American hospitals are reeling as another spike in cases threatens to overwhelm capacity and drive up deaths.

Almost 80,000 patients are hospitalized with Covid-19 in the U.S. — another high in a week that has pushed up the record every day since Nov. 10. California, Texas and Illinois made up almost a quarter of all hospital stays. The Midwest saw horrific pressure on its system. North and South Dakota hospitals saw the highest number of inpatients Wednesday when scaled for population, roughly one out of every 1,685 residents, according to Covid Tracking Project data.

The uptick comes despite improving treatments and falling mortality rates from the disease. Doctors have greatly expanded the array of treatments available to tackle Covid-19. However, some must be administered in hospitals, potentially prolonging a patient’s stay.

Currently Hospitalized

Patients currently hospitalized for Covid-19 have climbed since October

Source: Covid Tracking Project

Remdesivir, the Gilead Sciences Inc. antiviral therapy approved for treating the coronavirus last month, is given in five-day or 10-day courses. The U.S. has also issued an emergency-use authorization for a monoclonal antibody that can be given to patients before they wind up in the hospital, but it is still in limited supply.

Capacity Tested

15 states had more than three-quarters of beds full on Wednesday

Source: HHS

The U.S. reported an additional 163,975 cases on Wednesday, according to Covid Tracking Project data. There have been more than 250,000 deaths cumulatively, according to Johns Hopkins University.