EL PASO — Coronavirus patients filled beds on one floor. Then two. Then the University Medical Center, a teaching hospital in El Paso, set up tents to care for patients in a parking lot. A downtown convention center became a field hospital. To free up even more space, the state began airlifting dozens of intensive care patients to other cities.
Local leaders clashed over what to do to quell the spiraling coronavirus crisis. The top county official ordered a lockdown and curfew. But the mayor disagreed, and the police said they would not enforce it. Then the state attorney general weighed in — a lockdown was unnecessary and illegal, he said.
And the patients kept coming.
“We discharge one patient, and there are two that come in,” said Wanda Helgesen, executive director of the local council on emergency and disaster preparedness.
El Paso, a border city of 680,000, now has more people hospitalized with Covid-19 than most states — 1,076 as of Tuesday — and is more than doubling its supply of mobile morgues, to 10 from four.
The strain on the city, as it grapples with the pandemic’s deadly third wave, is mirrored across the country. The number of Covid-19 hospitalizations in the United States hit a record high of 61,964 on Tuesday, surpassing the horrific early days of the spring in New York and the summer in the South and West.
Hospitalizations have more than doubled since September, according to the Covid Tracking Project, passing the previous peak of 59,940 patients hospitalized in mid-April. But while the earlier spikes subsided, public health experts fear that the pace of new hospitalizations will continue to rise along with new infections, which are averaging 111,000 a day nationwide and show no signs of abating.
States that had appeared to control the spread, like New Jersey and New York, are seeing a resurgence. At the same time, rural hospitals in North Dakota and Idaho are desperate for doctors, nurses and technicians to deal with fast-growing patient populations.
And the risk factors that public health officials have long warned could spread the virus and strain hospitals in the fall and winter — more indoor activities, the onset of the flu season and gatherings over the winter holidays — have just begun.
“Things are not only bad, there’s no end in sight,” said Dr. Ashish Jha, dean of the Brown University School of Public Health. “If we stop all transmission today, which we can’t and won’t, we are looking at probably a month of overcapacity in lots of communities in America.”
Texas recently surpassed one million confirmed cases of the virus, with 19,000 dead. Of the 6,100 patients hospitalized across the state, one out of every six are in El Paso. Dr. Mario Rascon, the chief medical examiner for El Paso County, said Tuesday that his office had 154 bodies. “It’s exhausting,” he said.
The city has brought in more than 1,400 health care workers from around the state, and about 60 more arrived over the weekend in three teams sent by the Defense Department. But new patients have strained even those additional resources. Half of all patient beds in the city are now taken up by those with Covid-19.
“Things are not good,” Mayor Dee Margo said. But he said he also worried about the impact of new shutdowns on families struggling to survive. “I’m trying to walk that tightrope.”
The situation reflects the broader difficulty of trying to battle a national crisis in the absence of a national strategy. In El Paso, an urban island in remote West Texas between borders with Mexico and New Mexico, that absence has been acutely felt.
A pandemic response philosophy focused on local control and personal responsibility, starting with the Trump administration and reinforced by Texas’ Republican governor, Greg Abbott, has at times left local leaders at odds over how to deal with the serial outbreaks.
After shutting down in the spring, Mr. Abbott was quick to begin reopening the Texas economy. By the summer, as the virus surged once again, he paused the reopening, then clashed with local leaders in Houston and other cities who wanted to curtail activities but were prevented from doing so by his orders. He told Texans to wear face masks. In October, he eased more business restrictions.
By then, in El Paso, hospitals were already feeling strained.
The top county official, Ricardo A. Samaniego, issued a stay-at-home order and strict new limits on businesses on Oct. 29. But Mayor Margo did not believe that Mr. Samaniego had the authority to do so, and initially opposed it. While local county constables tried to enforce the lockdown, the much larger El Paso Police Department said it would not.
“Huge, huge confusion,” said Laura Rayborn, who owns a spa and other local businesses. “The mayor went on the radio and on TV and said, ‘Stay open.’” Ms. Rayborn decided to do so.
Restaurants kept serving, despite the order to stop all but takeout and delivery. “We decided to do what we had to,” said Aaron Means, who owns a restaurant near the campus of the University of Texas at El Paso.
Some went to court to fight the lockdown and were joined by the conservative state attorney general, Ken Paxton, who described the county’s action as “oppression” and vowed to end it. After a week of back-and-forth among three levels of Texas government, a state court on Friday ruled in favor of the new restrictions on businesses. Mr. Paxton is appealing.
By that point, frustration and confusion had spread widely, dampening any immediate benefits from the business closures and all but ensuring that a longer shutdown would be necessary.
“One thing almost worse than being closed down is being confused about whether you are closed down,” said David Jerome, the president of the El Paso Chamber of Commerce. “I’m a big fan of 50 experiments in democracy but not when it comes to a pandemic.”
The county’s two-week lockdown order, set to expire on Wednesday, has yet to show any appreciable effect on hospitalizations, officials said. “We do not seem to have met our peak,” Ms. Helgesen said.
As of Tuesday, the city was averaging 1,800 new coronavirus cases a day, nearly double the number in more populous Dallas County, the state’s next hardest hit.
Mr. Samaniego, the county executive, said he would like to extend the shutdown order, possibly through Thanksgiving. He worried that too few people had been following it, and that the holiday would bring new risks.
“We really never deployed a true stay-at-home,” Mr. Samaniego said. “We never got to see the full impact.”
The governor’s office said the focus for Mr. Samaniego and other local officials should be on enforcement of existing regulations, including restaurant capacity limits and mask requirements, not closures. “That strategy was effective in slowing the spread over the summer and containing Covid-19, while allowing businesses to safely operate,” said Renae Eze, a spokeswoman for the governor.
Like the country as a whole, El Paso has now entered into an uncertain period. Officials are hopeful that enough people are now following the lockdown order to slow the spread of infections. The police have begun ticketing businesses that do not comply.
On Monday, city officers riding thick-tired Segue vehicles and sheriffs in patrols cars could be seen cruising a mostly empty shopping district and visiting businesses near the border with the Mexican city of Ciudad Juárez.
Some officials and residents blamed trips to Juárez for the spread of infections in El Paso, even as cross-border travel has been limited almost entirely to American citizens. The two cities have long formed one hub of commerce in the mountainous desert, and Americans who live in Mexico have often traveled to El Paso to use its better-resourced hospitals.
That has continued during the pandemic, officials said, as Juárez has seen its hospital infrastructure buckle under the strain of its own serious outbreak. The scope of the pandemic in Juárez is not known because of inadequate testing, but even the mayor has been hospitalized with the virus.
The majority of infections in El Paso have come, health officials said, from local community transmission, especially within multigenerational families who often live together or come together frequently to shop or visit.
“We have seen multiple members of families coming in, usually on different days,” said Dr. Edward Michelson, chief of emergency medicine at the University Medical Center and a professor at the Texas Tech University Health Sciences Center.
Hector Balderrama, 55, a medical supply salesman, watched as his immediate family contracted the virus in mid-October: first his adult son. Then his wife. Then his eldest daughter.
“It just shut us down completely,” he said. His wife was hospitalized and his son, who is diabetic, spent days in an intensive care unit. They eventually recovered. Mr. Balderrama never caught it. “Thank God we’re here and getting better, but we’re not 100 percent.”
Vast swaths of the city are eerily empty, with indoor shopping malls surrounded by desolate parking lots. The afternoon wind whips through deserted downtown streets, tossing plastic bags like tumbleweeds in a spaghetti western with few actors.
Adriana Salas, 48, kept her small clothing store open despite the small number of customers and new restrictions. “I’m very late with the rent,” she said. “I came to open because I needed money.”
What activity continued in the city could be found at big-box stores along Interstate 10, in snaking lines of cars at drive-through restaurants or by people trying to find some space to be outside at a mostly quiet outdoor mall.
“We were all sick,” Xavier Gonzales, 45, said of his wife and his 6-year-old son, who at that moment was running with the family dog on a patch of artificial turf.
Mr. Gonzales, a singer who has been mostly without work since March, got it the worst — “I couldn’t get up anymore” — and was told by emergency room doctors that he had viral pneumonia. But because he could breathe on his own, he was sent home to recover to make room for other, more seriously ill patients.
He did not look to Mexico, as some Texans have, for the source of El Paso’s pandemic problems. “I think that’s an excuse for people who are looking to blame someone; it’s not us, it’s them,” he said. “But it is us. It’s us not following the rules.”
Neil MacFarquhar contributed reporting from New York, and Mike Baker from Seattle.