RACINE, Wis. — 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 121,000 cases were reported on Thursday, 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 America, the coronavirus churned through homes, workplaces, hospitals, schools and laboratories. From dawn to nightfall on Thursday, 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, N.D., a hospital scrambled to find space for the crush of coronavirus patients who came through the doors. In Unionville, Conn., grieving relatives finalized 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 percent 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 Ms. Reynolds, who echoed warnings from hospital leaders that capacity could be stretched if cases continue to surge.
Dr. David Williams, the 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,” Dr. 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,” Mr. 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 America, where laboratories — once overlooked in the back rooms of hospitals — have become front and center 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, on 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, N.D., patients on 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.
Confused by the terms about coronavirus testing? Let us help:
- Antibody: A protein produced by the immune system that can recognize and attach precisely to specific kinds of viruses, bacteria, or other invaders.
- Antibody test/serology test: A test that detects antibodies specific to the coronavirus. Antibodies begin to appear in the blood about a week after the coronavirus has infected the body. Because antibodies take so long to develop, an antibody test can’t reliably diagnose an ongoing infection. But it can identify people who have been exposed to the coronavirus in the past.
- Antigen test: This test detects bits of coronavirus proteins called antigens. Antigen tests are fast, taking as little as five minutes, but are less accurate than tests that detect genetic material from the virus.
- Coronavirus: Any virus that belongs to the Orthocoronavirinae family of viruses. The coronavirus that causes Covid-19 is known as SARS-CoV-2.
- Covid-19: The disease caused by the new coronavirus. The name is short for coronavirus disease 2019.
- Isolation and quarantine: Isolation is the separation of people who know they are sick with a contagious disease from those who are not sick. Quarantine refers to restricting the movement of people who have been exposed to a virus.
- Nasopharyngeal swab: A long, flexible stick, tipped with a soft swab, that is inserted deep into the nose to get samples from the space where the nasal cavity meets the throat. Samples for coronavirus tests can also be collected with swabs that do not go as deep into the nose — sometimes called nasal swabs — or oral or throat swabs.
- Polymerase Chain Reaction (PCR): Scientists use PCR to make millions of copies of genetic material in a sample. Tests that use PCR enable researchers to detect the coronavirus even when it is scarce.
- Viral load: The amount of virus in a person’s body. In people infected by the coronavirus, the viral load may peak before they start to show symptoms, if symptoms appear at all.
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 percent 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 Dr. Sather’s staff were working overtime to handle the huge demand. He said he was worried about an overworked staff, as well as about all they were seeing every day.
“They are witnessing people suffocate to death on a regular basis,” Dr. 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, Ms. 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 Ms. Foley’s small graveside service in Connecticut, there were still many details for Ms. Harper and the rest of the family to consider.
Would the Zoom link work for the friends and relatives who could not attend, including Ms. Foley’s beloved grandson in Australia? For the few attending in person, how could Ms. 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 Ms. 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.
Julie Bosman reported from Racine, Sarah Mervosh from Cleveland, and Audra D. S. Burch from Hollywood, Fla. Mitch Smith contributed reporting from Chicago, Lucy Tompkins from Bismarck, N.D., and Kate Taylor from Boston. Steven Moity contributed research.