The US has recorded more than 4.2 million coronavirus infections and 148,000 deaths since the pandemic began, and a leading expert says thousands more people could lose their lives in the coming months.
"If you look at the deaths as they're occurring right now -- about 1,000 per day -- unless we get our arms around this and get it suppressed, we are going to have further suffering and further death," said Dr. Anthony Fauci, the nation's top infectious disease expert.
"That's the reason why, as I've often said many, many times, there are things that we can do right now in the absence of a vaccine that can turn us around."
While there's still no guarantee the vaccines being developed will prove effective, at least one vaccine trial in the US has entered its third phase. In the meantime, health officials are urging states to implement stricter measures after weeks of surges in new cases following reopenings that mostly began in May. Nationwide, daily deaths exceeded 1,000 five times in the past week. And in hospitals across several states, doctors report more incoming patients and maxed out ICUs.
While President Donald Trump said Monday some governors should be quicker about reopening states, White House coronavirus response coordinator Dr. Deborah Birx said over the weekend some states are showing a concerning increase in positivity rates and new cases. Those states include Indiana, Ohio, Kentucky, Tennessee and Virginia.
Health experts, she said, recommend "100% of people" wear masks in all indoor public places and that social and indoor gatherings are limited to less than 10 people.
Across the US, at least 27 states have paused or rolled back their reopening plans and imposed new restrictions. More than 40 states have some kind of mask requirement.
In some places, the efforts seem to be working. In states including Arizona, Texas and Florida, which saw rapid case spread since June, new cases have flattened or slightly decreased recently. But that doesn't mean the states are out of the woods, and it's still too early to tell how long the trend will last.
States crack down on social gatherings
Birx said that among the states officials are tracking, there seems to be a "household" pattern of infections that starts with young people, usually less than 30 years old. Those residents, who are usually asymptomatic, then transmit the virus to their parents who then transmit it to other, older residents, she said.
In Mississippi, about 80% of surveyed coronavirus patients said they had attended a social gathering, includingfunerals and birthday parties, where people weren't adhering to social distancing. And in New Jersey, health officials said they have seen multiple outbreaks arising from gatherings of young people.
To stop those infections, states have cracked down on settings where people congregate -- like bars -- and pleaded with younger groups to heed guidelines including wearing masks and social distancing.
In Columbus, Ohio, the city council approved legislation that would require bars and restaurants to close at 10 p.m. each night starting Tuesday.
"Our city like many others across the country are seeing an increase in COVID-19 cases, and there is clear evidence of community spread -- especially indoors in places where groups are gathering," Mayor Andrew Ginther said in a statement. "We're also seeing a clear increase among younger people, and we know that bars and nightclubs have been the source of outbreaks locally."
In Kentucky, the governor on Monday announced restaurants' indoor dining would be restricted to 25% capacity. He also said bars will shut down for two weeks, starting Tuesday, and recommended schools postpone in-person instruction until late August.
"It's time to do the things that we got to do, given the stage that we're in, to control this virus," said Gov. Andy Beshear. "And I know there ended up being questions out there about 'why didn't you take this step four weeks ago, or six weeks ago?' Listen, this virus doesn't care about our schedules."
New York and Miami issuing hundreds of citations
Despite new restrictions, some local leaders have voiced their opposition to the mandates and others -- like sheriffs -- have said they won't be enforcing the rules.
But in Miami and New York, officials have doubled down on enforcement.
New York Gov. Andrew Cuomo said Monday the state had issued at least 132 violations over the weekend to bars and restaurants for not following coronavirus-related regulations. Most of them were in New York City, Cuomo said.
Since the state began reopening, at least 40 establishments have had their liquor licenses suspended as a result of violations and 10 of those suspensions had happened since Friday, the governor said. The lack of compliance with social distancing policies in bars and restaurants among young people is a concern for his administration, Cuomo said.
In Florida's Miami-Dade County -- which has reported more cases than all but 12 states -- police issued more than 300 citations in 10 days to individuals and businesses who weren't abiding by the local mask order.
Phase 3 of vaccine trial in US underway
Officials are now urging precautions like face masks and social distancing to curb the spread of the virus, but soon the country may have even more help.
Vaccine maker Moderna started its final trial of a coronavirus vaccine in the US Monday, and volunteers from dozens of sites across the country will participate in the study, Fauci said.
"There are 89 sites distributed throughout the country," Fauci said Monday. "They are widely distributed as a matter of fact in areas where there is clearly as of right now active infection going on."
About 30,000 adult volunteers are expected to take part in the Phase 3 trial. The first patient was dosed at a site in Savannah, Georgia, on Monday.
Fauci said that a vaccine likely won't be widely available to people in the US until "several months" into 2021.
And this part of the US trial can't be sped up, a vaccine expert told CNN Monday.
"Typically vaccine development programs take 15 years on average. This vaccine development program is probably going to take a year and a half," said Dr. Paul Offit, the director of the Vaccine Education Center and professor of pediatrics at the Division of Infectious Diseases at Children's Hospital of Philadelphia.