Coronavirus cases are rising once again, disrupting classrooms, overwhelming hospitals and alarming public health officials — even in areas with high vaccination rates — who warn the country is headed for a holiday surge that could leave thousands dead.

Though nearly 70 percent of the country has had at least one shot and hospitalizations have fallen from their September highs, the news in many states remains grim and the trend lines portend a fresh wave in the coming weeks.

Colorado, Idaho and New Mexico hospitals are operating under crisis standards of care. Michigan, Minnesota and Wisconsin hospitals are at, or near, the brink as cases that had been steadily increasing since school began exploded once the weather turned cold.

“This is taking up every waking moment,” Natasha Bagdasarian, the chief medical executive for the Michigan health department told POLITICO. “No part of the state has been spared.”

States across the country are also seeing a growing number of people with breakthrough cases end up in hospitals. In Michigan, for example, 28 percent of hospitalizations and 24 percent of deaths, between Oct. 7 and Nov. 5, were among fully vaccinated individuals.

The latest Covid surge is particularly concerning to health officials because holiday travel is expected to exacerbate the problem as it did last year when Thanksgiving and Christmas gatherings fueled a record number of new infections and led to more than 100,000 deaths in January.

There was hope that this year would be different. In addition to vaccines, there are effective treatments, such as monoclonal antibodies, that can significantly reduce the chance of hospitalization and death.

Yet, as of Sunday evening, the country is averaging more than 1,100 deaths a day — almost the same tally as last year at this time before the vaccines had been authorized. That’s partly because millions of Americans remain unvaccinated and because the Delta variant is so much more transmissible than the version of the virus circulating back then.

“I do think we will see more deaths than we are currently seeing,” said Eric Toner, a senior scholar at the Johns Hopkins Center for Health Security. “People need to be cautious about traveling and getting together.”

The risk to health systems across the country is further heightened because influenza and RSV, two other seasonal respiratory viruses that can land people in the hospital, are also on the rise — adding pressure to a health care workforce that is short staffed and experiencing unprecedented turnover after 20 months of battling the pandemic.

Making matters worse, the CDC last week said flu season could be upon us, noting a recent uptick in infections, particularly among college students.

The increasing Covid-related hospitalizations and deaths are still primarily among the unvaccinated but even places with the highest immunization rates are seeing spikes in cases.