“Our situation has changed, and we must change with it,” the governor said, as the United States breaks records for daily new cases and North Dakota leads in recent infections per capita.

A dark reality is sinking in for officials across the country, with Burgum just the latest leader to announce new restrictions in the face of surging cases and hospitalizations that health experts have been warning about for months. But doctors and health officials worry that the urgency of the escalating crisis has not gotten through to a public weary of pandemic shutdowns. And the push for stronger measures has triggered backlash and legal fights.

Chicago on Thursday became the first major city to announce a renewed stay-at-home advisory. A day later, New Mexico Gov. Michelle Lujan Grisham (D) reinstated many restrictions, prohibiting on-site dining and requiring nonessential businesses to close their physical locations. Three Western states — California, Oregon and Washington — urged people to cancel travel that’s not absolutely necessary, and Oregon Gov. Kate Brown (D) announced a two-week statewide “freeze” Friday, which included curbing gatherings ahead of Thanksgiving.

A vaccine breakthrough has buoyed hopes — “The cavalry is coming,” as Anthony S. Fauci, the nation’s top infectious-disease expert, put it — but the country is still facing what officials say could be its grimmest months yet of the pandemic, with tough decisions ahead and thousands of lives in the balance.

Many leaders are leery of stronger measures and economically painful shutdowns, as Democrats and Republicans remain stalled over a new coronavirus stimulus package that could blunt the economic fallout. President Trump on Friday said his administration would not under “any circumstances” resort to a “lockdown.”

“Lockdowns cost lives, and they cost a lot of problems,” Trump said at a news conference where officials said they hope to see millions of people immunized against the coronavirus by the end of the year.

A vaccine could be available to the general public as early as April, Trump said, a timeline echoed by experts such as Fauci. But in the meantime, coronavirus cases are soaring to new heights, pushing past 177,000 nationwide Friday — little more than a week after the country cracked 100,000 daily infections for the first time. The vast majority of states have recorded a single-day high in new cases over the past week, as total infections in the United States approach 11 million. More than 1,300 new coronavirus-related deaths were reported in the United States on Saturday, up more than 200 from last Saturday’s total. Current covid-19 hospitalizations have risen to record heights, too, approaching 70,000.

The stakes are high, and officials are bitterly divided over how to respond in some hard-hit communities.

On Friday, a state appeals court blocked El Paso County Judge Ricardo Samaniego’s stay-at-home order shuttering nonessential businesses in an area where growing coronavirus cases have packed hospitals to capacity and led local officials to call in mobile morgues. Samaniego said the order was necessary to combat a deadly crisis.

But the measures ran afoul of Republican Texas Gov. Greg Abbott’s statewide rules. State Attorney General Ken Paxton hailed the U.S. Court of Appeals for the 8th Circuit’s decision Friday on Twitter, decrying a “tyrant who thinks he can ignore state law” and vowing not to let “rogue political subdivisions try to kill small businesses and holiday gatherings.”

Samaniego was similarly biting in his response, accusing Paxton of gloating as the county suffered. More than half of the patients flooding the county’s health system have the coronavirus, Samaniego told The Washington Post. People are being sent out of state for care.

“Here we are in a really critical situation, he says, people, you can go to Thanksgiving?” Samaniego said of Paxton in an interview Saturday. “Just a complete disregard for our situation.”

Strain on health systems has pushed some states to not just reinstate old restrictions but also contemplate measures they had avoided earlier in the pandemic. In North Dakota, for instance, Burgum’s mask mandate came after rising pressure from health-care workers, as state officials authorized medical professionals to keep working in covid-19 units after testing positive for the coronavirus, if they lack symptoms.

Utah Gov. Gary R. Herbert, another Republican leader long wary of a sweeping mask order, said Sunday that he was mandating face coverings statewide in public settings and for people within six feet of anyone outside their household. The reversal came after swamped hospitals warned they might have to ration health care.

Some jurisdictions have narrowly staved off new orders and closures — for now. Officials in New York City, an early hot spot in the pandemic, said this past week that the nation’s largest school system could close if the rate at which coronavirus tests came back positive hit 3 percent. Mayor Bill de Blasio tweeted Saturday that the city remained below that benchmark but warned that things could change.

“We MUST fight back a second wave to keep our schools open,” he said.

Many are skeptical that leaders across the country will take serious new measures amid pushback. The changes announced Friday in Oregon drew an outcry from businesses.

“We were already hearing from members they were concerned about what another shutdown would do to their chances of staying open,” Jason Brandt, president of the Oregon Restaurant and Lodging Association, said in a statement, adding that the new rules “will trigger an unknown amount of permanent closures.”

Veronica Miller, a professor at the University of California at Berkeley School of Public Health who signed an open letter this summer urging renewed shutdown measures, said she worries public health experts’ strident warnings are not getting through “to that extent that we need.”

“You can just see the graphs, they’re just really over the top, and it’s so much worse. And it’s going to get worse, and I do not see at the national level — I do not see any sense of urgency,” she said.

Jacqueline Dupree, Mark Guarino and William Wan contributed to this report.





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