The latest spike marks the third surge of infections in the US this year, and doesn’t bode well for colder weather that will force more Americans indoors and increase their susceptibility to infection. Most of the new infections have come from the states in the midwest, but only Vermont is showing steady improvement on key metrics of viral spread.

The patchwork of state and local responses without a coherent federal coordinating effort has left the US facing an out-of-control outbreak. Public health officials have urged president Donald Trump to encourage the public to wear masks, keep their distance, and limit indoor gatherings, to little avail. There are still not enough rapid tests or protective health gear, and rising cases will only exacerbate these problems.

Biden has laid out plans for a national task force to take on the pandemic and a possible national mask mandate, but he will not have any legal power until he is inaugurated in January 2021. Until then, the Trump administration will still set the tone for policy.

Thankfully, physicians have improved their understanding of this disease and the tactics they use to treat it, which has helped limit deaths and hospitalizations from infections compared to the outbreak’s early months. But the number of Americans in the hospital is approaching previous heights, which raises fears that intensive care units could be stretched to the limit. Deaths from the virus continue to rise, even as they lag behind measures of infection and hospitalization.

Consider the previous peak of the infection trend, on July 17, with more than 76,000 cases. The last peak in deaths, at more than 1,500 reported in a single day, came almost month later, on Aug. 12. By then, national cases were falling. Now, neither trend is going in the right direction. Barring a sudden change in direction by the national government and local authorities, it’s hard to see what will bend that curve.

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