As the U.S. emerges from the COVID-19 crisis, Missouri is becoming a cautionary tale for the rest of the country: It is seeing an alarming rise in cases because of a combination of the fast-spreading delta variant and stubborn resistance among many people to getting vaccinated.
Intensive care beds are filling up with surprisingly young, unvaccinated patients, and staff members are getting burned out fighting a battle that was supposed to be in its final throes.
The hope among some health leaders is that the rest of the U.S. might at least learn something from Missouri's plight.
"If people elsewhere in the country are looking to us and saying, 'No thanks' and they are getting vaccinated, that is good," said Erik Frederick, chief administrative officer at Mercy Hospital Springfield, which has been inundated with COVID-19 patients as the variant first identified in India rips through the largely non-immunized community. "We will be the canary."
The state now leads the nation with the highest rate of new COVID-19 infections, and the surge is happening largely in a politically conservative farming region in the northern part of the state and in the southwestern corner, which includes Springfield and Branson, the country music mecca in the Ozark Mountains where big crowds are gathering again at the city's theaters and other attractions.
While over 53% of all Americans have received at least one shot, according to the Centers for Disease Control and Prevention, most southern and northern Missouri counties are well short of 40%. One county is at just 13%.
Cases remain below their winter highs in southwestern Missouri, but the trajectory is steeper than in previous surges, Frederick said. As of Tuesday, 153 COVID-19 patients were hospitalized at Mercy and another Springfield hospital, Cox Health, up from 31 just over a month ago, county figures show.
These patients are also younger than earlier in the pandemic — 60% to 65% of those in the ICU over the weekend at Mercy were under 40, according to Frederick, who noted that younger adults are much less likely to be vaccinated — and some are pregnant.
He is hiring traveling nurses and respiratory therapists to help out his fatigued staff as the rest of the country tries to leave the pandemic behind.
"I feel like last year at this time it was health care heroes and everybody was celebrating and bringing food to the hospital and doing prayer vigils and stuff, and now everyone is like, 'The lake is open. Let's go.' We are still here doing this," he said.
There are also warning signs across the state line: Arkansas on Tuesday reported its biggest one-day jump in cases in more than three months. The state also has low vaccination rates.
Lagging rates — especially among young adults — are becoming an increasing source of concern elsewhere around the country, as is the delta variant.
The mutant version now accounts more than 20% of new COVID-19 infections in the U.S., doubling in just two weeks, the CDC said Tuesday. It is responsible for half of new cases across a swath that includes Missouri, Iowa, Kansas, Nebraska, Colorado, Montana, North Dakota, South Dakota, Utah and Wyoming.
"The delta variant is currently the greatest threat in the U.S. to our attempt to eliminate COVID-19," said Dr. Anthony Fauci, the nation's top infectious disease expert. He said there is a "real danger" of local surges like the one in Missouri in places with deep vaccine resistance.
To help counter the threat, administration officials are stepping up efforts to vaccinate Americans ages 18 to 26, who have proved least likely to get the shot when it's available to them.
Elsewhere around the world, Britain, with an even higher vaccination rate than the U.S., has postponed the lifting of remaining restrictions on socializing in England because of the rapid spread of the variant. Israel, another vaccination success story, is reacting by tightening rules on travelers.
In Missouri, Republican Gov. Mike Parson has taken the position that it is better to ask people to take "personal responsibility" than to enact restrictions.
Missouri never had a mask mandate, and Parson signed a law last week placing limits on public health restrictions and barring governments from requiring proof of vaccination to use public facilities and transportation.
Missouri Health Department spokeswoman Lisa Cox said the agency is encouraging people to get vaccinated, but confessed: "This is the Show-Me State and Missourians are skeptical."
Frederick said some people in the heavily Republican state are resistant because they feel as if Democrats are pushing the vaccine.
"I keep telling people, while we are busy fighting with each other, this thing is picking us off one by one," he said. "It takes no sides. It has no political affiliation. It is not red. It is not blue. It is a virus. And if we don't protect ourselves, we are going to do a lot of damage to our community."
Steve Edwards, CEO of Cox Health, lamented in a tweet that while a number of major news organizations have contacted the hospital about the rise in cases, Fox News was not among them.
"Fox," he tweeted, "is the most popular cable news in our area — you can help educate on Delta, vaccines and can save lives."
Lisa Meeks, 49, of Springfield, is among those who haven't been vaccinated. She said that she is a Christian and that God gave her a strong immune system.
"As of right now, nobody knows anything long term or short term about these vaccines because they are brand new," she said, despite months of real-world evidence that the vaccines are highly safe and effective. "And so people are now basically the lab rats."
An offer of free beer from Mother's Brewing Co. in Springfield for those who get vaccinated drew a disappointing 20 to 50 people to each of the first three clinics.
"We keep trying," said Jeff Schrag, owner and founder of Mother's Brewing. "It is a game of inches."
As immunizations slow, the delta variant has become the predominant form of the virus in the region. Aaron Schekorra, a spokesman for the Springfield-Greene County Health Department, said it makes up 93% of the random sample of cases that the county is sending for analysis, up from 70% three weeks ago.
He said that unvaccinated people gathering for graduation celebrations and Memorial Day festivities also fueled the spread of the virus. The events came just as the community lifted its mask mandate.
"My concern," he said, "would be that this is a preview of what is to come in other parts of the country that don't have higher vaccination rates."