Every state is now seeing increases in COVID-19 cases, and many are also seeing spikes in hospitalizations, a marker that the third wave of the pandemic has arrived.

The U.S. reported 136,000 new cases of COVID-19 Tuesday, the largest single-day increase on record, according to a tracker by Johns Hopkins University.

Nearly 62,000 people were hospitalized with COVID-19 nationwide as of Tuesday, according to the COVID Tracking Project, a record-high number and a sobering indicator that increases in deaths are likely soon to come. 

“Today we set new record highs for #COVID19 cases AND hospitalizations. On the same day. Also had the highest death toll in months,” tweeted Craig Spencer, the director of Global Health in Emergency Medicine at Columbia. “The next few months will be hard and painful.”

Experts had long warned of increases in cases and deaths in the fall and winter, as the cold weather forces people indoors, where the virus spreads more easily. Experts also worry that pandemic fatigue has set in, leading people to let their guards down about wearing masks and social distancing. 

Every state has seen increases in cases over the past seven days, according to The COVID Tracking Project, but states in the Midwest continue to have the highest numbers of cases per 100,000 people.

North Dakota, South Dakota, Iowa, Wyoming, Wisconsin and Nebraska have the worst outbreaks in the country, with more than 100 cases per 100,000 people, according to New York Times data. 

The outbreaks show no signs of abetting, with all of those states seeing increases in cases over the past seven days of 17 percent or higher, according to The COVID Tracking Project. 

All states are seeing increases, but several saw double-digit percentage increases in the past seven days: Alaska, Colorado, Connecticut, Idaho, Illinois, Indiana, Kansas, Kentucky, Maine, Michigan, Minnesota, Montana, Nebraska, New Hampshire, New Mexico, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, Utah, Vermont, West Virginia and Wisconsin. 

Seventeen states also saw record-high hospitalizations Tuesday, according to the project, including Montana, Wyoming, Colorado, South Dakota, Nebraska and others.

Experts and local health officials have warned their health care systems are at the brink, which could lead to more deaths as hospitals run out of capacity to treat patients. 

“The velocity of the rise in Covid hospitalizations is perhaps the most ominous observation from the recent trends,” tweeted Scott Gottlieb, a former Food and Drug Administration commissioner under President Trump who has been advising states’ COVID-19 responses. 

Because hospitalizations lag behind deaths, it’s likely the U.S. will see a “tragic period of high and rising deaths despite the recent advances in care,” Gottlieb tweeted.

More than 231,000 COVID-19 deaths have been confirmed in the U.S., including the 1,347 fatalities that were reported Tuesday, according to The COVID Tracking Project.

Tags Coronavirus COVID COVID-19 Donald Trump

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