ALBANY, N.Y. — The snowstorm that blanketed the Northeast delivered record or near-record snowfalls to parts of upstate New York, prompting Gov. Andrew M. Cuomo on Thursday to declare a state of emergency in 18 counties outside New York City and its immediate suburbs.

The snow was particularly heavy in the state’s Southern Tier area, with the biggest city in the region, Binghamton, getting 41 inches, the National Weather Service said. At its heaviest, the snow was falling in Binghamton at a rate of more than four inches an hour, meteorologists said.

The city’s previous two-day snowfall record, set in March 2017, was 35.3 inches.

Officials in the city and in Broome County, where Binghamton is the seat, urged residents to stay off the roads to allow for plowing.

Early Thursday, the Broome County executive, Jason Garnar, said the county was using whatever four-wheeled vehicles were available to take hospital and nursing home workers to their jobs as the region continues to confront an increase in coronavirus cases over the last month.

In one instance, Broome County sheriff’s deputies used a Humvee to take a sick patient to the hospital after ambulances and snowmobiles were unable to reach a remote area. Parking lots at some hospitals and medical centers were also inaccessible, creating additional complications.

Some smaller towns and villages had not yet been able to get drivers into their snow plows.

The area’s major north-south highway, Interstate 81, was “basically a parking lot” on Thursday morning, Mr. Garnar said, after disabled vehicles snarled traffic. There were widespread reports of cars off the road elsewhere as well.

Richard C. David, Binghamton’s mayor, said that more than two dozen plows were working to clear the city’s streets on Thursday, but that several had broken down or gotten stuck in the snow.

“It’s historic levels here,” he said.

Most businesses were closed, and snow removal crews were planning to work through the night to try to dig out the city. There had been no reports of damage directly related to the snow, the mayor added.

Mr. David said residents of the region, a largely rural swath along Pennsylvania’s northern border, had been surprised by the storm’s intensity after initial forecasts that predicted from eight to 18 inches of snow.

Instead, the snowfall “was more than double” what was anticipated, he said, making it hard for plows to keep up.

The mayor said he woke up at 2:30 a.m. Thursday and was stunned to see what he described as whiteout conditions.

“I’d never seen it come down that fast, in that period of time,” he said.

“It was beautiful, actually,” he added.

The small rural town of Newark Valley, just northwest of Binghamton, appeared to have been hit even harder, getting around 44 inches of snow, according to Mr. Cuomo.

In Albany, the state capital, 22.7 inches had fallen at the airport as of Thursday afternoon. The city’s mayor, Kathy Sheehan, declared a state of emergency, closing civic buildings.

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