CHICAGO — A second wave of coronavirus cases is charting a path far from coastal Washington State, California, New York and New Jersey, and threatening population centers in America’s middle. Emerging hot spots include smaller communities like Greenville, Miss., and Pine Bluff, Ark., and large cities like New Orleans, Milwaukee, Detroit and Chicago.
Local and state leaders find themselves struggling to deal with the deadly onslaught, urgently issuing guidance to residents and sounding the alarm over a dearth of equipment in local clinics and hospitals.
As the threat expands, the orders from state and local officials have sometimes been a chaotic, confusing patchwork. With mixed signals from the federal authorities in Washington, D.C., local leaders have wrestled with complicated medical and economic choices. Mayors and governors in Oklahoma, Massachusetts, South Carolina and Texas have clashed over which restrictions to impose on residents, dispensing contradictory instructions, even as their communities are being ravaged by the virus.
This week, cities and states that had no known cases of coronavirus not long ago have seen the infection’s sudden, intense arrival. In Detroit, more than 850 cases have been identified and at least 15 people have died. In New Orleans, public health workers have identified more than 1,100 cases, including 57 people who have died. Eight deaths and nearly 400 cases have been reported in Milwaukee County, Wis. And in Chicago and its inner-ring suburbs, there have been nearly 2,000 cases, as of Friday morning.
“I look to New York to see what’s going on there, and I think, it’s a cautionary tale for the rest of us,” Mayor Lori Lightfoot of Chicago, a Democrat, said in an interview on Friday, a day when known cases in the United States rose above 100,000. “I look at New York and think, what do we do so that we are as prepared as possible as this begins to ramp up in a city like Chicago?”
A survey of cities conducted by the U.S. Conference of Mayors released on Friday found that despite assurances by the federal government that adequate medical supplies are available, cities say the equipment they need is not reaching them.
Nearly every American city is lacking the most basic supplies. More than 90 percent of the nearly 200 cities that responded to the survey said they did not have a sufficient supply of face masks, and nearly 90 percent lacked an adequate amount of personal protective equipment. Detroit said it needed 18,000 surgical masks. Dayton, Ohio, needed 200,000 N95 masks, 150,000 pairs of gloves and 100,000 digital thermometers.
Many local officials seeing a rise in cases have struggled to put in place robust restrictions that would help slow the spread of the outbreak. In Albany, Ga., a city of 73,000 where there have been 16 deaths and more than 160 confirmed cases of the virus, Mayor Bo Dorough imposed a stay-at-home order, similar to those enacted in New York, Illinois and California. But other than Albany and one nearby county, no other jurisdiction in southwest Georgia has restricted people’s movements or ordered businesses deemed nonessential to close.
“It’s not a natural disaster that’s confined to a certain geographic place,” Mr. Dorough said. “The county lines don’t mean anything to the virus.”
In Mississippi, the state government had largely resisted calls to put in place regulations around the virus. That had led to a jumble of regulations, as mayors of cities in Oxford, Jackson and Tupelo closed bars and restaurants and established shelter orders not much different than the rules in Houston, New Orleans, New York, Boston or San Francisco.
“You can only go so far with leading from below,” said Mayor Chokwe Antar Lumumba of Jackson, the capital, which has more than 31 confirmed infections. “We need the state.”
In Utah, a standoff between Democratic government officials in Salt Lake City and the state’s Republican governor has heightened worries about spread of the coronavirus in the state’s most densely populated region.
Erin Mendenhall, Salt Lake City’s mayor, said in an interview that she had drafted — but not yet issued — an emergency order instructing residents to remain in their homes. The order allows people to shop for groceries, pick up medications and exercise, among other activities.
But Ms. Mendenhall, a Democrat, said she had not invoked the order because Gov. Gary Herbert, a Republican, had not issued a similar statewide order.
“For a city to do it alone, particularly a city that’s the center for regional activities and business, it doesn’t do as much good as it would if we act as a county or region or even as a state,” she said.
Many of the new cases and deaths have been concentrated in the Midwest’s largest cities.
Detroit has seen an explosion of coronavirus cases, with nearly 900 in total — including the city’s police chief, James Craig — and at least 19 deaths. Residents have a hard time comprehending why so many people in their city have become ill, especially because they viewed state and city leaders as having taken aggressive actions early on, said Tonya Allen, the president and chief executive of the Skillman Foundation, a philanthropic organization that focuses on Detroit youth.
“I think we’re all surprised by how fast and hard it’s hitting in Detroit,” she said. “You can imagine why it would hit in some large cities on the coast. But why it’s moving so quickly in Detroit, we have no idea.”
The areas around Cleveland, St. Louis and Kansas City, Mo., have also seen spikes, leading officials to warn that medical facilities could be overwhelmed.
“What we do now will determine if we overrun Ohio’s hospitals and get to a situation where our medical teams are making life-and-death decisions,” the state’s governor, Mike DeWine, said on Thursday. “We don’t want to be in that position. I worry about this every day.”
The race to keep Americans at home has happened at astonishing speed. In just over a week, nearly half the states have issued orders or formal advisories for all residents to stay home, and others have strongly recommended it. As of Friday morning, at least 233 million people — or about seven in 10 Americans — were being told to stay home.
Some governors who initially resisted such a sweeping measure quickly changed their minds. Gov. Chris Sununu of New Hampshire, a Republican, who initially described a stay-at-home order as “not a practical ask,” later put one in place.
In independent-minded Texas, where there is no statewide order, at least 20 million people — from the Rio Grande Valley to sprawling suburbs of Dallas — were under local instructions to stay home.
Clay Jenkins, the Democratic judge of Dallas County, was the first county executive in Texas to shut down bars and restaurants and issue a stay-at-home order. He said he had been watching the outbreaks on the coasts with alarm, particularly in California and New York.
“Those cities are two steps ahead of us, and I say that every day,” he said. “The storm is coming. But there is a level of unhelpful Texas exceptionalism that leads people to believe that somehow their rugged individualism or gut instincts will handle the virus in a better way.”
One of the biggest challenges to managing the virus locally has been mixed messaging from the White House, said Mayor Marty Walsh of Boston, a Democrat. He pointed to President Trump’s statement that he was aiming to have the country up and running again by Easter.
“It’s really dangerous and puts us on a worse track than we’re on today,” he said. “If people get this false sense of security that they can go out in the next couple weeks, we’re not going to see the cases decrease. We’re going to see the deaths spike.”
Reporting was contributed by Mitch Smith from Overland Park, Kan.; John Eligon from Kansas City, Mo.; Michael Wines from Washington; Sarah Mervosh from Canton, Ohio; and Michael Powell and Timothy Williams from New York.