By Stephanie Stahl

PHILADELPHIA (CBS) — COVID-19 is on the rise again and that has officials concerned about a holiday surge with Thanksgiving happening next week. Timing is critical now with officials urging more people to get vaccinated and get their booster shots.

Officials say 73% of adults in Pennsylvania are fully vaccinated, but the state still has a growing number of COVID cases. Pennsylvania is the only state on the East Coast that’s a COVID hot spot.

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After a big decline in July, cases in Pennsylvania have been steadily increasing with thousands of new infections every day with the biggest concentration being in the southwest part of the state.

“Some areas of the country, we’re starting to see a bit of an uptick,” Dr. Anthony Fauci said.

The policy lab at Children’s Hospital of Philadelphia is projecting COVID-19 cases in Pennsylvania will continue to increase through Dec. 6.

While there are a growing number of breakthrough cases, most new infections are predominately among people who are not vaccinated.

“It’s tough because it’s a lot of preventable illness,” registered nurse Katie Kruzel said.

Nationally, COVID-19 numbers are also increasing with at least 20 states reporting a growing number of cases.

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“We now see very clear evidence of declining vaccine effectiveness over time,” Dr. Scott Gottlieb, former FDA commissioner, said. “Anyone who’s eligible for a booster, and most Americans probably are eligible for a booster at this point, should be going out and seeking it.”

Vaccine timing is critical now with Thanksgiving just days away and many predicting another surge.

“We’re going to see a post-holiday spike, there’s no questions about that,” Gottlieb said. “People are exhausted right now, but we need to remain vigilant.”

But the U.S. Centers for Disease Control and Prevention is still recommending boosters only for people at high risk. In spite of that guidance, they’re easy for anyone to get.

“If you’re in doubt, get the darn booster,” New Jersey Gov. Phil Murphy said.

Murphy expressed frustration about low booster rates.

“We know that some of the hesitancy for folks to get a booster is because of confusion over whether they meet the CDC’s eligibility limits,” Murphy said

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Also, Monday was the deadline in Philadelphia for people who work in health care and higher education to be fully vaccinated. Without an approved exemption, they will not be allowed to work.

Stephanie Stahl