Texas is at the centre of huge spike in coronavirus cases in the US, with hospital admissions quadrupling since the end of May.
Sky News's special correspondent Alex Crawford has travelled to Houston, the state's most populous city, where medics are warning that they are becoming stretched.
At the Houston Memorial Medical Centre (HMMC), one doctor told her they are "heading to pure hell".
One of the first tasks on entering the coronavirus wing at the HMMC is to get your photograph taken.
It's to hang around your neck so the patients can relate better to you and see what you really look like.
Because after three layers of protective tunics, double gloves, double shoe coverings, a plastic beret, two masks and a full face visor, you look more like an astronaut from the city's famous Lyndon B Johnson Space Centre than a medic.
The medics at HMMC are not taking any chances
Strict hygiene protocols are among the reasons the hospital team can boast a 100% success rate in treating COVID-19 patients over a period which lasted longer than 80 days.
"Then the lockdown was lifted," chief medic Dr Joseph Varon told us. "And it changed. We are getting many more patients, they are coming to us much sicker and a few are so sick, we can't save them."
Still, even the hospital's reduced success rate of 96% is impressive.
But now Dr Varon, along with the state's other doctors, is bracing himself for what's been called the "tsunami" of infections heading this way.
They are already adapting a 30-bed wing to cope with the extra patients they believe will come in the next few weeks.
The number of coronavirus cases in Texas has nearly tripled in two weeks and there have been days of record high infections in the largest city, Houston.
The city streets around testing centres are filled with vehicles carrying worried people waiting to be swabbed.
Those queues are likely to be a lot longer after the weekend's Independence Day celebrations, with the doctors frantic about how they'll cope and city hospitals already nearing capacity.
Dr Varon took the Sky News team around the hospital's ICU, joining the chorus of medics, scientists and politicians pleading with Texans to be vigilant in not spreading the virus.
"Because if you aren't, you will die," Dr Varon said.
"There's no more Mr Nice Guy now. You must stick to the guidelines, wear a mask and keep social distances because otherwise you are going to get killed or you will kill someone else."
Texas was one of the first states to end the stay-at-home measures in order to revive the economy - a decision which Governor Greg Abbott has admitted was a mistake.
That mistake now looks set to make the state the worst affected in the country, with Houston being the epicentre of the new epicentre.
The frustration among the medical staff is acute.
"I've been an emergency care nurse for 20 years," one tells me.
"I'm passionate about my job but I can't save everyone and if people are ignorant, and not going to take precautions, then they are going to have to die so the rest of us can live."
Dr Varon admits he's "thrown the kitchen sink" at trying to find new ways of beating this virus.
And now he thinks there's a game-changer.
He and a group of medical colleagues from five different hospitals across America have created a cocktail of commonly but separately-used drugs they're calling the Math+ protocol - and the combination is having some staggering results.
Math+ includes cortisone steroid, vitamins and anti-coagulants to try to curb the key challenges caused by the virus - blood clotting and inflammation.
"We've been doing it for a few months now,' Dr Varon said, and "it's working a charm".
He very much believes the hospital's 100% success rate for nearly three months is down to Math+.
But the medical team is also using other methods; among them, stem cells and a mechanically-operated "vest", which constantly vibrates to shift the secretions caused by coronavirus.
But Dr Varon is convinced the real difference is with Maths+.
"No-one needs to die from coronavirus any more," he said.
"This won't cure you of coronavirus but it can stop the build-up of problems which can lead to you needing a ventilator and when that happens, your chances of survival are only about 20%.
"Putting someone on a ventilator is like signing their death warrant.
"Finally, we have an option and I think it's going to work."
When I suggest that critics might accuse him of using his patients as guinea pigs, he insists he's not worried, saying: "They have life!"
But he's expecting to see many more thousands of infected people needing hospital help in the next fortnight.
"It will be critical and I think we are heading to pure hell."
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July 04, 2020 at 12:31AM
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