(CNN) - When the coronavirus pandemic hit its first peak in the spring, it took a dramatic toll on the nation: States ordered their residents to stay at home to control the surge. Patients packed into overcrowded hospitals. And millions lost their jobs.
Now, six months later, it seems history may be repeating itself, with cities ordering curfews, hospitals reaching their capacity and cases continuing to surge.
At 69,967 new cases per day, the seven-day average of new cases is at the highest levels since the pandemic began, bringing the national death toll to 225,720, according to data from Johns Hopkins University.
All these factors have led health experts to confirm their fall prediction: The dreaded second surge of the virus is here.
As a result, many hospitals are having to resort to opening alternative sites or even "rationing" their care, meaning they're determining what patients get the highest levels of treatment.
In Utah, hospitals could be days away from using a patient's age, health and other factors to decide who can remain in overcrowded intensive care units due to an onslaught of Covid-19 cases.
"It's a complex way of taking account of every patient's situation, age, health, and the ability to survive," Greg Bell, president of the Utah Hospital Association, told CNN affiliate KUTV. "It's a system of grading patients."
There are over 8.6 million cases in the US as of Tuesday, and over 225,000 people have died, according to Johns Hopkins University.
Funeral homes are running out of space
In the spring, New York City brought in refrigerated trucks to Brooklyn to store bodies -- a move designed to help funeral directors overwhelmed during the coronavirus pandemic, officials said.
The deaths had strained funeral homes' ability to keep up with the number of funerals and cremations needed in New York, then the epicenter of the pandemic.
Now, a surge of coronavirus cases in El Paso, Texas, is leading funeral homes to make similar plans.
Part of that effort, two funeral homes told CNN, is to prepare additional refrigeration units to house bodies if their usual space isn't enough.
Sunset Funeral Homes in El Paso has added three walk-in refrigeration units for bodies, manager Christopher Lujan told CNN on Thursday.
Lujan said most of the deaths his business is seeing are related to Covid-19.
Perches Funeral Homes General Manager Jorge Ortiz told CNN he's added two more coolers. His business has also seen a rise in Covid-19 related deaths in the past two weeks.
"I would say maybe 15% to 20% of all the services we are getting now are Covid cases," Ortiz said.
'Our hospital capacity is really tapped'
Hospitals in states like Idaho, Texas, Utah and Wisconsin have reported a drastic increase in their intensive care units.
One hospital in Wisconsin opened an alternative site just outside Milwaukee and asked patient Amanda Best, 34, to move her care there.
Best tested positive for Covid-19 and was also diagnosed with double pneumonia, according to CNN affiliate WGBA-TV.
"It was more, 'we need room and are you willing to (go), because you're the youngest one we have?'" Best told WGBA-TV. "It's so bad right now inside the hospitals, and I could tell even with the care."
Similarly out west, the Utah Hospital Association warned Sunday that rationing care could be just days away. Utah Gov. Gary Herbert said Monday "hospitals are starting to fill up," adding that 20% of the patients in ICU are Covid-19 patients.
"We've seen, in the past couple of weeks, that our health care system is at capacity," said Dr. Angela Dunn, state epidemiologist. "I don't know what to do anymore."
In Idaho, hospitals are either declining to accept transfers or they're being highly selective about which patients to accommodate, according to medical company Kootenai Health.
The surge in El Paso has left hospitals and ICUs in the area at full capacity.
"We've had significant spikes to the point that our hospital capacity is really tapped. We're probably at the end of our rope there," El Paso Mayor Dee Margo told CNN's Ana Cabrera Sunday night. "It's not good here at all."
The surge hit the county so bad that the Texas Division of Emergency Management (TDEM) established an alternate care site in El Paso to expand hospitals' capacity with additional hospital beds, medical equipment and personnel, according to statement released by Texas Gov. Greg Abbott's office on Saturday.
"The alternate care site and auxiliary medical units will reduce the strain on hospitals in El Paso as we contain the spread of COVID-19 in the region," Abbott said.
In North Dakota, the surge of cases has forced the National Guard to shift 50 soldiers from contacting close contacts to instead notifying people who have tested positive, the state health department said.
North Dakota officials are now leaving it up to people who test positive to notify their close contacts.
"A sharp increase in coronavirus cases in recent weeks has put increased pressure on contact tracing teams at the state and local level, leading to tracing delays and a backlog of positive cases that have yet to be assigned to a case investigator," the North Dakota Department of Health announced last week.
New restrictions to reduce the spread
To combat the spread of the virus on a national level, some officials are supporting the idea of a national mask mandate.
"A mandate can be expressly limited to the next two months," wrote Dr. Scott Gottlieb, former commissioner of the US Food and Drug Administration. "The inconvenience would allow the country to preserve health-care capacity and keep more schools and businesses open."
Some cities are already enacting new restrictions to reduce the spread.
El Paso's surge has also led city officials to institute a two-week curfew in an effort to mitigate the spread of the virus.
The curfew will run from 10 p.m. to 5 a.m. and went into effect Sunday, El Paso County Judge Ricardo Samaniego said. Those who don't comply with orders could face a fine of $250 for not wearing a mask and $500 for not following the order, Samaniego said.
Chicago also instituted a curfew for businesses and banned large social gatherings. Nonessential businesses will now have to shut down by 10 p.m., a curfew that went into effect Friday, according to Mayor Lori Lightfoot.
Bars without a retail food license won't be able to serve customers indoors at any time. And all establishments that serve alcohol for on-site consumption must end service at 9 p.m.
The city is also asking Chicagoans to avoid social gatherings of more than six people and to end all social gatherings by 10 p.m.