Dr Rochelle Walensky, the director of the federal Centers for Disease Control and Prevention, warned on Monday that a recent increase in coronavirus cases indicated a “fourth surge” could occur before a majority of the US is vaccinated.

“At this level of cases, with variants spreading, we stand to completely lose the hard-earned ground we have gained,” Walensky said, during a White House briefing.

“Now is not the time to relax the critical safeguards that we know can stop the spread of Covid-19 in our communities, not when we are so close. We have the ability to stop a potential fourth surge of cases in this country.”

According to Johns Hopkins University, the US has recorded more than 28.5m Covid-19 cases and nearly 513,000 deaths. Daily case numbers fell steeply after a peak in January but have started to increase again.

Jeff Zients, coordinator of the White House coronavirus response team, said the single-shot Johnson & Johnson vaccine which was approved for use on Saturday would start to be delivered “as early as tomorrow”.

According to Zients, Johnson & Johnson is ready to distribute 3.9m doses over the coming days, adding to a vaccine stockpile already supplied by Pfizer-BioNTech and Moderna, which both developed two-shot vaccines.

But he added: “J&J has indicated that the supply will be limited for the next couple of weeks.”

Johnson & Johnson is expected to deliver 16m additional doses by the end of March, but the White House coronavirus response team has warned governors that those deliveries will occur “predominantly in the back half of the month”.

Zients assured Americans that the federal government is ready to deliver the vaccine as soon as doses become available, saying: “We’ve done the planning. We have the distribution channels in place.”

He also announced that the US distributed an average of 1.7m doses a day over the past week. Vaccine distribution had rebounded after a winter storm affected deliveries across the central US, he said.

According to Bloomberg, about 2.4m vaccine doses were administered in the US on Sunday.

Also on Monday, the director of the National Institutes of Health, Francis Collins, said some people who have Covid “may not be on a path to get better in a few months and this could be something that becomes a chronic illness”.

“When you consider we know 28 million people in the United States have had Covid,” Collins told NBC Nightly News, “if even 1% of them have chronic, long-term consequences, that’s a whole lot of people. And we need to find out everything we can about how to help them.”

Collins also said scientists had not expected Covid-19 to lead to longterm illness.

“There’s really no precedent I know of,” he said.

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