By Holly Yan and Christina Maxouris, CNN

(CNN) — Health officials say the American health care system might not be equipped for what’s next in the coronavirus pandemic if people don’t heed warnings from authorities.

As the US death toll tops 110, states are ordering more shutdowns. Employees at a Georgia hospital are making their own face masks. And doctors are begging the public to keep their distance from others.

“We’re talking about potentially 12 or 18 months of this,” Dr. Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, told CNN’s Jake Tapper. “And so while we have to plan each day’s battle, as has been said, this is a war. We’ve got a number of days of battle to do.

“So we have to figure out now how we’re going to get these hospitals through, not just today, not this week, not next week, but potentially months of being under siege with these cases.”

He said many patients spend three weeks or more in the hospital, so bed space will become an issue for some health care facilities as early as this weekend.

More than 7,500 Americans have been infected with coronavirus, and that number changes by the hour.

Two major factors are fueling this pandemic: the fact that people with no symptoms can easily spread the virus, and problems with testing in the United States.

That’s why it’s critical for everyone — even those who don’t feel sick — to stay at least 6 feet away from others and avoid social gatherings.

The fight against the virus also has taken an economic toll. The Senate on Wednesday approved a coronavirus relief package that includes paid emergency leave and measures for free testing. The legislation, approved by the House, will go to President Donald Trump to sign.

‘History will not forgive us for waiting an hour more’

As the United States scrambles to fight the outbreak, states are ordering new shutdowns and restrictions every day.

At least 39 states have shut down schools.

Nevada ordered the closure of all non-essential businesses for 30 days.

New York Gov. Andrew Cuomo issued an executive order Wednesday that requires at least 50% of a business’ employees to work from home.

In Utah, Ohio, New York, New Jersey and Louisiana, customers can’t sit in restaurants or bars — all food must be ordered as takeout.

In Ohio, one bar was padlocked and barricaded for violating the governor’s order Sunday and Monday, the Cincinnati Police Department said.

“Not only are you putting the general public at risk, you’re putting our officers at risk that had to go in and deal with the individuals that were in violation,” Patrol Bureau Commander Paul Neudigate said.

States such as Michigan and New Mexico have limited public gatherings to fewer than 50 people. Oregon put the cap at 25.

Earlier this week, the federal government said Americans should avoid groups of more than 10 people.

In Northern California, about 8 million people have been ordered to shelter in place. The Southern California city of Palm Springs issued a similar mandate.

“The time for half measures is over,” San Jose Mayor Sam Liccardo said. “History will not forgive us for waiting an hour more.”

San Francisco has banned all non-essential travel, including walking, biking, driving and taking public transit.

“Individuals may go on a walk, get exercise, or take a pet outside to go to the bathroom, as long as at least six feet of social distancing is maintained,” the city’s mandate says.

Those riding public transit must maintain at least six feet of social distancing from other passengers.

“We know these measures will significantly disrupt people’s day-to-day lives,” San Francisco Mayor London Breed said. “But they are absolutely necessary.”

‘It will be ugly’

There won’t be enough hospital beds, medical staff or equipment to handle the coronavirus outbreak if continues at its current pace, officials say.

“We will have a shortage of ICU beds. It will be ugly,” Gov. Cuomo said this week.

New York state has 53,000 hospital beds. Wednesday, Cuomo said the state needs as many as 110,000 beds.

The challenges facing New York are “likely going to happen in the (rest of the) 50 states,” said Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine.

Health officials say the United States wasn’t adequately prepared for this pandemic.

Two years ago, the CDC stopped funding epidemic prevention activities in 39 countries, including China, after the Trump administration refused to reallocate money to a program that started during the government’s response to the 2014 Ebola outbreak.

At that time, former CDC director Dr. Tom Frieden said the move “would significantly increase the chance an epidemic will spread without our knowledge and endanger lives in our country and around the world.”

In response to the coronavirus outbreak, “we’re two months too late in starting to do this,” said Dr. Eric Toner, who studies hospital preparedness at the Johns Hopkins Center for Health Security.

“I really think this is a fundamental responsibility of government to have acted on this a long time ago.”

So now it’s up to the public to take precautions and avoid giving and receiving the virus.

“What needs to happen in this country is we need to break the cycle of transmission,” CNN Chief Medical Correspondent Dr. Sanjay Gupta said. “And it doesn’t look like that’s happening right now.”

Health workers are sewing makeshift masks

In southwest Georgia, Phoebe Putney Health System used six months’ worth of supplies less than a week, said Scott Steiner, the hospital group’s president and CEO.

“We’ve got a three-day supply of N95 masks on hand,” Steiner said Wednesday. “In order to preserve these, and get them to last longer, we’ve got a team of people sewing masks together.”

He held up a “prototype” made of surgical sheeting that can be placed over a real N95 mask.

“This is what we’re going to have to do because we don’t know when the next shipment is coming,” Steiner said.

Across the country, officials are taking drastic measures in the fight to control coronavirus.

New York state will waive Department of Health regulations on how many beds can be in a hospital room as it tries to double the number of beds.

The state is also reaching out to retired nurses and doctors plus medical and nursing schools to see whether they can help.

And two Navy hospital ships are being deployed along the East Coast to help alleviate the strain on hospitals.

Those ships, the Comfort and Mercy, won’t be treating coronavirus patients. Instead, they’ll treat other hospital patients so health care workers can concentrate on the growing numbers of coronavirus cases.

The Comfort will likely head to New York, but it will likely take weeks because the ship is undergoing maintenance, Pentagon spokesman Jonathan Hoffman said.

The Mercy will be ready much sooner, in a matter of days. But the destination is not clear.

“When it’s prepared to sail, we will make a determination on where it’s going to go.” Hoffman said.

Medical equipment providers struggle to keep up

Ventilator manufacturer Hamilton Medical Inc. said it has received hundreds of orders and requests within the past few weeks.

“It is more than we can currently provide,” said Kathrin Elsner, team leader of MarCom Ventilators at Hamilton Medical.

Michael Dowling, president and CEO of the Northwell Health, was picked by New York’s governor to lead a hospital surge team. He said he wants to purchase as many as 500 ventilators, which can cost as much as $20,000 to $40,000 a machine.

Meanwhile, smaller, rural hospitals across the United States — which often have no more than 25 beds and just one ventilator — might be forced to transfer patients to larger facilities if they see a surge in cases.

“Who’s at risk? Elderly, low-income, people with high health needs. That is rural America,” said Alan Morgan, chief executive officer of the National Rural Health Association.

“You have a high proportion of low-income, elderly people with high health needs. So, if you were to have a cluster in a rural community it would turn bad quickly.”

Also in rural America, “You’ve got a shortage of primary care, certainly a shortage of specialty care,” Morgan said. “You have a small clinical staff, so you can’t afford mistakes.”

But with the coronavirus outbreak, overworked employees are more likely to make errors.

“Part of it is just exhausting our personnel,” said Dr. David Hill, a pulmonary critical care physician and a spokesman for the American Lung Association. “Health care is complicated, and people make mistakes when they’re overworked.”

The-CNN-Wire

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