300 million doses by April 2021. Speaking to the BBC, Sahin said it is “absolutely essential” that countries achieve a “high vaccination rate until or before autumn, winter next year, which means all the immunization, vaccination, must be accomplished before next autumn.” He said he was confident this would happen due to “a number of vaccine companies helping us increase the supply so that we could have a normal winter next year.” Health experts have expressed concern about the spread in winter months. As the temperature drops, flu season kicks up and people crowd indoors — making infection more likely.

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https://www.cnn.com/2020/11/16/health/us-coronavirus-monday/index.html

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