NEW YORK - US governors are reversing plans to reopen their states as the country registered the biggest-ever jump in coronavirus cases, in a growing recognition that the contagion is increasingly dictating events in much of America.
Governor Greg Abbott halted the reopening of the Texas economy, as Houston runs out of intensive-care beds for Covid-19 patients and the workers needed to trace their contacts. North Carolina also paused plans to loosen restrictions this week, along with Louisiana and Kansas.
The rollback reflects a growing caution nationwide as the virus races across the US, extending its tentacles into places largely spared at the beginning of the outbreak three months ago.
"We reopened too early," said Prof Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston. "Masks alone are not going to be adequate."
On Thursday, America recorded more than 39,000 new Covid-19 cases, surpassing the previous daily peak on April 24, when the virus was hammering New York. Florida, California, Arizona and Texas account for almost half of all new cases, an outsize proportion even after adjusting for their large populations.
More than 2.4 million cases have been confirmed in the US, but the Centres for Disease Control and Prevention estimates infections may have been 10 times higher, with many not showing symptoms, the agency's director said on a call on Thursday.
Covid-19 deaths in the US, currently at 124,000, could rise by more than 45 per cent to 180,000 by October, according to the University of Washington's Institute for Health Metrics and Evaluation.
Texas set another daily record for virus cases, and its biggest city, Houston, said it couldn't hire or retain enough contact tracers to keep up. That means some patients and their recent whereabouts are going uninvestigated, heightening the risk of accelerated spread and raising the specter of mortality rates as high as in New York City three months ago.
Mr Abbott's executive order on Thursday suspended elective surgeries in the state's largest cities to free up hospital space. It permits already-open businesses to operate, but only at their current, reduced occupancy limits.
Mr Abbott had been quick to follow the lead of President Donald Trump, encouraging businesses to operate despite the pandemic and overruling local efforts to enact stringent controls. Thursday's measures were the first indication that the Republican governor is willing to scale back the reopening he initiated eight weeks ago, and was the latest blow to the American economy.
Mr Trump has deferred to the states on when to drop social-distancing restrictions and how to test and rein in the virus. Some governors have similarly deferred to local officials to decide whether to require face coverings and business closures.
As the spread accelerates, the White House said it will hold its first coronavirus task force briefing in almost two months on Friday, led by Vice President Mike Pence. Late Thursday night, Mr Trump tweeted that virus deaths are "way down", in what appeared to be an attempt to distract from the record case growth. The US economy is "roaring back" and "will NOT be shut down," he posted.
In Florida, governor Ron DeSantis said on Thursday that he wouldn't further reopen for now, although he downplayed the significance of the decision, saying he "never anticipated" such a step this soon.
Arizona Governor Doug Ducey said hospitals are likely to hit surge capacity "very soon", with the number of cases and hospitalisations expected to worsen in the next two weeks. Earlier in the day, the state reported the number of people admitted to hospitals had jumped by 183 to 2,453, the biggest single-day increase since the state began tracking the number.
"This is Arizona's first wave, and this will not be our last wave," said Mr Ducey, a Republican who previously had ballyhooed the state's accelerated reopening.
Residents should wear masks and avoid crowded social gatherings, Mr Ducey said, adding that some people have been "speeding" since the economy began reopening. He said he would focus on education and personal responsibility - not another executive order.
Texas added 5,996 cases, the third consecutive day of record-breaking increases, according to state health department data. In all, 131,917 have contracted the disease. The death toll grew by 47 to 2,296, the grimmest day in more than a month. The positive-test rate surged to 11.76 per cent, the highest since April 16.
The centre of that health crisis, Houston, sprawls over hundreds of square miles of swampy southeast Texas, a landscape of freeways and shopping malls largely unhindered by zoning. It has a metropolitan area of about 7 million residents who compose one of the most diverse communities in the nation.
Its medical infrastructure will be inundated by Independence Day, according to Prof Hotez. Current trends in Harris County, which includes the city, indicate the caseload will triple or quadruple by mid-July, Prof Hotez said, citing modelling by the Children's Hospital of Philadelphia's PolicyLab.
Such a scenario would be "apocalyptic," he said. "We can't go there."
But Houston's plan to staff a corps of 300 or more contact tracers has been unsuccessful, in part because of high turnover among recruits, said Mr Stephen Williams, director of the health department. As a result, the city may focus just on patients most likely to have mingled in large crowds.
"I don't know that we would ever develop the capacity to hire enough contact tracers to keep up with this volume of positives," Mr Williams said during a media briefing this week.
He said some people were unprepared for what the job entailed - painstaking accounting of a patient's every movement and a sometimes frustrating search for those he or she met.
"I think those positions have been glorified," Mr Williams said. "We've hired a number of people, but there's been some turnover because people didn't actually understand what the positions were."
The Texas Medical Centre - a cluster of hospitals, research facilities and medical schools south of downtown Houston - said the region's intensive-care capacity had reached maximum capacity, a situation that will force medical authorities to convert other facilities to ad hoc Covid-19 wards. Harris County officials said they are prepared to reopen a field hospital at a professional football stadium if so-called surge capacity shows signs of strain.
The Medical Centre can double its Covid-19 capabilities without overstretching staff or supply lines, chief executive Bill McKeon said in an interview.
"Obviously, when we see numbers that are growing exponentially, that's always a concern to us," Mr McKeon said. "But remember, capacity is like a giant bathtub. Sooner or later, if water goes unchecked and the faucets are filling, then at some point any place, even the biggest medical city in the world, will overflow."
The Medical Centre is seeing more young patients admitted, which means they're less likely to require intensive care, Mr McKeon said. More concerning is that the trend probably indicates that young people aren't practicing social distancing or masking up, whether because they're socialising in crowded bars or have less ability to do so when they go to work, he said.
"If people do not change their behaviour and really take this seriously across the entire community, then that will be a problem in the future," Mr McKeon said.