Coronavirus patients were piling beds on one floor. A teaching hospital in El Paso set up patient care tents in the parking lot. The downtown convention center has become a field hospital. The state started airlifting thousands of intensive care patients to other cities to open up still more rooms.
City officials disagreed over what to do to quell the spiraling coronavirus epidemic. The county official ordered a shutdown and a curfew. Yet the mayor would not consent, and the police said they would not follow it. Then the State Attorney General stepped in—a lockdown was needless and unconstitutional, he said.
And the patients were already arriving. Wanda Helgesen said that as they discharge one patient, there are two more that come in.
El Paso, a border town of 680,000, currently has more people hospitalized with Covid-19 than other states—1076, as of Tuesday—and more than doubled the supply of mobile morgues from four to ten.
As it grapples with the deadly third wave of the pandemic, the pressure on the city is expressed across the world. The number of Covid-19 hospitalizations in the United States reached a record high of 61,964 on Tuesday, surpassing the terrible early days of spring in New York and summer in the South and West.
Hospitalizations have more than doubled since September, according to the Covid Tracking Project, from a previous high of 59,940 patients hospitalized in mid-April. Although the previous rises subsided, public health officials warn that the rate of new hospitalizations will continue to increase along with new illnesses, which average 111,000 every day across the country and display no signs of abating.
States that tended to regulate the spread, such as New Jersey and New York, saw a revival. Around the same time, remote clinics in North Dakota and Idaho are scrambling for physicians, nurses, and technicians to cope with rapidly increasing patient populations.
Public health authorities have long cautioned the virus might burden hospitals in the fall and winter. The risk of infection is increased due to more indoor events, the start of the flu season, and celebrations over the winter holidays.
Dr. Ashish Jha, Dean of the Brown University School of Public Health, said that things aren’t just grim; there’s no end in sight. If they’re halting all transmission now, which they can’t and won’t, they’re potentially staring at a month of overcapacity in certain cities in America.
Texas has recently reached one million confirmed cases of the virus, with 19,000 dead. Of the 6,100 patients hospitalized throughout the province, one in six is in El Paso. Dr. Mario Rascon, Chief Medical Examiner for El Paso County, said Tuesday that his office had 154 deaths. “It’s exhausting,” he said.
The city carried more than 1,400 health employees from all over the state, and about 60 more came on the weekend in three teams sent by the Defense Department. But these extra services have been overwhelmed by new patients.
“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 circumstance represents the broader challenge of coping with a national problem in the absence of a national plan. This has become increasingly apparent in El Paso, an urban island in rural West Texas, near Mexico and New Mexico’s borders.
A pandemic response philosophy focused on local autonomy and personal responsibility, beginning with the Trump administration and continued by Texas Republican Governor Greg Abbott, has often left local officials at odds with coping with serial outbreaks.
After the spring shutdown, Mr. Abbott was quick to start reopening the Texas economy. When the flu re-emerged, he stopped reopening and battled with city officials in Houston and other cities who tried to scale back but were prohibited from doing so by his directives. He instructed Texans to put masks on their heads. In October, he relaxed control even further. By then, the hospitals in El Paso were already strained.
On October 29, the top county official, Ricardo A. Samaniego, released a stay-at-home order and stringent new business limits. But Mayor Margo disagreed that Mr. Samaniego had the right to do so, and he originally opposed it.
“Huge, huge confusion,” said Laura Rayborn, who owns a spa and other local businesses.
Restaurants continued to serve, prompting instructions to halt anything but pick-up and delivery. “We decided to do what we had to do,” said Aaron Means, who owns a restaurant near the University of Texas campus in El Paso.
Some went to court to combat the shutdown and were joined by the republican state attorney general, Ken Paxton, who characterized the county’s behavior as “oppression” and promised to bring an end to it. After a week of back-and-forth between the three branches of the Texas government, the state court ruled on Friday in favor of new company controls. Mr. Paxton is appealing.
At that time, anger and uncertainty had spread widely, dampening any potential gains from business closures and all but guaranteeing that a longer shutdown would be required.
Due to expire on Wednesday, the county’s two-week shutdown order has yet to have any appreciable impact on hospitalizations, officials said. “We don’t seem to have met our peak,” said Ms. Helgesen.
As of Tuesday, the city had an average of 1,800 new coronavirus cases a day, nearly double the number in the more populous Dallas County, the state’s next hardest hit.
Mr. Samaniego, the county executive, said that he would like to extend the shutdown order, possibly through Thanksgiving. He was afraid that very few tourists would follow his order and that the holiday would carry new dangers.
“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 that Mr. Samaniego and other municipal authorities’ priority should be on the compliance of current laws, including restrictions on restaurant size and mask standards, not on closures.
Like the nation as a whole, El Paso has now reached an unpredictable era. Officials are expecting that enough people can observe the lockout to slow the transmission of pathogens. The police have started to sell passes to organizations that do not cooperate.
On Monday, city officers riding heavy-duty Segway trucks and sheriffs in patrol cars could be seen cruising a largely deserted shopping area and visiting businesses along the border of the Mexican city, Ciudad Juárez.
Some officials and people have blamed Juárez for spreading pathogens in El Paso, even though cross-border travel has been restricted almost exclusively to American citizens. For a long time, the two cities have formed a center of trade in the mountainous desert, and Americans who live in Mexico have always driven to El Paso to use their better-resourced hospitals.
This continued through the pandemic, officials said, when Juárez saw the hospital system buckle under the pressure of its own serious epidemic. The Juárez pandemic scale is not understood due to inadequate monitoring, but even the mayor has been hospitalized with the virus.
Health officials said most of the infections in El Paso have come from local community transmission, particularly in multigenerational families who often live together or come together to shop or visit.
Dr. Edward Michelson, chief of emergency medicine at the University Medical Center and a professor at the Texas Tech University Health Sciences Center, said: “We have seen multiple members of families coming in, usually on different days.”
Hector Balderrama, 55, a medical provider, watched his immediate family catch the virus in mid-October: first his adult son, then his wife, then his eldest daughter.
Mr. Gonzales, a musician who has been largely unemployed since March, had the worst of it. “I can’t get up,” he said and was told by emergency room doctors that he had viral pneumonia. Because he was able to breathe independently, he was sent home to rest and make way for other, more critically ill patients.
Vast swaths of the area are vacant, with indoor shopping malls lined by deserted parking lots. The afternoon wind whips along empty downtown streets, scattering plastic bags like tumbleweeds.
Adriana Salas, 48, has kept her small clothing store open despite a small number of buyers and new constraints.
What activity was going on in the city could be seen in big-box shops along Interstate 10, in snaking lines of cars in restaurants, or in people seeking a place to be outdoors in a mostly silent outdoor mall.