DALLAS — Hospitals in Texas are suspending elective procedures and turning to 2,500 medical workers from other states to help combat a surge in Covid cases as increasingly younger and healthier patients who didn’t get vaccinated against the virus crowd treatment floors.

The state is bracing for what could be its most aggressive fight against the coronavirus yet as the delta variant rips across the country and hits states with low vaccination rates and relaxed public health measures, particularly in the South and Midwest.

Covid cases in the Lone Star State have exploded in the last few weeks. Texas is averaging about 15,419 new cases per day, according to data compiled by Johns Hopkins University as of Wednesday, up 34% from a week ago and more than double the seven-day average of 6,762 just two weeks ago.

“What’s concerning about the trajectory is that we’re seeing a much more rapid increase in the number of cases,” said Dr. Trish Perl, chief of infectious diseases at UT Southwestern Medical Center in Dallas.

“We are seeing unvaccinated people that are younger as opposed to earlier in the pandemic when we saw a lot of hospitalizations over 65. Now, the largest and the highest increases that we’re seeing are the 18-to-49-year-olds, and a lot of these people don’t have underlying illnesses.”

The surge in cases comes as Republican Gov. Greg Abbott wages war against local school and government officials who have reinstituted mask mandates, threatening $1,000 fines against municipalities and officials who defy him. He first banned local mask mandates in a May 18 executive order, then issued a second order July 29 levying fines against any county, city, school district, health agency, or government official who disobeys his directive.

The second order also prohibited all public and private entities, government agencies, from requiring individuals to get vaccinated or submit proof of vaccination.

Local officials across Texas are defying state leaders, turning to the courts to challenge Abbott.

A district court judge in Bexar County, home to San Antonio, issued a temporary restraining order Tuesday against Abbott’s ban on mask requirements, allowing local officials to reinstate the mandates and other emergency orders to combat the delta variant.

About 300 miles north, the Dallas Independent School District issued a temporary mask requirement on Monday for all district properties.

Dallas County Judge Clay Jenkins followed that with a new mask mandate for schools, businesses and county buildings on Wednesday after a local judge gave him a temporary restraining order that restricts Abbott from enforcing his ban.

Abbott has vowed to fight the restraining orders. In a joint press release with State Attorney General Ken Paxton, the two said they are relying on personal responsibility and protecting “the rights and freedoms of all Texans.”

“Attention-grabbing judges and mayors have defied executive orders before, when the pandemic first started, and the courts ruled on our side – the law,” Paxton said in the statement. “I’m confident the outcomes to any suits will side with liberty and individual choice, not mandates and government overreach.”

Austin Mayor Steve Adler said he is weighing a citywide mask mandate if “the science, the data, and the doctors tell us that’s something that needs to happen in order to keep the community safe.”

“Local school districts ought to be able to make that decision themselves to provide the best protection for their children,” Adler said in an July 28 interview with CNBC.

“I haven’t heard any scientific or data-driven rationale for a policy that doesn’t allow masking to be enforced in order to protect the public health,” Adler said, adding that he is “strongly recommending that all children in schools wear masks, and that teachers and guests in the school do the same thing.”

Hospitalizations, meanwhile, keep climbing. The Lyndon B. Johnson Hospital in Houston and St. Luke’s Hospital in the nearby Woodlands have set up overflow tents outside to handle the influx of patients, a majority of whom are unvaccinated, according to local officials. Texas lags the U.S. in vaccinations with 53.6% of its total population receiving at least one shot, compared with 58.9% nationwide, according to the Centers for Disease Control and Prevention.

Abbott asked the Texas Hospital Association earlier this week to voluntarily postpone elective medical procedures to free up ICU beds and said the state was bringing in 2,500 out-of-state medical personnel to relieve exhausted doctors and nurses.

“This help could not come fast enough. Many hospitals have already idled non-essential services and are diverting patients to extend staffing capability,” Texas Hospital Association President Ted Shaw said in a statement Tuesday. “The hospital industry is losing frontline staff, particularly nurses, to burnout and illness; many have left the profession due to the extreme nature of the work during a relentless pandemic.”

More than 90% of all ICU beds in Texas were full with roughly 40% dedicated to Covid patients as of Wednesday, according to the Department of Health and Human Services.

While cases and deaths across the nation are down from their January record highs, they are on the rise again — but at a much faster pace in Texas. The state’s death toll is also on the rise at a seven-day average of 57 daily Covid deaths as of Monday, up 36% from last week but below the record average of more than 341 deaths per day in late January 2021, according to Hopkins data.

“It’s honestly heartbreaking. There’s this feeling that they’re invisible but that’s not true, we are seeing critically ill individuals,” said Perl, of UT Southwestern Medical Center in Dallas. She said vaccinations are the “absolute best defense.”

Editor’s note: Nate Ratner and Robert Towey reported from New York and New Jersey, respectively.