So, here's what makes me nervous about this (beyond the obvious).

In the two previous big waves, only part of the country was affected at once. It was possible to surge hospital staff from less-affected to more-affected areas.

Can't do that if cases are spiking everywhere. https://twitter.com/maddow/status/1318265237846609925

Here's what the spring outbreak looked like in terms of case burden.

Very bad in NYC/NJ/CT, bad in Detroit, ATL, NOLA.

But imposition of social distancing slowed down spread before it exploded elsewhere.

And so the hard-hit places - NYC in particular - could draw on other parts of the country (and DoD) to supplement their hospital staff. This proved critical as existing staff got worn out by the intensive pace. https://www.healthaffairs.org/doi/10.1377/hlthaff.2020.00904

And during the summer surge across the Sun Belt, NYC and other previous hard-hit areas reciprocated, surging staff to Houston and elsewhere to help overwhelmed hospitals there. https://www.chron.com/coronavirus/article/New-York-medical-teams-Army-task-force-help-15415590.php

And that was in turn possible because, again, only some regions of the country were badly affected - not all. So other parts of the country had enough slack bandwidth to help.

And this is where it now gets ugly.

The surge that appears to be building is not as regionally limited. It's much more widespread.

Already, cases have been steadily rising across a much wider area and are approaching daily peaks from over the summer. Hospitalizations are following; deaths will too.

But with the wider geographic dispersion, the ceilings for cases/hospitalizations/deaths could be higher. And the ability to surge hospital staff to the worst-hit areas would be less - as there would be far more areas to surge to, and far fewer to surge *from*.

And did I mention that hospitals still don't have enough PPE? Like, still?

We will all need to do our part in protecting the health system. https://twitter.com/gregpak/status/1317903096102662148?s=20

We are in for a rough winter. And because we still don't have adequate testing and tracing, we're back to flatten-the-curve.

Please wear your masks, please keep distancing, please avoiding super-spreading conditions (closed spaces, close contact, crowds, prolonged exposures).

Its going to be a hard few months, and the federal government won't be much help for the time being. So please take the actions you can to protect yourself, your community, and your local health system.

(Charts screenshotted from this incredible NYT visualization) https://twitter.com/sciencecohen/status/1316734613855895552?s=20