HOUSTON (AP) — Texas’ most populous county on Thursday joined the legal battle by local officials seeking to override Gov. Greg Abbott’s ban on mask mandates and institute protections against COVID-19 as hospitals around the state continue to swell with patients sickened by the virus.

Harris County, where Houston is located, first filed a lawsuit against Abbott’s executive order banning mask mandates by any state, county or local government entity. A few hours later on Thursday, Harris County Judge Lina Hidalgo announced the county health authority had issued an order requiring that people must wear masks when inside any public school, non-religious private school or licensed child care center in the county.

“Vaccination remains the primary way to protect our community from COVID-19. However, children 12 and under remain ineligible for the vaccine. At this point, public health interventions like masking, contact tracing and notifications in schools remain their only protection against this virus,” said Hidalgo, the top elected official in Harris County, which has 4.7 million residents and is the third most populous U.S. county.

Bexar, Dallas and Fort Bend counties along with San Antonio have also sued Abbot t and have been granted temporary restraining orders that for now let them put mask mandates in place in their communities.

The dispute over mask mandates in Texas comes as COVID-19 hospitalizations continued to rise, increasing to 10,791 on Thursday, the most since Feb. 2. In the past month, hospitalizations have increased by 343%. State health officials reported 120 deaths on Thursday, the most since March 1.

“The current wave of the Delta variant presents a real and imminent threat to our most vulnerable populations, and local officials need to be able to respond to this crisis. The governor’s executive order acknowledges this crisis, and then bans any meaningful action to address it,” Harris County Attorney Christian Menefee said in a statement.

Abbott said Wednesday the Texas Disaster Act gives him the power to guide the state through emergencies and “the path forward relies on personal responsibility—not government mandates.”

“Any school district, public university, or local government official that decides to defy the order will be taken to court,” Abbott said.

Texas Attorney General Ken Paxton’s office has already asked a state appeals court in Dallas to stay a temporary restraining order granted to Dallas County on Tuesday that is allowing the county to require that masks be worn inside schools, county buildings and businesses.

The lawsuits filed against Abbott’s executive order were expected to end up before the all-Republican Texas Supreme Court, which has often ruled in favor of Abbott and Paxton.

In addition to the lawsuits, various school districts around the state have also defied Abbott’s executive order and have mandated that students, faculty and staff wear masks as a new school year resumes this month. School districts in Austin, Dallas, Fort Worth, La Joya, San Antonio and Spring have put in place mask mandates.

Late Thursday afternoon, the Brownsville school district board of trustees approved a mask mandate for its campuses in South Texas. The board announced it also planned to sue Abbott over his executive order.

The superintendent of Houston’s school district, the state’s largest, planned to ask his school board to approve a mask mandate during a Thursday evening meeting.

Officials from hospitals around the state say their facilities are overrun with COVID-19 patients and many don’t have enough nurses and other personnel to adequately staff intensive care unit or ICU beds.

In Corpus Christi in South Texas, officials on Thursday began using an ambulance bus, which can care for up to 21 patients, as a temporary emergency room to relieve the “current strain on our health care system,” said Mayor Paulette Guajardo.

Dr. Rohith Saravanan, chief medical officer at Odessa Regional Medical Center in West Texas, said Thursday the surge of COVID-19 cases has many medical personnel at his hospital feeling defeated as they thought they were winning the battle against the virus, feeling angry that people are not using the tools — vaccines and masks — that are available to beat the virus and feeling depressed because younger individuals are now getting sick.

“Nobody wants to go through this again. The hospitals do not want this surge, do not want to take care of these many COVID patients. We are here for you if you need us. But we’re hoping that you’ll do your part to make sure this does not get to where it’s projected to get to,” Saravanan said.

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Juan A. Lozano, The Associated Press