The U.S. surged past 150,000 COVID-19 fatalities Wednesday as states battle a resurgence of the virus with differing attitudes about how to stop the spread.

The bleak milestone, reported by Johns Hopkins, comes on the heels of the U.S. hitting 4 million confirmed infections July 23. The death toll stood at 150,034 as of 4 p.m. EDT on Wednesday.

And there is not much relief in sight. The three most populous states – California, Texas and Florida – were among several that set seven-day records for virus deaths this week. Others set records for new cases. Tennessee and Arkansas set records for both.

The first known U.S. death was Feb. 6. Almost six months later the number of deaths is appalling – and could reach 200,000 in less than two months from now. That’s based on the current average of 1,019 deaths per day this last week.

Exact models and projections are even more disturbing. A coronavirus forecastcited by the White House now projects more than 220,000 Americans could die of Covid-19 by Nov. 1.

Experts say the increase in cases and deaths is largely because of states easing restrictions and reopening their economies too soon.

“We were not careful and it became like a domino effect,” Dr. Anne Rimoin, epidemiologist and director of UCLA’s COVID-19 Rapid Response Initiative, told USA TODAY.

State and local laws differ widely on how to curb the spread of the virus: Some governors are advocating more aggressive social distancing and masks; others have fought mandatory restrictions and balked a shutting down their economies a second time in the face of a surge.

“Everybody rushed back to normal when what we really needed to be doing was doubling down,” Rimoin said. “We are not doing enough to suppress the spread of the virus.”

Increasingly, the virus is having a ripple effect on other areas of health. The United Nations said this week that coronavirus-linked hunger is leading to the deaths of 10,000 children a month because of fears of contamination and movement restrictions.

Dr. Deborah Birx of the White House coronavirus task force warned local and state leaders of a concerning rise in cases in 11 cities, according to audio obtained by the Center for Public Integrity. She listed Baltimore, Cleveland, Columbus, Ohio; Indianapolis, Las Vegas, Miami, Minneapolis, Nashville, Tennessee; New Orleans, Pittsburgh and St. Louis.

“What started out very much as a southern and western epidemic is starting to move up the East Coast into Tennessee, Arkansas, up into Missouri, up across Colorado, and obviously we’re talking about increases now in Baltimore,” Birx said. “So this is really critical that everybody is following this and making sure they’re being aggressive about mitigation efforts.”

The record numbers of new weekly coronavirus cases that Arizona, Florida, Texas and California experienced a month ago are now playing out as record numbers of deaths in those states. Texas’ death toll continues to rise, and the state had a record 1,607 deaths in the week ending Monday, a USA TODAY analysis of Johns Hopkins University data shows.

That translates into a Texan dying every 6 minutes, 16 seconds. Texas’ weekly death toll is more than seven times its worst week through April.

An analysis of Johns Hopkins data released late Monday show eight states set records for new coronavirus counts – and eight set records for deaths. Many states that were seeing cases surge several weeks ago have stopped breaking records for new cases, including Alabama, Georgia, Nevada and South Carolina. But all of those states broke records for deaths on Monday night.

The U.S. is “knee-deep” in the first wave of the coronavirus pandemic, Dr. Anthony Fauci, the nation’s top infectious disease expert, recently said. “And I would say, this would not be considered a wave. It was a surge or a resurgence of infections superimposed upon a baseline.”

Southern and Southwestern states became a hotbed for the resurgence soon after they reopened in late May and early June. In about one month, Florida saw its case rate quadruple.

In the west, Arizona’s death toll is now more than five times worse than its worst week in the spring, while Florida is well over double. California is about 24% above its worst spring death toll.

Note: The spike in deaths on 6/25 is due to New Jersey adding over 1,800 probable deaths to the state's totals.According to a federal report, the “Red Zone” states climbed to 21, meaning they reached more than 100 new cases per 100,000 people in one week. According to The New York Times, the “Red Zone” states are Alabama, Arizona, Kansas, California, Florida, Georgia, Idaho, Iowa, Kansas, Louisiana, Mississippi, Missouri, Nevada, North Carolina, North Dakota, Oklahoma, South Carolina, Tennessee, Texas, Utah and Wisconsin.

With deaths rising, Americans are preparing for precautions to continue into the fall season. According to The Harris Poll survey of 1,970 U.S. adults from July 18-19, 61% of Americans are anticipating a stay-at-home fall with jobs continuing to be remote and parents choosing virtual courses from home.

Meanwhile, more and more retailers are mandating that face masks or coverings be worn in their stores, including large companies like Walmart, Target, CVS, Home Depot and Walgreens. Those decisions only add to the hot button issue as some believe that wearing a mask violates constitutional rights while the Centers for Disease Control and Prevention recommended masks as a way to prevent the spread of the virus.

Only recently did President Donald Trump make his first attempt at encouraging the use of face masks since the pandemic started. He also brought back daily coronavirus task force briefings this month after suspending them in April. The resurgence in cases, he claims, has been fueled by protests over the death of George Floyd, an increase in travel, migrants crossing the U.S.-Mexico border and summer holidays.

Though experts generally blame the spike in cases on lax restrictions, the resurgence has left some states reconsidering their safety mandates. Infectious disease physician Alysse Wurcel told USA TODAY that some states might consider going back to an earlier phase. She said people won’t see immediate effects of safety protocols such as wearing a mask, but that wearing one is a best practice in preventing the spread of the virus.

“I think actions now will only show benefits in a month or two because the infection that spreads today will cause the illness in 14 days, which will cause the death a month or so later,” Wurcel said. “It’s really hard to convince people that whatever they are doing today, you won’t see the benefits of it for a month.”

A COVID-19 vaccine at what price? Should all Americans be able to get a shot for free?

As for a potential COVID-19 vaccine, scientists across the world are rushing to develop one. The Trump administration announced a $1.95 billion deal with Pfizer and BioNTech for 100 million doses of their vaccine candidate, which the companies hope to get approved by the U.S. Food and Drug Administration by October. The firms said Americans will receive the vaccine for free.

Meanwhile, the National Institutes of Health and a U.S. biotech company called Moderna began the first large-scale American test for a potential vaccine with 30,000 volunteers.