CNN  — 

November isn’t even over, and the US has already seen more new Covid-19 cases than any other month of this entire pandemic.

More than 3 million new cases were reported between November 1 and 22, according to data from Johns Hopkins University. That’s about a quarter of all US cases since the beginning of this pandemic.

Yes, testing has increased. But it hasn’t kept pace with the rate of new infections.

As of late last week, the number of daily new cases increased 25% compared to the previous week, according to Johns Hopkins data.

But the number of new tests increased only 14.55%, according to the Covid Tracking Project.

And in 44 states, the percentage of positive tests is higher than the recommended 5% threshold.

“If a positivity rate is too high, that may indicate that the state is only testing the sickest patients who seek medical attention, and is not casting a wide enough net to know how much of the virus is spreading within its communities,” Johns Hopkins said.

And every surge in new cases leads to more hospitalizations and deaths in the following weeks.

Hospitals are getting overwhelmed

Once again, the US smashed its record for people hospitalized with Covid-19 – putting enormous strain on the health care system and threatening to reduce care for even those who don’t have coronavirus.

At least 83,227 Covid-19 patients were hospitalized Saturday, according to the Covid Tracking Project. That’s the 12th straight day that the US has broken its record for Covid-19 hospitalizations.

At least 24 hospital leaders warned the American Hospital Association they’re having staffing shortages, said Nancy Foster, the association’s vice president for quality and patient safety policy.

Health experts say new infections, hospitalizations and deaths will get worse before they get better, as the upcoming holidays and colder weather trigger more indoor socializing.

“Think about where spread of this virus happens. It is indoors, without masks, over long periods of time. And that’s exactly what Thanksgiving is,” emergency medicine physician Dr. Megan Ranney said.

“If even 1% of the 50 million people who are traveling for Thanksgiving transmit or catch this virus, we’re looking at an extra 500,000 cases across the country,” Ranney said.

“This is the year to stay home. If you must see people, do so only outdoors and at that safe distance. Because you just don’t know who’s infected.”

Why infections might be higher than we know

More than 12.2 million people in the US have been infected with coronavirus, and more than 256,000 people have died, according to Johns Hopkins.

But the real case count is likely to be “multitudes” higher because there’s not enough testing, said Dr. Esther Choo, professor of emergency medicine at Oregon Health & Science University.

Choo said she’s especially concerned by how quickly new cases are accelerating.

“So many states have test positivity rates above 20%, which means that we are vastly lagging behind in our confirmed cases,” she said.

For context, the World Health Organization has recommended governments not reopen until they keep their test positivity rate at or below 5% for 14 days.

As of Sunday, only six states – Vermont, Hawaii, Maine, New York, Massachusetts and New Hampshire – plus the District of Columbia met that WHO standard, according to Johns Hopkins data.

Of the remaining 44 states, several had test positivity rates of more than 40%: Wyoming, South Dakota, Iowa and Idaho.

States and communities have tried to get the virus under control by implementing new restrictions. Los Angeles County announced Sunday it would halt outdoor dining after the 5-day average of Covid-19 cases surpassed 4,000 cases, according to the county’s Department of Public Health.

The order goes into effect Wednesday evening and will remain in place for at least three weeks, officials said. It includes dining at restaurants, breweries, wineries and bars, all of which will be limited to takeout and delivery service.

“Public Health reminds everyone to stay home as much as possible for the next two to three weeks to change the trajectory of surging cases and save lives,” the department said in a statement.

The CDC urges Americans to stay home this Thanksgiving

With this unprecedented surge of Covid-19, the US Centers for Disease Control and Prevention warned against Thanksgiving travel and against celebrating with anyone outside your own household.

The CDC said in new guidance last week that more than 50% of Covid-19 infections are spread by people who don’t show symptoms.

The combination of people wanting to get tested before Thanksgiving and more people getting infected nationwide are causing long lines outside testing sites around the country.

And commercial labs say their capacities are being stretched.

But even a negative test result doesn’t necessarily mean you’re safe to see friends and family.

The safest way to enjoy a holiday meal with friends and family outside your household is to strictly quarantine for 14 days beforehand.

“If you do that properly, you don’t need a test,” said Dr. Rochelle Walensky, chief of the infectious diseases division at Massachusetts General Hospital.

Americans can now get Trump’s antibody treatment

On Saturday, the US Food and Drug Administration issued an emergency use authorization of Regeneron’s antibody cocktail to treat Covid-19 in high-risk patients with mild to moderate symptoms.

It is one of the treatments President Donald Trump received when he was hospitalized.

How Trump’s Covid-19 treatment was far beyond what most Americans get

“What we know is the sooner you receive this treatment, the better it is – for example, like (when) the President received it,” said Dr. Carlos del Rio, executive associate dean at Emory University School of Medicine.

“The reality is if you are over 65, if you have comorbid conditions like diabetes, obesity or some other immunosuppression, and you get diagnosed with Covid-19, you should be considered for this therapy pretty much immediately. The sooner – within the first three to four days of getting diagnosed – is the best time to receive it,” del RIo said.

“The challenge, of course, is finding it, because it’s actually a limited supply.”

In an open letter published Saturday, Dr. Leonard Schleifer, president and CEO of Regeneron, said that while the emergency use authorization gives more patients access to the therapy, clinical studies still need to be completed.

“And we must work to continue rapidly scaling up additional supply, including through our collaboration with Roche which will more than triple total manufacturing capacity for REGEN-COV2,” Schleifer wrote.

He also explained the decision to grant compassionate use of REGEN-COV2 to Trump, saying the “unique national security considerations” of the presidency were one of the things that led to their decision.

While the company knew it would generate “unprecedented scrutiny” for the company, Schleifer said, “frankly, that’s not the kind of calculation we do in these moments. Rather, we considered if it was the right thing to do for the patient and if it adhered to our policies and ethical standards. In this case, it was, and it did.”

Vaccines are months away for most people

There’s more good news on the vaccine front.

Days after Moderna said its vaccine was 94.5% effective in a clinical trial, another vaccine – from partners Pfizer and BioNTech – applied for an FDA emergency use authorization.

The application came after early data showed the Pfizer/BioNTech vaccine was 95% effective, even in older adults, and caused no serious safety concerns.

The FDA has set a meeting for December 10 with an outside advisory panel to discuss the application.

“While we can’t predict how long FDA’s review will take, the agency will review the request as expeditiously as possible,” FDA Commissioner Stephen Hahn tweeted Sunday, “while still doing so in a thorough and science-based manner, so that we can help make available a vaccine that the American people deserve as soon as possible.”

While the application is “encouraging,” the Infectious Diseases Society of America stressed that a transparent review of Pfizer’s data is still needed.

And even if a vaccine gets the green light from the FDA, most Americans probably won’t be vaccinated until the spring or summer of 2021, health experts say.

In the meantime, tens of thousands of lives could be saved or lost – depending on our behavior.

“Measures that include wearing masks, frequent hand washing, maintaining physical distance and restricting the size of gatherings will remain crucial,” the Infectious Diseases Society of America said.

CNN’s Chuck Johnston, Hollie Silverman, Christina Maxouris, Claudia Dominguez, Jamie Gumbrecht, Jacqueline Howard and Lauren Mascarenhas contributed to this report.