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    The map of Texas lays bare the unrelenting march of the pandemic.

    A new coronavirus surge is driven by outbreaks in cities, towns and wind-swept outposts, stretching from Dallas to west Texas. Health officials along the border in El Paso extended a stay-home order, more than doubled their mobile morgues to 10 and expanded a temporary hospital at the convention center. Fresh outbreaks were piling up in Amarillo and Lubbock, too.

    Big cities were also hit hard, but because the infections were spread across larger populations — the Houston metro area alone is home to about 7 million people — they didn’t trigger lockdowns or public outcry. By the end of a disquieting and startling week one thing was clear: Texas, like much of the nation, is overwhelmed by a virus that is more stubborn than the will of many quarantine-fatigued Americans who want to wish it away.

    A line of patrons stretches down the block Friday outside Houston’s Turkey Leg Hut, where diners ate at tables crammed together under tents.
    (Molly Hennessy-Fiske / Los Angeles Times)

    “The country is in freefall. It’s in disaster mode,” said Dr. Peter Hotez, dean of Baylor College of Medicine’s National School of Tropical Medicine. “It’s really scary in terms of the surges on the ICUs, the hospital staff getting exhausted and, you know, mortality is just going to shoot up. These are lives that don’t have to be lost.”

    COVID-19 cases are increasing in 46 states. Public health officials announced more than 177,000 new infections in the U.S. on Friday, a record high for the third straight day. Coronavirus hospitalizations also reached a record 67,096 this week, double from five weeks ago. New Mexico Gov. Michelle Lujan Grisham reinstated the country’s most restrictive pandemic measures, saying the state was at a “breaking point,” while Oregon Gov. Kate Brown announced a two-week statewide “freeze” to limit gatherings ahead of Thanksgiving.

    U.S. deaths have increased to an average of more than 1,000 a day. More than 244,000 have died of the virus since the pandemic began. An additional 40,000 could die in the next month, according to the Centers for Disease Control and Prevention. By year’s end, Hotez expects at least 400,000 COVID-19 deaths.

    Healthcare workers decontaminate a COVID-19 testing site in El Paso on Friday.

    Healthcare workers decontaminate a COVID-19 testing site Friday as the number of cases surges in El Paso.
    (Getty Images)

    Texas became the first state to surpass 1 million COVID-19 cases this week (followed by California), matching peak levels reached this summer and alarming public health experts ahead of the winter holidays, when infections are expected to soar.

    Despite exhausted doctors and steady funeral processions, many Texans refused to wear masks or avoid crowded public places. In the border city of McAllen, Bianca Lilley, 36, took her mom and 3-year-old daughter out to eat at the La Plaza Mall this week. They plan to gather with their extended family on Thanksgiving, she said, but only after one member of each of their nuclear families tests negative for the virus.

    “We obviously don’t want to get sick,” she said as she watched her daughter play outside the mall. “But also, we don’t want to live in fear.”

    Public health officials said that testing one family member won’t necessarily protect the rest of the family, because they could have a false negative or other family members could still be infected but asymptomatic.

    Texas Gov. Greg Abbott and other state leaders have resisted pandemic shutdowns and restrictions, even in places such as El Paso. Texas’ attorney general joined local businesses suing to overturn the El Paso stay-home order.

    Unlike California’s governor, Abbott hasn’t issued a coronavirus-related travel advisory ahead of the holidays or warned residents who travel out of state to quarantine when they return, even though Texas colleges have more infected students than any other state. On Friday, Dallas County’s chief executive sent a letter to the governor requesting added pandemic restrictions.

    Wells Fargo Plaza in downtown El Paso is lit with an American flag design.

    Wells Fargo Plaza in El Paso is lit with an American flag design above a mostly empty downtown area. Health officials along the border in El Paso extended a stay-home order as virus cases rise.
    (Getty Images)

    Hotez has become frustrated with people socializing at cafes without masks in his Houston neighborhood. He had been looking forward to a visit by his daughter and her husband from Los Angeles during the holidays. He canceled it when cases in El Paso soared.

    “People are choosing to make such horrible decisions because of this medical freedom ideology that came out of Texas and is now being pushed on us by the White House coronavirus task force,” Hotez said. He is at work on a COVID-19 vaccine that’s in clinical trials but will still take months to develop.

    As temperatures drop in north Texas, Hotez expects infections to multiply as they have in the Upper Midwest as people spend more time indoors, especially in Dallas-Fort Worth.

    “We’re starting to see hospitalizations go up,” he said, including in Houston, where coronavirus hospitalizations nearly doubled this week compared with last month. “The more aggressively we can social-distance for the next two or three months, the more lives we’ll save.”

    Small gatherings in north Texas have increased community spread of COVID-19, said Dr. Erin Carlson, an associate clinical professor in the College of Nursing and Health Innovation at the University of Texas at Arlington.

    A worker cleans the floor in the mostly empty El Paso International Airport.

    A worker cleans the floor near a display with an American flag and Christmas decorations in the mostly empty El Paso International Airport.
    (Mario Tama / Getty Images)

    “People have quarantine fatigue. They’re tired of it. They want to go over to their friend’s house and have poker night just like they used to,” she said. “Pretty much any contact tracer you talk to, they’re seeing small gatherings and that’s driving the rates up. They’re tired and they want to see their families, so they’re going ahead to the birthday parties.”

    Catherine Troisi, an infectious disease epidemiologist at the University of Texas Health Science Center at Houston, said she is concerned about diminishing hospital resources due to the virus’ “exponential spread.” If families gather for Thanksgiving without quarantining for two weeks beforehand, she said, there’s a chance the pandemic will worsen.

    “We want to keep up our social routines,” she said. “But we aren’t getting that public health message across. That can have devastating effects.”

    A breast cancer survivor, Troisi, 68, has grandchildren in Washington, D.C., whom she hasn’t seen since the start of the pandemic.

    “I’m sick of it. I miss my grandbabies,” she said. “But what we’ve got to emphasize is it’s not about you, it’s about your community.”

    Her message was lost among many. Indoor malls and restaurants in Houston were packed Friday with patrons, some maskless.

    At the Galleria Mall, pharmacist Michael Varnado, 36, stopped for lunch in the food court with his parents, who were visiting from New Orleans. Varnado and his mother share a birthday Monday, and they had come to celebrate. But his father had to be persuaded to go to the mall, concerned about the pandemic. They all wore masks.

    “Walking through the mall, we saw people who didn’t have masks on,” said Sharon Varnado, 66, despite signs warning that masks are required. “They don’t take it seriously. A lot of people don’t comply because it hasn’t hit home.”

    Across from the food court, Oscar Castillo of San Antonio and his parents visiting from Guadalajara, Mexico, wore masks as they watched maskless ice skaters glide across the mall’s indoor rink. They had been isolating since the start of the pandemic and were surprised to see such crowds.

    “We are getting used to it,” Castillo, 26, who teaches at a migrant shelter, said of the pandemic. “The numbers are going up, but we’re going out and getting on with our lives. I don’t know if it’s the best thing, but humans are social.”

    Nearby, a dozen shoppers rushed to leave the mall and drive across town to the Southern comfort mecca, Turkey Leg Hut, in Houston’s Third Ward neighborhood. By 4 p.m., the outdoor tented patio was already packed. Construction worker Robert Rodriguez said he felt safe: He was wearing a mask and technically eating outside.

    “We got hit hard at first, but since we adapted, it’s all right,” said Rodriguez, 35, who planned to gather with family as usual this Thanksgiving.

    The restaurant’s pre-dinner line stretched down the block. Those waiting had traveled from as far as St. Louis, Florida and New York.

    “I refuse to be at home on my 25th birthday,” said Jonae Mims, who was waiting to celebrate after traveling from North Carolina with friend Lativia Nash.

    “You only live once,” said Nash.

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