With coronavirus hospitalizations surging in much of the United States and daily cases hitting all-time highs, the pandemic is putting new strain on local health systems, prompting plans for makeshift medical centers and new talk of rationing care.

In Texas, authorities are scrambling to shore up resources in El Paso, where covid-19 hospitalizations have nearly quadrupled to almost 800 in less than three weeks. In Utah, the state hospital association warned that if current trends hold, it will soon have to ask the governor to invoke “crisis standards of care” – a triage system that, for example, favors younger patients.

“It’s an extreme situation, because this means that all your contingency planning has been exhausted,” said Greg Bell, president of the Utah Hospital Association.

“I think all of us agree that the situation we have right now is unsustainable,” said Joe Dougherty, a spokesman for the Utah Department of Public Safety.

New reported infections nationwide surpassed 80,000 for the first time Friday and again Saturday as hospitalizations push past 40,000 and daily death tolls begin to climb. This new wave of infections, expected to intensify as winter draws closer, is spread wider than the spring surge that devastated East Coast states and the summer wave that slammed the South and the Southwest. It comes as some Republican leaders are leery of renewed shutdowns, as Americans grow wearier of restrictions and as the Thanksgiving travel season threatens to supercharge the virus’s spread.

“We are set up for just a perfect storm – a conflagration,” said Megan Ranney, an emergency medicine professor at Brown University. “Right now, you can talk about there being lots of little burning fires across the country. And then Thanksgiving will be the wind that will whip this fire up into an absolute human disaster for our country.”

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This past week brought the highest number of coronavirus cases since the pandemic started. Dozens of states have seen a seven-day average of more than 100 new cases per 100,000 people, with more than 700 per 100,000 in North Dakota – population-wise, the equivalent of Florida reporting more than 20,000 cases during the same time period.

Speaking Sunday on CNN’s “State of the Union,” White House Chief of Staff Mark Meadows suggested that the spread of the virus is a foregone conclusion: “We’re not going to control the pandemic,” Meadows said. “We are going to control the fact that we get vaccines, therapeutics and other mitigation.”

But public health officials say every effort to minimize the virus’s damage matters – and could mean all the difference for hospitals on track to become overwhelmed.

In Utah, for instance, authorities are hoping that a recent expansion of mask mandates to more counties can help turn the tide, said Dougherty, the Department of Public Safety spokesman. Data shows that mask mandates in Utah’s biggest counties worked earlier this year to slow the virus’s spread, he added.

Utah is “marching toward” what it considers to be full capacity for hospitals, or 85% of beds occupied, Dougherty said. Any more than that, he said, risks having beds free but insufficient staffing to crew them. Some facilities have already reported bed usage higher than the 85% benchmark.

Before crisis triage kicks in, Dougherty said, the state may turn to a field hospital that it set up earlier in the pandemic but has not previously needed. Officials also believe that more urgent messaging to the public could help stave off the worst.

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Asked about Meadows’s comments that the virus cannot be controlled, Dougherty said: “We completely believe in slowing it as much as possible.”

In El Paso, authorities are urging people to stay home as efforts to add hospital beds kick in. On Sunday, El Paso County Judge Ricardo Samaniego announced a curfew aimed at combating the virus, to take effect immediately.

Total infections in El Paso County have rocketed from fewer than 25,000 at the beginning of the month to nearly 40,000 this weekend, according to Washington Post tracking. New deaths have yet to surpass a peak in August, but fatalities lag behind spikes in cases and hospitalizations.

Samaniego said at a news conference Sunday that the community is in “crisis” mode, with area hospitals maxed out.

Texas Gov. Greg Abbott, a Republican, on Sunday announced plans for a new medical facility at El Paso Convention and Performing Arts Center, which will start at 50 beds but can expand to 100 if necessary. “Auxiliary medical units” will boost hospitals’ capacity, the governor’s office said, and the Department of Health and Human Services is sending out teams, too.

In a Sunday call, Abbott also asked the Department of Health and Human Services whether a Defense Department medical center in El Paso could help ease the pressure. Abbott, his office said, wants to house non-coronavirus patients in William Beaumont Army Medical Center so hospitals in the El Paso area could give more beds to those with covid-19, the illness caused by the novel coronavirus.

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The Department of Health and Human Services did not immediately provide comment.

As cases spike, some public health experts see slim chances of national leaders ramping up coronavirus restrictions again across the country.

“I don’t see forceful policy intervention happening any time soon,” former FDA commissioner Scott Gottlieb said Sunday on CBS News’s “Face the Nation.” “We have a moment of opportunity right now to take some forceful steps to try to abate the spread that’s underway. But if we don’t do that, if we miss this window, this is going to continue to accelerate.”

Ranney, the Brown University professor, said she is seeing “people just kind of throw up their hands” amid hospitalization numbers not seen in months.

In previous waves, “our governments reacted,” she said. “We closed bars. We closed restaurants. We enforced mask mandates. And I’m not seeing a lot of that nationally right now.”

She said she feels OK about hospital capacity in Rhode Island, which was hit hard by the virus early on and in Ranney’s view has developed good plans for another surge.

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But she doubted that governments and hospitals elsewhere in the country are ready. Even with good planning, she said, the mounting surge will be “emotionally and physically draining on everyone in the system.”

Some officials’ attempts to tamp down cases with stricter rules have quickly run into opposition. Wisconsin Gov. Tony Evers, a Democrat, is asking residents to “rise above” an appeals court’s temporary block on limits to indoor gatherings, the latest challenge to coronavirus restrictions in a state posting record covid-19 hospitalizations. In recent court filings, officials said Wisconsin is facing “by far [its] worst COVID-19 surge” of the pandemic.

But an October order restricting gatherings – to 25% of room or building capacity or 10 people total when there is no occupancy cap – drew outcry from businesses and a lawsuit from the Tavern League of Wisconsin.

“I’m once again asking folks to rise above tonight’s ruling, stay home, and mask up so we can get through this weekend and this pandemic together,” Evers tweeted in response Friday night. “This crisis is urgent, folks. Please stay home.”

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The Washington Post’s Cat Zakrzewski and Felicia Sonmez contributed to this report.