The number of people hospitalized with COVID-19 is reaching record highs in several states, as Americans vote for their next president under the shadow of a resurging pandemic.

While daily infections are rising in all but three states, the surge is most pronounced in the Midwest and Southwest. Missouri, Oklahoma, Iowa, Indiana Nebraska,

North Dakota, Colorado and New Mexico reported record high hospitalizations this week. Nebraska’s largest hospitals started limiting elective surgeries and looked to bring in nurses from other states to cope with the surge.

Hospital officials in Iowa and Missouri warned bed capacity could soon be overwhelmed. The resurgence loomed over candidates and voters, who were fearful about both the virus and its economic toll.