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The United States may soon record as many as 100,000 new cases of Covid-19 a day if the current trajectory of the outbreak is not changed, the director of the National Institute of Allergy and Infectious Diseases, Anthony Fauci, warned on Tuesday.

The number of new cases is currently hovering around 40,000 per day.

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Fauci’s remarks, made during an appearance before the Senate Health, Education, Labor, and Pensions Committee, came as the number of new cases in some Southern and Southwestern states has soared.

Some states that had moved to reopen businesses and activities quickly in response to frustration with lockdowns are finding themselves forced to dial back on some moves. California has closed bars in some counties, for instance, and New Jersey announced this week that it would not reopen indoor dining as planned.

“Clearly we are not in total control right now,” Fauci told the committee, warning that far worse conditions are ahead without new efforts to tamp down spread.

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“It is going to be very disturbing, I will guarantee you that,” he said.

“What was thought to be unimaginable turns out to be the reality we’re facing right now,” Fauci said, adding that “outbreaks happen, and you have to deal with them in a very aggressive, proactive way.”

Fewer than 20 countries have recorded more than 100,000 cases in total. Canada, for instance, has confirmed about 106,000 Covid-19 cases since the outbreak began.

Public health and infectious diseases experts, who have been gravely concerned about the way the U.S. response has unfolded, concurred with Fauci’s assessment.

“It’s unfortunately just a simple consequence of math plus a lack of action,” said Marm Kilpatrick, an infectious diseases dynamics researcher at the University of California, Santa Cruz. “On the one hand it comes across as ‘Oh my God, 100,000 cases per day!’ But then if you actually look at the current case counts and trends, how would you not get that?”

A daily count of 100,000 new cases a day could occur within about three to six weeks, warned Michael Osterholm, director of the University of Minnesota’s Center for Infectious Diseases Research and Policy.

States with rapidly rising case numbers — Texas for instance — are struggling to care for patients; if the numbers rise to the level Fauci is predicting, hospitals be overwhelmed, Osterholm warned.

“We have to understand if we have 100,000 cases a day, we will have a crisis in intensive care units around the country,” he said, warning that many hospitals still don’t have adequate supplies of protective equipment, and more health workers will die if the outbreak spirals further out of control.

The Centers for Disease Control and Prevention estimates that 88,000 health workers in the U.S. have been infected with Covid-19 and 481 have died.

Osterholm said the U.S. needs to come to a consensus about how to control Covid-19. That’s going to take national leadership, he said.

“This country has to come to grips with: What is it that we’re willing to accept?” Osterholm said. “And I think if we leave it up to every governor, I think that is short-sighted. We need a national consensus of what are we trying to do. And then each state can … tailor it to what fits them. But right now, we don’t have a national consensus.”

He advocates finding a middle ground between total shutdown — for which there is waning support in the country — and the rapid reopening that some states have embraced. “It’s got to be something in the middle.”

The country needs to think about what restrictions it can live with as a means of suppressing transmission of the SARS-CoV-2 virus, and about how to compensate businesses that are may be forced to stay shut as a consequence, Osterholm said, pointing to bars as an example of a type of business that may need to remain closed while transmission rates are high.

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