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GRAND RAPIDS, Mich. - At Spectrum Health, a major health-care system here, officials spent part of last week debating whether to move to “red status” in a show of how strained hospitals had become.

A flood of mostly unvaccinated covid-19 patients was arriving at emergency departments already packed with people suffering other medical issues, sending capacity to unprecedented levels. The only hesitation for Spectrum's decision-makers? Data suggested the covid surge was not over.

"We don't have a darker color," said Darryl Elmouchi, president of Spectrum Health West Michigan. "So if we're red now, what are we in two weeks?"

He and other leaders ultimately decided Thursday to make the change, upgrading the health-care system to the most serious tier for the first time since the pandemic began. In recent days, the state had emerged as a new covid hot spot, leading the nation in new infections and hospitalizations. By the end of last week, its seven-day average of new cases had hit a pandemic high. State leaders asked the U.S. Department of Defense to provide emergency hospital staffing to handle the surge - a request granted Wednesday.

Coronavirus cases are on the rise nationally, an unwelcome trend after leveling off earlier this fall. On Monday, the United States reported a seven-day daily average of just under 93,000 cases - an 18% jump from a week earlier, according to figures from a briefing by the White House covid-19 response team. Hospitalizations were also up, increasing 6% to about 5,600 patients admitted per day.

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At least two dozen states have seen cases rise at least 5% in the past two weeks, with Michigan, Minnesota, New Mexico, New Hampshire and North Dakota each recording per capita jumps of more than 60%. Some highly vaccinated states, including Vermont and Massachusetts, were also seeing steep rises in cases.

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The growing caseload across the country has raised the specter of another surge this winter - what would be the nation's fifth. Expert opinions vary, but Amber D'Souza, a professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health, said a surge seems imminent. This one, though, could prove to be much milder than last winter's due to vaccines, boosters and therapeutics that were not available last year.

"We are absolutely heading into an additional wave this winter across the country that may hit at different times and it may be at different extents in different parts of the country," she said. "The good news is that we really do have hope that the toll from this wave this winter will be much less than last winter."

For now, Michigan appears to be experiencing the worst of it, with Minnesota following closely behind. The current surge is affecting "virtually every part of Michigan, both urban and rural," said Brian Peters, chief executive officer of the Michigan Health & Hospital Association, which represents all of the state's community hospitals.

In the two weeks between Nov. 8 and Nov. 22, cases in Michigan increased 86% and hospitalizations 37%, according to tracking by The Washington Post. The state on Monday reported 3,775 covid inpatients - more than anywhere else in the country.

Peters said current trends indicated the state could hit its peak of 4,640 hospitalizations, set in April 2020.

"Just doing the math, we are going to reach an all-time record high in hospitalizations in the not-too-distant future if this current surge does not reverse course," he said. "And we're not seeing anything that would tell us it's going to reverse course any time soon."

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There were 4,090 covid patients in the state as of Wednesday.

In what feels like a flashback to an earlier phase of the pandemic, hospitals are now deferring nonessential procedures, adding beds, limiting visitors and warning of increased wait times. Some school districts canceled classes in the days leading up to Thanksgiving, pointing to increased cases and staffing shortages. The state Department of Health issued an advisory recommending everyone over 2 years old wear a mask, regardless of vaccination status.

The surge can be attributed to several factors. The baseline for cases was already high toward the end of the summer, said Spectrum Health's Elmouchi. Cold weather is driving more gatherings indoors, and a sizable portion of the public has stopped adhering to strict mitigation measures that were once common.

Hospitals in Michigan, like in other states with recent surges, are largely filled with people who have not gotten the coronavirus vaccine. The unvaccinated made up about three-quarters of cases, hospitalizations and deaths in the 30 days ending Nov. 5, according to the state health department. About 54% of Michiganders are fully vaccinated, trailing the national figure of 59%.

At this point in the pandemic, months after the shots became widely available, the state's health-care workers expected to see occasional ebbs and flows in case numbers. But not at this level.

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"I think all of us had hoped that with relatively reasonable vaccination rates - and a year-plus under our belt - we would not get another surge like this," Elmouchi said.

Spectrum reported more than 370 people hospitalized with covid last week. The system has converted floors and tripled its intensive care unit space, yet there are still patients waiting for beds. Conference space and shared workspaces have been identified for conversion if the surge continues as expected. Elmouchi described the situation as “almost unmanageable.”