Updated at 4:20 p.m.: Revised to include Abbott comments and additional information.

Dallas-area hospitals are pressuring Gov. Greg Abbott to order residents to stay at home and warning a surge of patients sick with the new coronavirus could deplete their bed capacity by late April, according to an email from a Dallas-area hospital association obtained by The Dallas Morning News.

But Abbott, saying that the outbreak is concentrated in the state’s urban centers, indicated Sunday that he wanted to take other steps first before imposing stricter standards statewide that would impact rural areas still unaffected by the virus.

The chilling warning, based on one projection the association included in the email sent Saturday, illustrates how quickly Texas hospitals could be overrun by the spread of the new coronavirus and the disease it causes, COVID-19.

“We need your help,” Steve Love, president and CEO of the Dallas-Fort Worth Hospital Council wrote in an email Saturday urging his members to pressure the governor to impose a shelter in place order. “Thank you for your immediate action as we want the governor to take this urgent action statewide rather than individual counties or cities.”

Love’s email, coupled with additional letters sent this weekend from mayors, health care executives, school leaders and business owners in the Dallas area, represents the latest effort to pressure the governor for stricter restrictions to combat the virus’s spread.

As of Sunday, there have been nearly 600 positive cases of COVID-19 in Texas, based on The News’ database of reported cases.

Abbott said Sunday, however, he needs to measure the effectiveness of his recent executive order that temporarily closed schools and banned large crowds before enacting stricter steps.

President Donald Trump defended Abbott on Sunday night, when asked at a White House briefing if he is comfortable with Texas holding off on a stay-at-home order despite warnings from hospitals of dire consequences within weeks.

“He’s a great governor, and he knows what he’s doing. A lot of the areas that he’s talking about, a lot of the counties he’s talking about are not very strongly affected," Trump said. “. ..I have total confidence in Gov. Greg Abbott.”

Pressed as to whether the lack of uniform restrictions among states and within states is acceptable, Trump said it is.

“Every state’s different. Idaho, West Virginia, Iowa, Nebraska, are much different than New York, than California — Los Angeles as an example or San Francisco,” he said, noting that current hot spots for the outbreak are in Washington state, California and New York. “That’s the hot spot like no other hot spot.”

Still, to expand hospital bed capacity, Abbott ordered health care facilities postpone nonessential procedures and suspended certain regulations to let hospitals treat more than one patient in each room. The measure directs dentists as well as doctors to delay for a month “all surgeries and procedures that are not immediately medically necessary” to preserve a patient’s life or avoid “adverse medical consequences.”

“Together these orders will free up countless hospital beds across the entire state of Texas to be able to treat the potential increase in COVID-19 patients,” Abbott said in a press conference at the Capitol.

Abbott’s current executive order — which took effect over the weekend — bans “social gatherings” larger than 10 people and closes certain businesses such as bars and gyms, but allows other offices to remain open.

Under California’s stay-at-home order, only business sectors identified as essential — such as health care, energy, financial services, food and agriculture — can continue having employees show up at work.

The hospital council suggested in a graphic it attached in its email that if nothing changes more than 200,000 Texans will be hospitalized by the middle of May — far outpacing some 50,000 beds available. However, if Abbott immediately adopts a shelter ordinance similar to California’s, the number of people needing hospital care would be drastically reduced to the low thousands, according to a projection included in Love’s email.

A graphic attached to an email sent by the Dallas-Fort Worth Hospital Council illustrates when hospitals may reach capacity based on several different approaches to stop the spread of coronavirus.

Love said Sunday that all models have different assumptions, but most show hospitals experiencing “significant increased volume."

“I sent that graph to really illustrate what one epidemiologist projected and to say this could be quite serious,” he said. “We’re asking the community to do their part and let’s all work together to flatten the curve related to increased volume.”

CEOs from every member hospital — including Parkland Hospital & Health System, Baylor Scott & White, and UT Southwestern — approved the urgent plea to the governor, Love wrote in his pitch.

“UT Southwestern supports the stay-at-home intervention request from the DFW Hospital Council,” spokesman Russell Rian said in a statement. “The chart offers compelling analysis indicating the need to adopt further intervention to prevent community transmission and the impending threat of overwhelming Texas hospital capacity.”

The email asked for additional review and more data to better gauge when hospitals may run out of room.

Separately, the mayors of Dallas, Fort Worth and Arlington wrote a letter to Abbott on Saturday requesting he consider issuing a shelter-in-place order, or at least strongly recommending people stay at home to stop the spread of the highly contagious virus. Several Dallas-area medical centers and the hospital council also signed on.

“While the temporary economic ramifications of such decisions weigh heavily on us, we know that public health must be our primary concern,” the letter said. “Our recommendation for statewide shelter-in-place directives are based upon our health care system’s ability to handle volume surges in our hospitals.”

A similar letter, on Dallas city letterhead, was signed by the superintendent of DeSoto ISD, the CEO of Goldman Sachs Realty Management and the president of the Dallas Regional Chamber.

Abbott said cities and counties could impose their own shelter-in-place orders. On Sunday evening Dallas County did just that, ordering residents to stay in their homes except for essential work and errands, in what are the strictest limits yet on social gatherings and movement in Texas.

“At this time, it is not the appropriate approach to mandate that same strict standard across every area of the state, especially at a time when we are yet to see the results coming out of my most recent executive order," Abbott said. “That said, as I have said before, I will always remain flexible.”

In a televised town hall last week, Abbott said he recently evaluated hospital bed inventory in Texas. If capacity is reached, he said, CEOs of major hospital groups told him medical tents and recently closed healthcare facilities can provide backup. Those without serious symptoms, but who need to isolate for two weeks, could do so in hotel rooms, he said.

For most people, the new virus causes only mild or moderate symptoms, such as fever and cough. For some, including older adults and those with existing health problems, it can cause more severe illness, including pneumonia. The vast majority recover.

The hospital association also wants the governor to obtain the maximum amount of medical supplies from the federal government and issue an executive order allowing medical and nursing students to immediately get to work after graduation even if they did not complete their clinical rotations due to the spread of the coronavirus.

Abbott explained Sunday the state does not have enough testing equipment or personal protective gear that doctors must wear when meeting potentially ill patients.

“We have the money for it, but the supplies are not available for us to able to purchase,” Abbott said, adding he is asking the federal government to accelerate production and supply of both.

“The financial challenges they are grappling with in Washington, D.C., to try to address the economic consequences of COVID-19 can be solved quicker the sooner they provide states with the supplies that we need," he said.

Meanwhile, the state’s largest hospital association said they were monitoring a number of scenarios.

“We’re constantly discussing what stronger actions are needed from our perspective, but at a minimum, an extension past the 15 days [of Abbott’s current order] is going to be necessary given the modeling,” Carrie Williams, a spokeswoman for the Texas Hospital Association, said in a statement. “Our most important resources are our health care workers, and we have to do everything we can to protect them.”

Austin Bureau Chief Robert T. Garrett and Washington Bureau Chief Todd J. Gillman contributed to this story, which includes material from the Associated Press.