Thursday brought mostly sunny skies and a high of 84 degrees to El Paso. Aside from a fluky late-October snow day, temperatures have remained typically warm the last two months, as COVID-19 infections in the city have overwhelmed hospitals and prompted officials to temporarily close nonessential businesses in an attempt to control the spread of the novel coronavirus. Public health experts have warned for months about the dangerous spike in cases now under way nationally, expecting that cooler fall temperatures would drive gatherings of family and friends indoors. But the grim milestone El Paso marked on Thursday—surpassing more than 1,900 new daily cases of COVID-19 for the first time—can’t be blamed on the weather.

El Paso experienced a summer spike along with much of the rest of the state, but this time around it’s far worse off than other major Texas cities (though infections are trending up statewide). There’s no single convincing reason why that’s the case. Some blame weak enforcement of coronavirus restrictions by local authorities. Some blame failures of the city’s contact tracing system, which does appear to have buckled under the strain of the skyrocketing case counts. Others suggest the relatively high percentage of larger, multigenerational households in El Paso County, compared with much of the country, is a factor. There’s also been talk of how El Paso’s proximity to Ciudad Juárez, just across the Rio Grande, may have contributed to the rise.

While El Pasoans often speak of their close relationship to Juárez with pride, as a source of strength for the region, in recent weeks leaders on both sides of the border have pointed to international crossings as significantly affecting the circulation of the virus. The city’s public health authority suggested as much in early October, and a city analysis of contact tracing data found that 19 percent of those who tested positive for the virus had recently traveled to Mexico (though shopping at stores and dining inside restaurants were much more common activities among the infected).

Likewise, Juárez mayor Armando Cabada, who himself was recently hospitalized for COVID-19 complications, has blamed “indiscriminate crossings at the border in Ciudad Juárez” for his city’s spike in coronavirus infections. Last week, the state of Chihuahua announced that multiple hospitals in Juárez had reached capacity, and the city instituted a two-week shutdown of nonessential businesses. The extent of the spread of the virus in Juárez, where it has already killed more than 1,300 people, is unknown. Partly that’s because free coronavirus tests there are available only to high-risk and severely symptomatic patients. Those outside of the high-risk category can pay for a test at a private health center, but those cost at least 2,500 pesos, more than $100, a price out of reach for many in the region.

Together the cities of El Paso and Juárez are home to more than two million people, tens of thousands of whom crossed the border daily before the coronavirus arrived, for work, recreation, and shopping. Last year, U.S. Customs and Border Protection reported millions of pedestrian and personal vehicle entries each month at ports of entry in El Paso. At the onset of the pandemic, Mexico and the United States reached an agreement to ban nonessential travel (like tourism, gambling, recreation) each way. However, it’s unclear how well those restrictions are being enforced. Anecdotally, American citizens who have traveled south from El Paso recently told me that Mexican authorities did not question them about their reasons for crossing the border.

CBP reported about 400,000 fewer pedestrian entries into El Paso this September (the most recent data available) compared with the same month last year, but there were still nearly 204,000. Other Texas border communities—including Brownsville, Laredo, and Hidalgo County—have seen smaller percentage drops in border entries, without a surge in COVID-19 cases, though it’s worth noting that the El Paso–Ciudad Juárez region is by far the most populous on the Texas-Mexico border.

Because of the symbiotic relationship between El Paso and Juárez, Congresswoman Veronica Escobar, who has had friends die of the virus, has been advocating for a “science-based binational COVID plan.” Last month she introduced legislation, cosponsored by other representatives along the U.S.-Mexico border, that would require the U.S.-Mexico Border Health Commission, a division of the federal Department of Health and Human Services, to develop a plan for both countries to share public health data, establish a vaccine distribution strategy for the borderlands, and mitigate the pandemic’s economic consequences. “We’re not going to combat the crisis if we don’t have a plan to address it with our neighbors,” Escobar says. “We have to have consistent rules, consistent testing, consistent consequences on both sides of the border.”

Yet greater binational cooperation might be difficult to achieve quickly, especially considering that El Paso’s local leaders can’t agree on an approach to combatting the virus—and face resistance from state leadership as well. The rapidly deteriorating public health situation prompted El Paso County Judge Ricardo Samaniego to order all nonessential businesses to close for two weeks, as of last Friday. “Our hospitals are at capacity, our medical professionals are overwhelmed, and if we don’t respond, we will see unprecedented levels of death,” he said during a virtual press conference at which he was joined by Escobar, state representative César Blanco, and Jacob Cintron, the CEO of University Medical Center, in presenting the emergency measures to the public.

But El Paso mayor Dee Margo—who faced backlash recently for telling a Jewish city council member that his call for a pause on indoor dining was “Gestapo-like”— says the county judge didn’t consult him in advance. A couple of hours after the press conference, Margo sent a letter to Attorney General Ken Paxton requesting an opinion on the legality of the shutdown. The next day, Paxton joined El Paso restaurant owners in a lawsuit opposing the shutdown, and this week he filed for a temporary injunction to stop the order, which he says is unlawful.

During last week’s press conference, Samaniego had preemptively asserted his legal authority (later supported by the county attorney). “I’m also very cognizant and respectful of the governor’s orders,” he said. “The hard truth is that the people who are dying are El Pasoans. They are not in Austin, and I have the responsibility to do everything I can to protect El Pasoans.”

Meanwhile, El Paso’s fourth mobile morgue arrived on Sunday. Just since the beginning of October, COVID-19 has been confirmed to have killed more than sixty people in the county, and the medical examiner’s office has been struggling to keep up with hundreds of other decedents awaiting a determination of cause of death. Since more than a week ago, every available hospital bed in the county has been occupied. Hospitals have had to set up additional beds in tents outside of their buildings, and the state opened a fifty-bed auxiliary hospital at the El Paso Convention and Performing Arts Center.

The county’s seven-day average has climbed to more than 1,700 daily new cases. Since early October, the positivity rate has increased from 9 percent to more than 23 percent—a sign that testing lags far behind undetected cases spreading through the community. The number of El Pasoans hospitalized as a result of the virus has risen over the last month from 160 to more than 1,000, a situation worsened by the relatively high prevalence in the region of underlying conditions, like diabetes, that increase the likelihood of serious infection. Of the more than 600 people who have died of COVID-19 complications since the onset of the pandemic, half suffered from hypertension and 43 percent were diabetics.

The staff at Del Sol Medical Center, on El Paso’s East Side, hoped they’d seen the worst of COVID-19 during the summer, when many of them were working around the clock. But the relief they felt as cases declined into the early days of September proved short-lived. “It’s nonstop,” says Dr. Ogechika Alozie, Del Sol’s chief medical officer, says of the stress this fall surge has placed on doctors and nurses. “It’s constantly being on edge, constantly being on alert, constantly having sick patients.”