New coronavirus hot spots are emerging in the Chicago, Detroit and New Orleans areas -- and health officials there are pleading for medical resources to meet the surges.
Michigan's roughly 3,000 cases are nearly a tenfold increase from March 19, and officials there say the federal government needs to prioritize states like theirs that face case surges, rather than having governors compete for supplies.
Doctors and nurses in the Detroit area are "using one mask for their entire shift," Dr. Joneigh Khaldun, the Michigan health department's chief medical executive, told CNN Friday.
"I've heard of (them) putting their mask in a paper bag ... and taking it out when they think they have a patent who has coronavirus," Khaldun said.
"We don't have enough masks; we don't have enough gowns; and we need more from the federal government and others."
These pleas come as the US just became the nation with the greatest number of confirmed coronavirus cases, overtaking China and Italy. The US has at least 90,700 cases and 1,347 deaths, and several health officials and experts say it's still the beginning.
Outbreaks in New York, which has just under half the country's cases, and California, Washington and New Jersey have captured the nation's attention for weeks. Health officials there have long been clamoring for more equipment.
But officials warn the newer hot spots will soon look like the earlier ones.
"Hot spots like Detroit, like Chicago, like New Orleans ... will have a worse week next week than what they had this week," US Surgeon General Dr. Jerome Adams told "CBS This Morning" on Friday.
A prominent Detroit-area hospital system, meanwhile, has acknowledged a letter circulated online detailing how life-and-death decisions may have to be made in a public health emergency.
"The letter is part of a larger policy document developed for an absolute worst-case scenario. It is not an active policy," a Henry Ford Health System spokesman told CNN Friday. The system also said no Henry Ford hospital is at capacity with coronavirus patients.
The letter, addressed to patients and their families in the event it is sent, says patients with the best chance of improving would be the first priority. It also says patients treated with a ventilator or ICU care may have those treatments stopped if they do not improve over time.
"Henry Ford is one of America's great health care systems, and what they put out is honest," Detroit Mayor Mike Duggan told CNN's Jim Sciutto on Friday. "... Everybody is doing everything we can to stop it, but you would be irresponsible as a health system CEO if you weren't planning for that eventuality."
Developments around the country
• Chicago's Rush University Medical Center is converting a large part of its lobby into a potential ward with beds to help handle an expected surge.
• Chicago "could be expecting upwards of 40,000 hospitalizations in the coming weeks, not 40,000 cases," Mayor Lori Lightfoot said Thursday.
• Police are starting to fine people up to $500 for breaking Chicago's shelter-in-place rules, interim police Superintendent Charlie Beck said.
• New Orleans is facing critical shortages of ventilators and protective equipment, an official told CNN Thursday. "This is going to be the disaster that defines our generation," said Collin Arnold, director of the city's Homeland Security and Emergency Preparedness.
• The USNS Mercy, a 1,000-bed Navy hospital ship, will arrive Friday at the Port of Los Angeles. It will take non-coronavirus cases from area hospitals. Another Navy hospital ship, the USNS Comfort, is expected to reach the New York area next week for the same purpose.
• The US House of Representatives on Friday is expected to vote on a $2 trillion stimulus package to help offset the pandemic's economic effects, including sending checks directly to individuals and families.
Experts say the battle is just beginning
Several health officials and experts say it's still the beginning.
"We are in for a bumpy ride for the next 12 to 18 months," Dr. Ashish Jha, the director of the Harvard Global Health Institute, said Thursday. "If we are aggressive now about stopping things, shutting down, building up a test regime, we can then open up again .... and most places can go back to work."
"But only when we are ready. And we are nowhere near ready now," he said.
When President Donald Trump said he hopes to have Americans back at work by Easter, he was making an "aspirational projection," said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.
Across the country, at least 22 states have issued stay-at-home orders, with some not going into effect until the end of the week.
State leaders like Massachusetts Gov. Charlie Baker have complained that states are competing against each other for health professionals' personal protective equipment and devices like ventilators.
"Everybody deserves to have that gear, and I'm telling you, we're killing ourselves trying to make that happen," Baker said Thursday.
Some experts have called for Trump to use the Defense Production Act, partly to compel coordination of companies' supplies to states and ensure fair prices.
Hospitals and states trying to distribute among themselves is ridiculous, when the national government could coordinate, CNN national security analyst Juliette Kayyem said Friday.
Talking about when to get people back to their workplaces is "distracting us from what we need to do," she said, adding that the focus should be on aggressively keeping people apart and addressing hospitals' equipment shortages.
"This is the surge phase, and we need to focus on it," she said.
The areas officials are worried about
In New York, hospitals are overwhelmed, with many already low on staff and running out of equipment.
New York Bellevue Hospital Center created a makeshift morgue using tents and refrigerated trucks. At Elmhurst Hospital Center in Queens, 13 patients died from coronavirus within 24 hours this week.
Health officials say California, with more than 3,000 cases, isn't far behind from seeing a surge in cases similar to New York's. And with positive tests rapidly increasing across the country, experts worry other states may follow.
Earlier this week, Louisiana Gov. John Bel Edwards said cases in his state were growing faster than anywhere in the world. Health experts said they were monitoring "clusters" in six nursing homes and in New Orleans. One official said hospitals were already facing shortages of ventilators and protective equipment.
Jefferson and Orleans parishes, which make up most of metro New Orleans, ranked among the top seven counties nationwide in deaths per 100,00 residents for areas reporting 100 cases or more. And at least 3,000 were expected to be tested Thursday.
Dr. Deborah Birx, the White House's coronavirus response coordinator, said 40% of the country has "extraordinary low rates" of coronavirus. About 19 states have fewer than 200 cases, she said.
But she said counties including Wayne County, Michigan, and Cook County, Illinois, are showing a "more rapid increase" in cases.
Michigan Gov. Gretchen Whitmer said this week she sent Trump a request for a major disaster declaration and was hopeful the President would grant it in full "and within a matter of days, so we can provide more services to Michiganders who need them."
The declaration would allow the state to provide rental assistance and temporary housing, counseling and therapy for residents and the ability to quickly set up field hospitals or other facilities to treat coronavirus patients.
Doctors, nurses on the front lines
Responding to the rising numbers, some hospitals say they've reached a breaking point -- both because of overworked staff and few medical supplies left.
A Long Island hospital nurse said patients were streaming in with "non-stop coughing, sweaty, fevers" and with "fear in their eyes."
"I haven't slept because my mind won't shut off. I cried in the bathroom on my break, as I peeled off the PPE from my sweaty self, mask indentations on my face. I cried the entire ride home," the nurse, whom CNN is not naming, wrote in a social media post.
In one New York City hospital, an assistant nurse manager who suffered from asthma died less than a week after testing positive for the virus.
Kious Jordan Kelly was a "beloved member" of the nursing staff at Mt. Sinai Hospital, the hospital said.
The coronavirus crisis has "turned our frontline professionals into true American heroes," Mt. Sinai said in a statement Tuesday. "Today, we lost another hero -- a compassionate colleague, friend and selfless caregiver."
To combat a desperate need for more hands on deck in hospitals across the country, medical schools are considering early graduation for their senior medical students to become doctors, according to Dr. Alison Whelan, the chief medical education officer for the Association of American Medical Colleges.