CHICAGO — A second wave of coronavirus cases is charting a path far from coastal Washington State, California, New York and New Jersey, and threatening population centers in America’s middle. Emerging hot spots include smaller communities like Greenville, Miss., and Pine Bluff, Ark., and large cities like New Orleans, Milwaukee, Detroit and Chicago.

Local and state leaders find themselves struggling to deal with the deadly onslaught, urgently issuing guidance to residents and sounding the alarm over a dearth of equipment in local clinics and hospitals.

As the threat expands, the orders from state and local officials have sometimes been a chaotic, confusing patchwork. With mixed signals from the federal authorities in Washington, D.C., local leaders have wrestled with complicated medical and economic choices. Mayors and governors in Oklahoma, Massachusetts, South Carolina and Texas have clashed over which restrictions to impose on residents, dispensing contradictory instructions, even as their communities are being ravaged by the virus.