Schools going virtual, airlines canceling flights, pharmacies and testing centers closing temporarily, shelves emptying in grocery stores because of transportation delays, blood donations dropping to crisis levels for the first time ever and the country's hospitals are becoming stretched. This is the US in the grip of the Omicron variant.
Omicron may cause milder symptoms in some people, but its effects are ricocheting throughout America and creating some of the greatest challenges of the Covid-19 pandemic.
"We have supply shortages, we have transportation shortages, that are a result of people being out because of Covid, and especially Omicron being so infectious. And that is obviously limiting the workforce, and limiting the workforce is creating some of the havoc that we're all experiencing," said Ezekiel Emanuel, vice-provost at the University of Pennsylvania.
Joe Biden has vowed to keep businesses and schools open, but some experts wonder if that's possible given the nature of Omicron and the lack of adequate measures to combat it.
"The economy cannot stay open and schools cannot stay open when so many people are getting sick," said Margaret Thornton, an educational researcher at Princeton School of Public and International Affairs. "We must take action to slow the spread in order to keep schools running, to keep businesses running," she said - but much of that action has been slow to happen.
In order to control Omicron and future surges, officials need to rely on tried-and-true tactics, from testing to high-quality masks and better ventilation, say some health experts.
"We now have tools such as N95 masks, vaccines, treatments and rapid diagnostics to help prevent infection and reduce severity of illness," said Rick Bright, CEO of the Pandemic Prevention Institute at the Rockefeller Foundation and a former official for the US Department of Health. "However, we need to do more to make them affordable and available to everyone, with clear guidance on when and how to use them most effectively."
Facing an astronomical rise in cases and hospitalizations, health systems have been slammed. Omicron comes on the heels of a devastating Delta wave in the fall and existing staff and supply shortages, with little opportunity to recover. The seven-day average of infections in the US is now running at more than 750,000 cases, far higher than during Delta's peak.
"It was back-to-back," said Jorge Moreno, assistant professor of medicine at the Yale School of Medicine. "It's affecting every section of healthcare."
Health workers have spoken out on social media about being asked to volunteer to restock supplies and answer phones, or to volunteer in housekeeping, food service and transportation. One resident physician was reportedly asked to work as a scrub tech - a job they never trained for, and were not paid for. Meanwhile, nurses in New York are stretched so thin, there are parts of facilities where no one is scheduled to monitor patients.
"We can have an empty bed, but if there's not a nurse to manage it or even a doctor to manage it, there's no way to manage the patient. So we're really in a crunch," Moreno said. "We're bursting right now at the seams" - and since hospitalizations lag by a week or two behind cases, the worst is still to come, he said.
Hospitals across the nation may already be more full than official numbers suggest. In Maryland, hospitals are 87% full, according to official reports - but in reality they are closer to or exceeding 100% capacity, according to an analysis.
There are also fewer hospitals now than when the pandemic began, particularly in rural areas. In 2020, 19 rural hospitals closed - the most in one year since 2005, when data first began being collected.
Omicron is also responsible for staff shortages in nursing homes. That leads to facilities limiting the number of new patient admissions - and a backup in hospitals among patients who could transition to a lower level of care.
Childcare facilities are also facing rising cases and staff shortages. Daycares were already strained, with some centers losing up to 90% of workers as of December. According to Cindy Lehnhoff, director of the National Childcare Association, "catastrophic" shortages have hit about 80% of centers across the country, leading to closures and long wait lists.
Schools have also struggled to remain in-person. "It's chaos. It's complete chaos," Thornton said. In Philadelphia, for example, 98 schools have now gone virtual, she said. "There truly are just not enough grownups who are well enough to be in the building."
Leaders have "gotten the reasoning backwards" on keeping schools open, she said. "This administration has said they prioritize schools because of the economy, in order to get parents back to work. And I think that's just a really backward approach. We need to prioritize schools because they're important to kids."
In schools, there are proven ways to reduce the spread of any variant. The measures just need to be taken, Thornton said.
These measures include well-run remote options for those who want them in order to reduce classroom sizes and reduce exposure risks. Regular testing, where families opt in instead of opting out, would make a huge difference, as well as providing guidance on what to do if you test positive. Making sure that all students have high-quality masks is also essential, Thornton said.
"Keeping schools open and the economy running is very important and a real challenge with so much of society getting sick over the next few weeks," Bright said. "I believe we can do so safely. However, we need to follow the science, use the tools at our disposal and use the tools we have appropriately.
"The reality is that Covid-19 is not going away anytime soon. We need to move from crisis to control," he said.
"We are going to have a rocky next two or three weeks," Emanuel said. But if measures can be put in place, it would have an enormous effect.
And whatever measures are put in place now will help address future surges, Bright said. "I believe the next variant is already lurking among us now, which makes it all the more critical that we get ahead and stop it before it has the chance to spread like Omicron did."