Americans went to the polls Tuesday under the shadow of a resurging pandemic, with an alarming increase in cases nationwide and the number of people hospitalised with Covid-19 reaching record highs in a growing number of states, AP reports.

While daily infections were rising in all but three states, the surge was most pronounced in the Midwest and Southwest.

Missouri, Oklahoma, Iowa, Indiana, Nebraska, North Dakota, and New Mexico all reported record high hospitalisations this week. Nebraska's largest hospitals started limiting elective surgeries and looked to bring in nurses from other states to cope with the surge. Hospital officials in Iowa and Missouri warned bed capacity could soon be overwhelmed.

The resurgence loomed over candidates and voters, fearful of both the virus itself and the economic toll of any new shutdowns to control its spread.