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There are 61,964 people hospitalized with COVID-19 in the United States, an all-time high.

The Covid Tracking Project says the number of hospitalizations has more than doubled since September. Previously, the record was made on April 15 with 59,940 hospitalizations, and that was almost broken on July 23, when 59,718 hospitalizations were reported.

The spikes in April and July were short-lived, but health experts warn that with winter coming up, they do not expect the number of hospitalizations to drop quickly, especially as more flu patients will likely be coming in. There is also a shortage of nurses being reported in several states, including North Dakota, which has the country’s worst infection and death rates per person.

North Dakota Gov. Douglas Burgum (R) on Monday said if the rates stay the same, the state could be just weeks away from having “severe constraints” in hospital capacity. In order to keep up with demand, he said health care workers who have tested positive for COVID-19 but do not show any symptoms can continue to work in hospitals and nursing homes, as long as they only treat COVID-19 patients.

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Intermountain Health Care runs 22 hospitals in Utah, and its CEO, Dr. Mark Briesacher, said while they were able to bring on 200 more nurses, including 30 from New York, it’s going to be difficult to find more. “We are at the tipping points,” he added. “We are beyond our normal capacity of caring for patients who are the most sick.” On Sunday, the U.S. recorded its 10 millionth coronavirus case, and on average, more than 111,000 new cases are being reported every day. Catherine Garcia