The U.S. is facing its second Thanksgiving of the pandemic in better shape than the first time around, thanks to the vaccine, though some regions are seeing surges of COVID-19 cases that could get worse as families travel the country for gatherings that were impossible a year ago.

After months of progress, the number of COVID-19 infections has been rising again over the past couple weeks in Georgia. For the past seven days, the average of newly confirmed and suspected cases was 1,145 according to state data published Monday. That’s up 18% over the past two weeks.

While the number of cases remains relatively low when compared to other parts of the country, the uptick is a worrying sign heading into the busy holiday season.

Nearly 200 million Americans are fully vaccinated. That leaves tens of millions who have yet to get a shot in the arm, some of them out of defiance. Hospitals in the cold Upper Midwest, especially Michigan and Minnesota, are filled with COVID-19 patients who are mostly unvaccinated.

Michigan hospitals reported about 3,800 coronavirus patients at the start of the week, with 20% in intensive care units, numbers that approach the bleakest days of the pandemic’s 2020 start. The state had a seven-day new-case rate of 572 per 100,000 people Tuesday, the highest in the nation, followed by New Hampshire at 522.

In the West, New Mexico, Arizona, Colorado, Utah and Montana also ranked high. Some Colorado communities, including Denver, are turning to indoor mask orders to reduce risk, a policy that has also been adopted in the Buffalo, New York, area and Santa Cruz County, California.

Meanwhile, the number of COVID-19 patients hospitalized in Georgia was down from more than 7,000 in early September to 855 on Wednesday.

The statistics in Michigan are “horrible,” said Dr. Matthew Trunsky, a respiratory specialist at Beaumont Health in suburban Detroit.

“We got cold and moved indoors and have huge pockets of unvaccinated people,” he said.

“We’ve had several people in their 40s die in the last month — 100% unvaccinated,” Trunsky said. “It’s just so incredibly sad to see a woman die with teenagers. Especially with that age group, it’s nearly 100% preventable.”

In Detroit, where less than 40% of eligible residents were fully vaccinated, Mayor Mike Duggan said hospitalizations have doubled since early November.

Despite hot spots, the outlook in the U.S. overall is significantly better than it was at Thanksgiving 2020.

Without the vaccine, which became available in mid-December 2020, the U.S. a year ago was averaging 169,000 cases and 1,645 deaths per day, and about 81,000 people were in the hospital with COVID-19. The U.S. now is averaging 95,000 cases, 1,115 deaths per day and 40,000 in the hospital.

Dr. Eric Topol, head of the Scripps Research Translational Institute, said his optimism is tempered by the delta variant’s ability to jump from person to person, especially among the millions who are unvaccinated or are due for a booster.

“That equals very high vulnerability,” Topol said.

AP reporters Colleen Slevin in Denver, Corey Williams in Detroit, Ted Shaffrey in Newark, New Jersey, and AP medical writer Carla K. Johnson contributed to this story. The Atlanta Journal-Constitution staff writer Helena Oliviero also contributed to this story.