LAREDO, Texas — Each day at around 6 p.m., Dr. Ricardo Cigarroa goes through the same grim ritual. He sits at his desk and counts the dead.

“Five to seven death certificates, that’s how many I’m signing every single day,” Dr. Cigarroa, a 62-year-old cardiologist, said as he stared at the paperwork piling up one afternoon last week. “It only gets worse.”

During the pandemic’s deadliest month, Laredo has held the bleak distinction of having the most severe outbreak of any city in the United States over the last two weeks. As cases soar, the death toll in the overwhelmingly Latino city of 277,000 now stands at more than 630 — including at least 126 in January alone.

When the virus made its way to the borderlands almost a year ago, the bespectacled Dr. Cigarroa could have just hunkered down. He could have focused on his profitable cardiology practice, which has 80 employees. He could have kept quiet.

Instead, Dr. Cigarroa has become the top crusader and the de facto authority on the pandemic along this stretch of the border with Mexico.

On regional television stations, he calmly explains in his baritone voice, in both English and Spanish, how the virus is evolving. Known for making Covid-19 house calls around Laredo in his old Toyota Tacoma pickup, he is interviewed so often that Texas Monthly calls him “The Dr. Fauci of South Texas,” comparing him to Dr. Anthony S. Fauci, the country’s top infectious disease expert — though he holds no official government portfolio.

Lately, Dr. Cigarroa has been losing his patience.

Looking exhausted in a video posted on Facebook, he blasted political leaders for allowing the virus to rampage through this part of South Texas. Dr. Cigarroa singled out Gov. Greg Abbott, a Republican, for refusing to allow Laredo to impose stricter mitigation measures.

“To the governor: It’s OK to swallow your pride,” Dr. Cigarroa said, stunning some viewers with a warning that the virus could kill 1 in 250 Laredoans by midyear. “It’s OK to say that you’re not going to do it, and then do it to save lives.”

Pleading with the people of Laredo to consider civil disobedience in the form of staying home from work if politicians fail to act, he added, “The only thing that will save lives at this point will be staying home and shutting down the city.”

But his battle is not just with the governor: Though the city is 95 percent Latino, a group that has suffered a disproportionately high number of cases and deaths, many local leaders have been reluctant to close down businesses, and some in the public at large still flock to bars, restaurants and holiday gatherings.

The Republicans who dominate politics at the state level in Texas seem unmoved by appeals for more regulations. Mr. Abbott has rolled back occupancy at bars and restaurants and imposed a mask mandate in most of the state. But he said in November that he was ruling out “any more lockdowns,” determined to keep Texas — even parts of the state staggering under the effects of the virus — open for business.

“Increased restrictions will do nothing to mitigate Covid-19 and protect communities without enforcement,” Renae Eze, a spokeswoman for the governor, said of requests for tighter restrictions in Laredo.

She said the policies on restaurant and bar occupancy and face masks, adopted after consulting with medical experts, had proved effective in slowing the spread of the virus over the summer. And they can also work, she argued, in communities that have experienced spikes in recent weeks. “They can continue to work, but only if enforced,” she said.

Her implication — and Dr. Cigarroa admits it is not entirely wrong — was that local officials had not been aggressive enough about holding business owners and members of the public accountable for complying with the limited social distancing measures in place. But Dr. Cigarroa said that “a strong leader” is needed to guide cities through the crisis.

Around Laredo, Dr. Cigarroa sometimes steps into that void. Earlier in the pandemic, he said he confronted the members of a local bicycle club gathered at a taqueria after a long ride. “I don’t know why you bothered to take a 40-mile ride on your bicycle to stay healthy,” he told them, as he recounted the story. “You’re sitting here without masks, and I promise you within a month several of you will have Covid and may be intubated.”

Dr. Cigarroa said he has “no qualms telling people they need to protect themselves.” But he emphasized that Laredoans have become much better about wearing masks as the crisis has grown more severe.

Yet not everyone shares the same sense of urgency. Hundreds of families are mourning loved ones while chain restaurants like Olive Garden and IHOP remain busy with indoor diners.

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Bars remain open for business, and the parking lots of stores like Walmart, Target and H-E-B, a grocery chain, bulge with cars. Some enforcement orders, such as the city’s move in January to temporarily shut down two popular bars found by undercover police officers to be violating Covid-19 restrictions, have irked local businesses.

The rising death toll has laid bare the vulnerability of a city that is not just a frenetic hub for cross-border trade but a place where many people are at risk because of conditions like diabetes and obesity. Several generations often live in the same home in Laredo, limiting social distancing.

Similar challenges exist across the border in the Mexican city of Nuevo Laredo, where Dr. Cigarroa also occasionally makes house calls. He said cartel members there had begun controlling the trade in oxygen tanks. Some Nuevo Laredo families, Dr. Cigarroa said, plead with doctors to list pneumonia instead of Covid-19 as the cause of death so they can skirt regulations that prohibit family members from being present at Covid-19 burials, a phenomenon he said is contributing to an undercount of the pandemic’s toll along the border.

Sergio Mora, the host of the Laredo political podcast Frontera Radio, said the crisis hit home recently when in the space of a few days he lost two people close to him — a treasured longtime employee at his family’s towing company across the border, in Nuevo Laredo, and his grandmother.

“Dr. Cigarroa is a respected voice who is out there ringing the alarm bells,” Mr. Mora said. “People just need to listen.”

Agitating against the virus’s spread comes somewhat naturally to Dr. Cigarroa, a fourth-generation Mexican-American whose family forged one of Texas’s most remarkable medical dynasties.

Both Dr. Cigarroa’s father and uncle were influential doctors who led the effort to bring Texas A&M International University to Laredo at a time when state officials thought the city could not support a four-year university.

Born into a family of 10 children, two of Dr. Cigarroa’s siblings are nurses and three are doctors, including his brother, Francisco, a transplant surgeon and former chancellor of the University of Texas System. Dr. Cigarroa’s son, also a doctor, now practices in the same cardiology clinic he does.

When Laredo’s hospitals began struggling with the influx of coronavirus patients, Dr. Cigarroa, a graduate of Princeton University and Harvard Medical School, took the unconventional step of converting his practice into a makeshift Covid-19 clinic.

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  Each evening after Dr. Cigarroa signs death certificates, patients from around Laredo stream into the clinic where they are diagnosed, treated and sometimes promptly hospitalized in an adjacent part of the medical complex.

  Many are uninsured, but Dr. Cigarroa treats them anyway. He said his aim during the pandemic was not to make a profit but to stay afloat financially while paying the salaries of his employees.

  The daily grind of such a routine takes its own toll. In July, Dr. Cigarroa himself came down with Covid-19. At first he thought it would be a case of relatively mild “corona light” and opted to rest at home for a few days.

  But then he awoke short of breath, in a panic. Weighing on his thoughts, Dr. Cigarroa said, were the deaths just days earlier of two doctors in Nuevo Laredo who had contracted the virus.

  Wary of using any of Laredo’s last remaining doses of remdesivir, the antiviral drug used for treatment of Covid-19, he opted to be taken to University Hospital in San Antonio, where his brother is a doctor.

  “I went down like a dog baying at the moon,” Dr. Cigarroa said. “I was a bit callous before that. I came back a much better physician.”

  After recovering from what proved to be an intense bout of Covid-19, Dr. Cigarroa went back to work, treating patients while redoubling his efforts to educate the public about the pandemic. While the recent arrival of vaccines has sparked some hope, he is demanding answers as to why Webb County, home to Laredo, is still getting hit so hard.

  In the interview in his office, Dr. Cigarroa questioned whether racism was a factor in how the crisis was being managed in Texas. He asked why Republican state officials had allocated far more vaccine doses in recent weeks to a county like Lubbock, which has a population comparable to that of Webb County, but is proportionately less Latino.

  “Is it back to MALDEF and discrimination?” Dr. Cigarroa asked, citing the long-ingrained racism in Texas that pushed lawyers in the state to create a pioneering civil rights organization, the Mexican American Legal Defense and Education Fund, in the 1960s.

  One reason for the lower allocation could be that Laredo has thousands fewer health care workers, targeted for the early rounds of vaccinations, than does Lubbock, some local authorities have suggested.

  Dr. Cigarroa said the state’s “total disorganization” is surely one of the biggest problems.

  So he has started a very organized campaign of his own.

  His videos pleading for help from state officials are posted on Laredo Contra Covid 19 (Laredo Against Covid-19), a Facebook page created by his daughter, Alyssa, when the virus began tearing through the city in 2020. Then Ms. Cigarroa, a painter involved in urban revitalization projects, ran as a write-in candidate for a seat on the City Council.

  She sailed to victory in November, dislodging an incumbent by taking 84 percent of the vote. In a heated emergency council meeting in January in which members debated superseding Gov. Abbott’s relatively lax restrictions — a move that would almost certainly trigger a legal battle with the state — Ms. Cigarroa urged officials to request help from the National Guard to bolster vaccine distribution in the city.

  Pausing to reflect on how the pandemic is reshaping life along the border, Dr. Cigarroa beamed with pride for a moment about his daughter’s foray into politics. Then he seemed to remember what they were up against: political leaders as well as some in their own city who still seem unsure about which is the greater threat — the virus, or the loss of a semblance of normalcy and a way to make a living.

  Dr. Cigarroa has made it his mission to be sure they understand what is at stake.

  “This virus is going to continue to drill and drill and drill until people realize they’re not going to have employees,” he said. “Until we make the right decisions, it’s about money versus life.”

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