Hundreds of thousands of Americans will test positive for the novel coronavirus between now and Election Day, leaving many scrambling for alternatives to in-person voting and injecting another dimension of uncertainty into an election already shadowed by the pandemic.

Those voters will need to navigate an unfamiliar and varied landscape to cast their ballots. Some will be required to get doctor’s notes or enlist family members to help. Others, in isolation, will need to have a witness present while they vote. Planned accommodations — such as officials hand-delivering ballots — may prove inadequate or could be strained beyond limits.

Sudden illness is an impediment to voting every election year, typically for a small number of Americans. Many provisions to help those voters apply exclusively to people who are hospitalized.

But with around 70,000 new cases of the coronavirus being recorded each day, a swath of Americans larger than the population of Wyoming or Vermont will probably contract the disease in the 10 days leading up to Nov. 3, which is now just days away. The number of people affected is greater still when accounting for those who quarantine not because they are diagnosed but because they had contact with an infected person.

Many of these people will already have voted or will not be eligible to vote. But for those who intended to vote in person, the options are dwindling.

In many states, deadlines for requesting absentee ballots are fast approaching or have already passed, and the limited time remaining poses logistical challenges that multiply as Election Day nears.

“We’re very concerned about it,” said Julie Houk, an attorney for the nonpartisan Lawyers’ Committee for Civil Rights Under Law. “People who are isolating and being careful to protect public health should not be penalized in this election for doing what medical experts are saying they should do.”

In Texas, anyone needing an emergency absentee ballot must have a signature from a doctor, chiropractor or Christian Science practitioner affirming that they have a medical emergency.

That may not be possible for Vanessa Danjuma, a middle school teacher in San Antonio who had planned to vote in person this week. Danjuma, 31, tested positive for the coronavirus Monday and has been isolating at home, racked with body aches and a cough.

“I’m trying to come to terms with the fact that I might not be able to vote,” she said by phone Wednesday. “It’s frustrating. This was a historic time to vote and get your voice out there.”

Even after a reporter explained her options, Danjuma — who says she has voted in every election in which she was eligible — feared she might not be able to clear the hurdles. She does not have a primary care doctor, and family members who might have helped retrieve her ballot are all in quarantine.

In Georgia, which in the past week has reported more than 9,000 new cases, requests for mail-in ballots must be received by Friday. State law requires that in most cases, those ballots be sent to voters via the U.S. Postal Service, a method that becomes less practicable with each passing day.

Georgia counties are permitted to make an exception: Ballots may be delivered to hospitalized voters. The secretary of state’s website says those requests should be initiated at least five days before the election.

Asked what voters should do if they are diagnosed with covid-19, the disease caused by the coronavirus, after the deadline to request mail-in ballots, Chris Harvey, a spokesman for the secretary of state’s office, said, “They can still vote in person.”

In Arizona, a battleground state that added 6,000 cases to its official tally in the past week, applications for mail-in ballots were due Oct. 23. Those who missed that deadline and have been unexpectedly hospitalized can ask their county’s “special election board” to deliver a ballot to them.

Pandemic-related guidance sent to counties by Secretary of State Katie Hobbs (D) recommends that the boards help hospitalized voters and those at a “caregiving facility.” It is unclear whether counties will extend that service to those who are quarantined or self-isolating at home or, if they do so, whether the volume of requests will be manageable.

“Our numbers are spiking,” said Alex Gulotta, Arizona state director of the nonprofit advocacy group All Voting Is Local. “There’s this hard deadline for when you have to request a paper ballot. After that, you have to vote in person, and if you’re not capable, the only option is this resource-intensive avenue.”

Sophia Solis, a spokeswoman for Hobbs, said voters quarantined or isolated at home “should contact their county elections department to see if there are special election board opportunities.”

Most states allow a voter to designate a family member or friend to collect what is often known as an emergency absentee ballot. That representative would need to hand-deliver the application to a local elections office, bring the ballot back to the voter and return with the marked ballot.

In Wisconsin, which recorded more than 25,000 new cases in the past week, every envelope containing an absentee ballot must be signed by a witness. The Wisconsin Elections Commission website notes that to socially distance, the witness “may watch the voter mark their ballot through a window, open door or other physical barrier.”

In some cities, local officials and other volunteers are stationing themselves by ballot drop boxes and in city parks, offering to serve as witnesses for those who need them.

“We’re painfully aware that this need for a signature might prevent some individuals from safely voting, but we’re really trying hard to overcome that,” said Deborah Cronmiller, director of the Wisconsin League of Women Voters. “We have what we have and we’ve tried to make the best of it.”

Under Wisconsin law, witnesses can also serve as an “agent” for hospitalized voters, retrieving and delivering their ballots in the week leading up to Election Day. This year, the state’s election commission decided that agents can do the same for voters who are “under a doctor’s order to quarantine at a place other than a hospital.”

For its March primary, Ohio expanded the definition of a hospitalized voter to include those in quarantine or isolation, allowing them to get emergency absentee ballots, but it has since rescinded that directive. Illinois never took that step, despite a plea from voter advocates.

Maggie Sheehan, a spokeswoman for the Ohio secretary of state, said that “county boards of elections must offer curbside voting for voters physically unable to enter polling locations.” After this story published online, Sheehan said Ohio voters in quarantine or isolation would qualify for emergency ballots. It was unclear when that decision was made.

Matt Dietrich, a spokesman for the Illinois board of elections, said state lawmakers did not expand the group of people who are eligible for emergency absentee ballots. He recommended that newly diagnosed people seeking to vote check with local election authorities about curbside voting, which has been expanded in Illinois.

In the past week, Ohio and Illinois have added 15,000 and 30,000 cases, respectively.

In many states, voters began confronting these challenges on a smaller scale during the primaries, when the number of voters was a fraction of what it will be in the general election.

Austin resident Linda Harrison was diagnosed on July 2, 12 days before Texas’s primary runoff. She asked a judge to waive the requirement for a doctor’s signature but was denied.

“I already had my lab results that said ‘covid-positive,’ ” said Harrison, 62, a nurse. “Those weren’t good enough.”

Harrison located a doctor to sign her application, just in time for an intern from the Texas Civil Rights Project to present it to an elections clerk, deliver the ballot to Harrison and return the marked ballot minutes before 5 p.m. on the day of the runoff.

Local media accounts chronicled the hurdles Harrison had to overcome to vote. After learning of her experience, advocates in Texas created a telemedicine program that connects voters with doctors who can sign their emergency ballot application ahead of the November vote.

Advocates have also challenged the constitutionality of the signature requirement in a lawsuit that is wending its way through the Texas court system.

Attorney General Ken Paxton (R) defended the requirement in his response to the lawsuit, writing that it protects against “fraudsters masquerading as late-ballot representatives and marking ballots on behalf of voters who did not, in fact, request them.”

In Florida, Saturday was the deadline to request a mail-in ballot. Voters who need to quarantine or isolate after that date can send a friend or family member to apply for a ballot on their behalf. As is the case in many other states, the person can pick up and drop off ballots for a limited number of people and must fill out extra paperwork.

In Miami-Dade County, returning such a ballot on Election Day comes with a special hurdle if the representative is not a family member: Along with the marked ballot and a photo identification, the representative must present “a statement signed by a physician on that physician’s stationery that, due to a medical emergency involving the voter or voter’s dependent, the named voter is unable to vote at the polls and is unable to return a mail ballot in person.”

The county recorded 3,500 new cases in the past week.

Emma Brown contributed to this report.