As healthcare facilities nationwide continue to prepare their facilities and operations for the long-anticipated resurgence of coronavirus cases, the realization came recently: the next wave of cases is here.

The United States set a pair of alarming coronavirus records last week, surpassing 200,000 new infections and topping 100,000 covid-19 patients hospitalized — the first time the country has reached either metric in a single day, according to The Washington Post. And Robert Redfield, director of the Centers for Disease Control and Prevention, said the worst might still be ahead. He predicted that the U.S. COVID-19 death toll could reach 450,000 by February, and he warned that this winter could be “the most difficult time in the public health history of this nation.”

California’s hospitals are being hit especially hard. With much of California beginning a stay-at-home order Sunday night, it’s becoming clear that the COVID-19 surge is likely to get worse before it gets better, according to The Los Angeles Times.

Average daily coronavirus cases have jumped sixfold since early October; hospitalizations have quadrupled since late October; and average daily deaths have nearly tripled in just the last month. Hospitalizations and daily deaths are expected to rise. It can take two weeks after someone is diagnosed with the coronavirus to get sick enough to require hospitalization, and seven to 10 more days for them to be admitted into the intensive care unit.