BUFFALO, N.Y. — Over the past month, the number of coronavirus cases has increased tenfold in the upstate city of Buffalo and its surrounding suburbs. Hospitalizations already have surpassed the levels seen in the spring. And the Covid-19 hotline for Erie County, where Buffalo is situated, is getting “annihilated,” the health commissioner said, with 1,500 calls in one 24-hour period this week.
“The second wave is here, and it is here with a vengeance,” Mark Poloncarz, the county executive, said at a news conference, urging residents to take the surge seriously.
Western New York, a bustling five-county region of some 1.4 million people along the Canadian border, has emerged as the biggest trouble spot of the state’s second coronavirus wave. If New York City was the hot spot of the spring, then this area seems to presently have that distinction.
Normally known for its neighborliness, its Buffalo Bills football team and its namesake spicy chicken wings, the region now gets regular criticism from Gov. Andrew M. Cuomo for its average positive test rate, which has remained around 5 percent for two weeks.
By the numbers alone, the Buffalo area already meets the benchmarks for the harshest restrictions available to the state — the closing of nonessential businesses and the banning of public gatherings — yet officials have held off.
But as the cases continue to rise, that designation seems almost inevitable.
“We’re watching the numbers,” Mr. Cuomo said on Wednesday. “We’re going to watch through this Thanksgiving season.”
The rise in Erie County has been a more extreme version of what is happening statewide, and more so resembles the uptick in other regions of the country. Since mid-October, the number of cases in the county has gone from 322 per week to 3,449 per week. Hospitalizations have risen from 84 on Nov. 10 to 264 on Nov. 23. While hospitals have sufficient beds for now, county officials said, staff is being stretched thin.
The St. Joseph Campus Hospital, part of the region’s Catholic Health hospital system, has returned to being a coronavirus-only hospital as it was in the spring, with its emergency department temporarily closed.
Intensive care admissions are increasing at a slower rate, because of improvements in care, though 40 people have already died of the virus in November, bringing the total coronavirus fatalities in the county to 788 people.
In an encouraging sign, Erie County’s infection rate has leveled off at around 7 percent in the last few days, indicating that some restrictions are having an effect. As the message has gotten through, there are now lines to get coronavirus testing, and masking in public places is generally good, residents said, although there has been some pushback regarding current virus restrictions.
“I do believe the vast majority of people in my community are taking it seriously, whether they live in the city of Buffalo or they’re in a rural community,” Mr. Poloncarz, a Democrat, said in an interview. “But there are some folks who are not. And unfortunately, those individuals put at risk the entire community for further shutdowns.”
How Western New York got here is not clear cut. Local epidemiologists and officials say that there was no large outbreak that triggered this second wave. Multigenerational households in Buffalo’s poorer neighborhoods, which suffered disproportionately early in the spring — when more than 500 people died in the county — have not been the hardest hit this time.
Rather, said Mr. Poloncarz, it seems that the November surge started in the wealthier, more conservative suburbs, where people appeared to be not taking enough precautions in private gatherings, bars or restaurants. The spike also began in the days after Halloween, leading some epidemiologists to believe that parties played a part.
But transmission at this point is so widespread in the county that irresponsible behavior is not required to get sick, said Dr. Thomas A. Russo, the chief of infectious disease at the Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo. In what he calls the “innocent bystander effect,” many infections now are being spread among family members in private homes, brought in by people who are asymptomatic.
Coupled with the small, but significant, minority resisting masking and other restrictions, the virus is finding enough hosts to fuel the ongoing community transmission, he said. Even 20 percent of people not complying is enough, he added.
“I think people here certainly know that we have to regroup, and we have probably been doing better in the last week or so,” Dr. Russo said. Still, he was worried. “Whatever ground we might have gained, I’m nervous we will lose it over Thanksgiving.”
In the past few weeks, Mr. Cuomo designated most of Erie County a yellow zone, the lowest level of his tiered, color-coded restriction system that limited gatherings and indoor dining, and then as an orange zone, the midlevel categorization that triggered the mandatory closure of personal care businesses like salons and gyms, as well as indoor dining. Schools are also closed for in-person attendance, but can reopen with strict testing protocols.
These restrictions have led to some anger, particularly from the more politically conservative suburbs around the city of Buffalo. A video recorded on Friday showing health inspectors and sheriff’s deputies attempting to stop an illegal gathering inside a gym in Orchard Park has been viewed nearly three million times. It gained national attention after Donald J. Trump Jr. retweeted it and said it was an example of “the tyranny from Democrat politicians.”
On Monday, the gym owner led an evening protest, attracting about 150 people. Across the street from Buffalo Bills Stadium, the protest had the jubilant air of the kind of tailgate parties normally held there that have been canceled this year because of coronavirus restrictions. Demonstrators waved signs at passing traffic on Southwestern Boulevard insulting Mr. Cuomo and calling on the area to reopen for the sake of peoples’ livelihoods.
“We’re here to fight for everybody,” said the gym owner, Robby Dinero, who was fined $15,000 for the gym gathering, as demonstrators in the background shook tambourines and gave speeches from the bed of a pickup truck. He said he planned more protests for as long as the restrictions remain in place.
But Rita Los, a retired attorney from Hamburg, where there were 236 cases last week, said she supports increased restrictions in part because she has noticed people getting “too comfortable” with one another and inviting people to their homes.
“Buffalo is ‘The City of Good Neighbors,’” she said, referring to one of the community’s nicknames. “And the problem with Buffalo is nobody thinks their neighbor will make them sick.”
Elsewhere, families are struggling and expressing frustration with the micro-cluster restrictions, even if they are not attending public protests. Laura Hodges, a physical therapist in the suburb of Amherst, was furloughed in the spring, and has yet to return to permanent, full-time work.
“I’ve applied for a bazillion jobs,” Ms. Hodges said. “And now this is just causing more uncertainty.” She said her family has had to use credit cards to pay off some bills, a situation that can’t be sustained indefinitely.
Kellie Klos, co-owner of Clayton’s Toy Store, a 105-year-old shop on Main Street in Williamsville, said she at least was relieved that Mr. Cuomo did not designate the area a red zone, the highest level of restrictions, on Wednesday.
“We do 60 percent of our business between Thanksgiving and Christmas,” she said. “If we had gone into a red zone now, that could have been permanently detrimental to this business, which would break my heart.”
“At least now we know we get another weekend,” she added.
Policymakers have been at a crossroads. For days, Erie County has technically met the standards for the governor’s red zone, which requires a rolling seven-day average positivity rate of 4 percent for 10 days. Some suburbs, including Lancaster and Hamburg, have reached a 9 percent positivity rate, among the highest in the state.
On Wednesday, Mr. Cuomo said that he was going to tweak the formula used to designate restriction zones to put more of an emphasis on hospital capacity, and that he would revisit the issue after Thanksgiving.
As the number of cases in Erie County ballooned from 350 a week in mid-October to 500 a day, contact tracers were swamped. Dr. Gale Burstein, the health commissioner, announced a triage system on Monday. Now, everyone tested by the county will get their results within 24 hours after the county receives them, but tracers will call back a day or two later to do the full interview and find out who else they should notify.
Third-party testing sites, like urgent care facilities and pharmacies, often send their coronavirus tests to labs, and results are sometimes not available for five to seven days. So contact tracing for those cases, especially as the numbers climb, can be futile.
“We can only control the testing the county does,” Mr. Poloncarz said. “It is a problem. We’re doing our best.”