Given that there is no unified response to the pandemic surge. It is yet again down to Governor’s and state leaders to introduce measures that will attempt to halt the spread. States are using different tactics the use of masks and strict hygiene, the restriction in bars and eating places. The closure of schools and the restriction of gatherings to a few people. Doctors have identified that it is this lack of a unified response that has allowed the numbers to be higher. As hospitalisation increase to unprecedented levels, they place pressure on both health staff and people with other health conditions. Vaccines will not be available until early in the new year. As winter sets in it is expected to get worse as every degree lower increases the cases exponentially.