In Northern Virginia, hospitals are reaching their breaking point with only a few hundred beds left until they reach capacity.
Every shift, nurses helping COVID-19 patients carry the weight and duty of understanding that their voice could be the last voice their patient ever hears.
There is no level of training to prepare someone for that moment – and those moments just keep happening.
Virginia reported dozens more of those moments Tuesday as 51 people, 29 of whom had confirmed cases of COVID-19, lost their lives.
"I see this every day, when no one else is looking – it'll never make any headlines," said Dr. Steve Narang, the President of INOVA Fairfax Medical Campus. "That's what makes this particular pandemic so poignant, so painful, and so tragic."
Dr. Narang says his staff is exhausted.
Since early October, coronavirus patients have been filling up more and more hospital beds.
Northern Virginia only has about 500 open beds because across the Commonwealth there are now more COVID-19 patients in the hospital than at any other time during the pandemic.
As of Tuesday, 2,166 patients confirmed positive for COVID-19 were hospitalized in Virginia, according to the Virginia Hospital and Healthcare Association.
"I am concerned, like everyone else in the country, with the next set of holidays coming in, if we're going to continue to be able to match that demand," said Dr. Narang.
Dr. Narang says there's something else adding to the mental and emotional burden of his staff.
He says when nurses and doctors leave the ICU after a long shift, they step back into the world to see people socializing without masks – a slap across an already exhausted face.
"Take a look at the mirror, every single member of our community, and see what can you do to protect yourself and your neighbor," he said.
By now, we all know the answer. It's a choice. Our families and our neighbors are counting on each of us.