Sitting far from the South American nation’s bustling capital, health workers in Ushuaia were initially able to contain a small outbreak among foreigners hoping to catch boats to the Antarctic at the start of the crisis.

But as Argentina passed 1 million coronavirus cases Monday, it is now smaller cities like Ushuaia that are seeing some of the most notable upticks. Doctors have had to quadruple the number of beds for COVID-19 patients over the last month. At least 60% of those tested recently are coming back positive for the virus.

“We were the example of the country,” said Dr. Carlos Guglielmi, director of the Ushuaia Regional Hospital. “Evidently someone arrived with the coronavirus.”

Across Latin America, three other nations are expected to reach the 1 million case milestone in the coming weeks — Colombia, Mexico and Peru. The grim mark comes as Latin America continues to register some of the world’s highest daily case counts. And though some nations have seen important declines, overall there has been little relief, with cases dropping in one municipality only to escalate in another.

The trajectory is showing that the pandemic is likely to leave no corner of Latin America unscathed.

“The second wave is arriving without ever having finished the first,” said Dr. Luis Jorge Hernandez, a public health professor at the University of the Andes in Colombia, AP reported.

Argentina has seen cases spiral despite instituting one of the world’s longest lockdowns. Colombia’s major cities have seen a dip, but smaller areas like the department of Caldas in the coffee region are only now reaching a peak. Peru’s overall numbers have dropped, but officials recently reported 12 regions are spiking back up. Mexico, likewise, has seen a rise in a quarter of all states over the last week.

The result is that rather than a second virus wave like that being seen in Europe, epidemiologists anticipate a more sustained, plateau-like trend.

“Our countries are still getting out of the first wave,” said Dr. Marcos Espinal, director of the Pan American Health Organization’s Department of Communicable Diseases. “A great part of the population remains exposed and community transmission continues.”

The virus’ cruel path through Latin America is a consequence of weak public health systems, social factors like poverty and poor government decisions early on that resulted in flawed or limited testing and little contact tracing. Today the region is home to half the 10 countries with the highest total cases around the globe.

Argentina initially registered low virus case numbers but now has one of the highest rates of new daily infections per capita, according to Our World in Data, a non-profit online scientific publication based at the University of Oxford. It is on par with several European countries that are experiencing a resurgence of the virus.

Dr. Adolfo Rubinstein, a former Argentine health minister, said the nation depended too heavily on lockdowns as its primary means of controlling the virus, failing to purchase enough tests in the initial months of the pandemic.

Where the virus is appearing is also shifting. Initially, up to 90% of the confirmed cases were in metropolitan Buenos Aires. Today, 65% of Argentina’s cases are in its provinces and even faraway places like Ushuaia, authorities said.

“Now it is everywhere in the country,” Rubinstein said.

Dr. Carissa F. Etienne, director of the Americas branch of the World Health Organization, warned recently that the coronavirus is appearing in places that were previously not affected, with high numbers popping up in regions like the English-speaking Caribbean.

“In many countries, the pandemic has also moved to less populated areas,” she said.

That can be seen not just in Argentina but in Colombia as well. The city of Manizales in a region known for its coffee farms now registers 440.98 cases per 100,000 residents, far higher than the nationwide average of 284.09 per 100,000, according to the Ministry of Health. Officials say the slower rise in cases allowed them to expand ICU capacity.

“Here we didn’t have a peak like in Europe,” Hernández said. “We had a plateau.”

Throughout the region, testing remains a hurdle. In Peru, officials have relied heavily on antibody tests to identify cases — even though the tests are not designed to make a diagnosis because they can only detect proteins that develop a week or more after infection. Argentina’s testing is still far below that of neighboring countries; on Sunday, just 13,890 were tested, compared to 31,988 the same day in Colombia.

The high percentage coming back positive in Argentina suggests the country is still likely missing vast numbers of infections.

Brazil reached 1 million cases in June and now is up to 5.2 million for the pandemic.

“These are huge undercounts of what is really going on in terms of numbers,” said Felicia Knaul, director of the Institute for Advanced Study of the Americas at the University of Miami. “We need more consistent mask use — but we have to couple that with testing and tracing — or else the numbers are going to rise tremendously.”

In Ushuaia, officials believe truckers carrying in produce from the Buenos AIres region may be responsible for the rise in cases since mid-September. The city famous as a departure point for cruises to the Antarctic had been a model for the nation. Closed off air travel and a halt on tourism left it virus free for months.

But that false sense of comfort may have led people to relax on basic pandemic norms like hand washing and social distancing. The Tierra del Fuego province, which has a population of about 150,000, now has over 8,000 confirmed cases.

In Ushuaia, anxious residents line up in their cars for drive-thru testing. A sports center that had been empty is now set up to take care of patients. One month ago, the regional hospital was treating just seven COVID-19 patients; now it has 28, occupying all of its bed set aside for adults with the illness.

“The failure in Argentina was the low amount of testing,” Guglielmi said.

Jose Bongiovanni, a lawyer in Ushuaia, said a worry that seemed distant now feels close.

“Living at the end of the world was never easy,” he said. “It’s a lot less easy in a moment like this.”

Protesters set up a coffin outside a health center in Cobble Hill, Brooklyn, and adorned it with flyers of Cuomo’s new book, “American Crisis: Leadership Lessons from the COVID-19 Pandemic.”

“We would forgive! But we need an apology, a sincere apology!” exclaimed Peter Arbeeny, who said he lost five family members — three in nursing homes — in April.

Janice Dean, a Fox News meteorologist, called for an investigation of Cuomo’s handling of nursing homes during the peak of the pandemic, which by Saturday had claimed the lives of 25,644 New Yorkers — about 6,600 of them in nursing homes, according to the state Health Department.

Protesters who lost loved ones to coronavirus in nursing homes demand accountability from Gov. Cuomo outside the Cobble Hill Health Center in Brooklyn on Sunday.

Gates said life can get back to normal only when a second generation of COVID-19 vaccines is widely available and the virus is eradicated worldwide – a higher bar than was set for any disease in history.

“The only way we’ll get completely back to normal is by having, maybe not the first generation of vaccines, but eventually a vaccine that is super-effective, and that a lot of the people take, and that we get the disease eliminated on a global basis,” Gates said Sunday in an interview on NBC’s Meet the Press program. “That is where we can finally start taking all the problems that have been created — in education, mental health — and start to build back in a positive way.”

According to that standard, Americans might need to live for years, or for life, under social-distancing guidelines and other COVID-19 restrictions. It’s certainly gloomier than the assessment Gates gave in a Fox interview last month, when he said progress on vaccines might make it possible for a return to normalcy in the US by the summer of 2021. He said he expects several of the first generation of vaccines to get emergency approval by early next year.

Gates blasted the US COVID-19 response as one of the worst in the world, except for the Trump administration’s aggressive investments in vaccine development. “There are lots of additional deaths coming if we don’t get our act together,” the billionaire philanthropist told NBC host Chuck Todd.

Gates cited the fact that test results often don’t come back within 24 hours, a problem that could be alleviated by not reimbursing “for these worthless things.” He said the US COVID-19 testing system is the worst of any country “in terms of who gets access to it.” “You do have to admit that you haven’t done a good job and make some straightforward changes,” he added.

That message won’t likely resonate with US President Donald Trump, who has hailed his administration’s COVID-19 response as “phenomenal” and it saved potentially millions of lives, although 215,000 Americans have reportedly died from the virus. Trump himself tested positive for COVID-19 on Oct. 1 and said he was cured by an experimental monoclonal-antibody treatment.

Gates said it’s wrong to call the treatment a “cure” because it won’t work for every patient, but he sees it as the most promising COVID-19 therapeutic developed so far. His foundation reserved factory capacity last spring and has partnered with drug-maker Eli Lilly & Co. in hopes of getting a monoclonal-antibody drug approved by the FDA with supplies ramped up in the next few months.

“Adding this to the tools would be a great thing,” Gates said.

Trump staged an extraordinary drive-by photo-op Sunday in front of supporters gathered with flags and banners outside Walter Reed National Military Medical Center. The stunt, which risked exposing Secret Service agents riding in his armored SUV, amounted to a familiar flouting of government recommendations to stop the spread of the virus which has infected 7 million Americans. It was the latest flagrant sign of politics superseding Trump’s duties as a steward of the national well-being — with Election Day only 29 days away and voting in many states already underway.

It came amid lingering confusion about the President’s true state of health after a weekend in which the White House undertook strenuous efforts to minimize the seriousness of his case. But details about the cocktail of therapies that he is taking suggest that he is experiencing complications from the disease, even as his doctors said it was possible he could return to the White House Monday.

The showman President’s motorcade photo-op followed a misleading and politicized White House performance that displayed all the failures that have made the US anti-COVID effort one of the worst in the world.

White House physician, Navy Cmdr. Dr. Sean Conley, admitted on Sunday to not telling the full truth about Trump’s condition the day before — including about two drops in his oxygen levels — to avoid overshadowing the “upbeat” official line on the President’s health.

Trump and his aides worked hard to show he was strong and getting better before he faces off with Democratic nominee Joe Biden, whose campaign said he again tested negative on Sunday. But the contradictions and misrepresentations from his medical team means that Americans can have no confidence that the White House is giving a complete picture of what’s going on. Conflicting messages and half-truths underscored the administration’s inability to properly manage the machinery of the state and to understand the importance of sending clear information about the President’s health and the continuity of power to Americans and potential adversaries abroad.

The extraordinary attention that accompanies a presidential illness — in this case multiplied because the commander-in-chief is sick from a disease he has ignored, downplayed and said will soon go away — has obscured the alarming trajectory of the pandemic in recent days.

Including Friday, when Trump was dramatically flown to the hospital on Marine One, the US has recorded another 121,000 cases of COVID-19 and another 1,800 deaths. None of those new patients will get the dedicated round-the-clock medical care, experimental treatments, hospital suites and joy rides that are available to the President amid a national emergency in which many have died alone and patients are isolated from loved ones in crowded hospitals.

In a video on Sunday, the President said that he had learned a lot of interesting things about COVID-19 that he planned to share with the country. It was not clear if he was finally appreciating the danger of the virus following his own infection. For months, the President has been briefed by the some of the best epidemiological experts in the world but did not treat the pandemic with the necessary seriousness. His video, posted on Twitter, did not include any admonition to Americans to take the disease more seriously after months of his flouting government health warnings and mocking those who observe them — including Biden.

“I learned it by really going to school. This is the real school. This isn’t the let’s read the book school and I get it. And I understand it,” Trump said.

The President’s subsequent jaunt outside the hospital in Bethesda, Maryland, clearly showed his education in COVUD-19 does not include new respect for social distancing.

Such precautions were also ignored at a mostly mask-free event at the White House nine days ago at which Trump nominated Judge Amy Coney Barrett for the Supreme Court. At least eight people who attended the event, including the President, have been infected with COVID-19. Trump also ignored precautions at a fundraising event in New Jersey Thursday, where he went despite knowing his close aide Hope Hicks had been diagnosed with COVID-19. His conduct raises the question of whether he endangered others while knowing he had been in close contact with someone who had tested positive for the virus. White House press secretary Kayleigh McEnany said Sunday that the President learned about his positive test when he returned from the trip. She did not say when he took the test. And given the obfuscation by the White House over the weekend, the truthfulness of any official statements at this point is in serious doubt.

Several Secret Service officers in the vehicle with Trump Sunday, who were wearing surgical masks and face shields, must presumably now quarantine after being in close contact with a patient with COVID-19, and risk becoming the latest casualties of Trump’s political ambitions.

“Why leave? What is the purpose of this?” asked Dr. James Phillips, head of disaster medicine at George Washington University and an attending physician at Walter Reed.

Certainly looking at the risks of transmission of COVID-19, what we know is being in enclosed spaces is dangerous,” Phillips said on “The Situation Room” on CNN. “Masks or no masks. Being inside a vehicle that is hermetically sealed circulates virus inside and potentially puts people at risk.”

The White House insisted that the car ride was cleared by the President’s medical team. But there is no medical protocol that suggests it is advisable for a patient with a serious, contagious illness to leave a hospital until they have recovered or are no longer contagious.

Trump’s desire to show that he is fit, compulsion to bask in the adoration of his supporters and desire to dictate news coverage is typical. But his latest behavior also may hint at how he feels about the political impact of his confinement a month before an election in which he is trailing Biden and that threatens to turn on his mismanagement of the pandemic. Trump, who has spent the last two presidential campaigns attacking the health of his rivals, Hillary Clinton and Biden, cannot afford to look weak at this critical moment.

With time running out to turn things around, the President was jolted by new polling data over the weekend. A NBC/Wall Street Journal survey taken following Trump’s boorish performance at last week’s first presidential debate showed Biden leading 53% to 39% among registered voters nationally. An ABC News/Ipsos poll, conducted after news about the President’s coronavirus diagnosis, found that 72% of voters believe the President didn’t take the threat of contracting coronavirus sufficiently seriously. A CBS News poll, meanwhile, found Biden with a 7-point lead among likely voters in the key swing state of Pennsylvania and even with Trump in Ohio — another Midwestern battleground that went to the President in 2016. These surveys were largely completed by the time the President’s coronavirus diagnosis became known.

It remains unclear how the President’s sickness changes the final weeks of the campaign. He is unable to fly around the country and fire up his loyal base voters. The fate of the last two presidential debates — following the upcoming vice presidential clash on Wednesday between Mike Pence and California Sen. Kamala Harris — remains in doubt. And Trump’s infection now makes it almost impossible for the President to deflect from the one issue that reflects the presidency in its worst light — the pandemic.

Earlier on Sunday, Trump’s doctors revealed that the President had suffered several alarming drops in oxygen levels. Conley again delivered a briefing that raised more questions than it answered about Trump’s condition. He said that he didn’t mention drops in Trump’s oxygen levels Saturday because he didn’t want “to give any information that might steer the course of illness in another direction.”

He acknowledged that his evasive answers “came off that we were trying to hide something” but said that “wasn’t necessarily true,” adding that the President is “doing really well” and is responding to treatment.

The episodes prompted doctors to start treating Trump with the steroid drug dexamethasone, which has been shown to help patients with COVID-19. It is typically given to patients on supplemental oxygen or ventilation.

Conley also hinted at more unrevealed details when he refused to say what was revealed by X-rays or CT scans of Trump’s lungs.

“There’s some expected findings, but nothing of any major clinical concern,” he said.

All patients have expectations of privacy. But Trump shoulders a public trust given his position. It is not just crucial for voters to have some understanding of his condition. The health of the President is a crucial national security issue and commanders-in-chief have a higher duty to disclosure than regular citizens.

The approach taken by the President’s doctors suggests to many experts that the White House has been downplaying the seriousness of his condition as he fights a disease in which a patient can quickly deteriorate during the course of the infection over a period of days.

“His physicians are treating him very aggressively. And based on what we know so far, the President is ill,” said Dr. Patrice Harris, a past president of the American Medical Association, told CNN’s Wolf Blitzer.

“We know that during the course of the illness, a patient can feel just fine and suddenly take a turn for the worse. So really for the President’s own health and safety, this visit outside of the hospital was quite risky today.”