MOUNTAIN HOME, Ark. – When the boat factory in that green town in the Ozark Mountains offered free coronavirus vaccinations this spring, Susan Johnson, 62, a receptionist there, declined the offer, thinking she would be safe as long as she never leaves her home without a mask.
Linda Marion, 68, a widow with chronic lung disease, worried that a vaccination could actually trigger Covid-19 and kill her. Barbara Billigmeier, 74, an enthusiastic golfer who has withdrawn from California, believed she didn’t need it because “I never get sick”.
Last week, all three patients were on 2 West, an overflow ward now primarily devoted to treating Covid-19 at Baxter Regional Medical Center, the largest hospital in northern Arkansas. Ms. Billigmeier said the scariest part was that “you can’t breathe”. For 10 days, Ms. Johnson relied on her lungs to be supplied with oxygen through nasal tubes.
Ms. Marion said that at one point she felt so sick and scared that she wanted to give up. “It was just awful,” she said. “I felt like I couldn’t take it.”
But despite all the hardships, none of them changed their minds about the vaccination. “It’s just too new,” said Ms. Billigmeier. “It’s like an experiment.”
As much of the nation tiptoes toward normalcy, the coronavirus is once again inundating hospitals in places like Mountain Home, a town of fewer than 13,000 not far from the Missouri border. One of the main reasons, say health officials, is the emergence of the new, far more contagious variant called Delta, which is now responsible for more than half of all new infections in the United States.
The variant has opened up a new divide in America, between communities with high vaccination rates, where it barely makes waves, and those like Mountain Home that are under vaccinated, where they turn life upside down again. Part of the country breathes a sigh of relief; a part is holding its breath.
While infections increased in more than half of the country’s counties last week, those with low vaccination rates were far more likely. Among the 25 counties with the highest increases in cases, all but one had vaccinated less than 40 percent of residents and 16 had vaccinated less than 30 percent, according to an analysis by the New York Times.
In Baxter County, where the hospital is located, fewer than a third of residents are fully vaccinated – below both the state and national averages. In the surrounding counties that the hospital serves, even fewer people are protected.
“It’s absolutely flooded,” said Dr. Rebecca Martin, a pulmonologist, on the round of 2 West one morning last week.
In the first half of June, the hospital had an average of only one or two Covid-19 patients a day. On Thursday, 22 of the unit’s 32 beds were occupied by coronavirus patients. Five more were in the intensive care unit. Within a single week, the number of Covid patients had increased by a third.
Overall, Arkansas ranks at the bottom end of the state for the percentage of the vaccinated population. Only 44 percent of residents received at least one shot.
“Boy, we’ve tried pretty much anything we can think of,” said Robert Ator, retired National Guard Colonel who leads the state’s vaccination efforts, in an interview. For about every third resident he said: “I don’t think there is anything we could do in the world to get them vaccinated.”
The state pays a price for this. Hospital admissions have quadrupled since mid-May. More than a third of the patients are in the intensive care unit. Deaths, a lagging indicator, are also expected to rise, health officials said.
Dr. José R. Romero, the state health director, said he still believes that enough Arkansans are vaccinated or immune to Covid-19 that the “darkest days” of December and January were behind them. “What worries me now is that we will have a climb or a climb,” he said, “then the winter will add another climb, so we will have a climb in addition to a climb.”
Dr. Mark Williams, the dean of the University of Arkansas College of Public Health for medical sciences, said the Delta variant would turn his predictions for the pandemic upside down. It is spreading “very quickly” in the unvaccinated population of the state and threatens the ability of hospitals to cope with it. “I would say we are definitely at the alarming stage,” he said.
At Baxter Regional, many doctors and nurses are gearing up for another wave while they are still exhausted from battling the pandemic they thought had subsided.
“I got flashbacks like PTSD,” said Dr. Martin, the pulmonologist obsessed with caring for her patients. “That sounds very selfish, but unfortunately it’s true: the fact that people aren’t vaccinated means that I can’t go home and see my kids for dinner.”
The Biden government has pledged to contain outbreaks by providing Covid-19 tests and treatments, promoting vaccines with advertising campaigns, and sending community health workers door-to-door to convince those who hesitate.
But not all of these tactics are welcome. Dr. Romero said Arkansas would like to accept more monoclonal antibody therapies, a Covid-19 treatment widely used in outpatient settings. But Mr Ator, the vaccine coordinator, said that knocking would “probably do more harm than good,” as local residents suspect federal authorities are suspicious.
Both said the Arkansas public has been saturated with vaccination campaigns and incentives, including free lottery tickets, hunting and fishing licenses, and booths offering shots in state parks and high school graduations.
July 18, 2021, 2:49 p.m. ET
The last mass vaccination event was May 4th, when the Arkansas Travelers, a minor league baseball team, had their first game since the pandemic outbreak. Thousands gathered at the Little Rock Stadium to watch. Fourteen shots accepted.
Even healthcare workers have shied away from being vaccinated nationwide, said Dr. Romero.
In April, state lawmakers added another roadblock, making it essentially illegal for state or local facilities, including public hospitals, to have a coronavirus vaccination as a condition of education or employment until two years after vaccination is fully licensed Food and Drug Administration to request. That almost certainly means that no such requirements can be enacted until the end of 2023.
Only the fear of the Delta variant seems to drive some off the fence.
When the pandemic broke out, Baxter Regional became a vaccine distribution center and vaccinated 5,500 people. However, according to Jonny Harvey, his coordinator for occupational medicine, only half of the 1,800 employees accepted syringes. By early June, demand had dropped so much that the hospital was administering an average of one per day.
Now, Harvey said, he is ordering enough vaccine to give 30 shots a day because people are increasingly afraid of the Delta variant. “I hate that we have the boom,” he said. “But I think it’s good that we vaccinate people.”
Vaccines are also suddenly becoming more popular at the state’s only academic medical center in Little Rock, operated by the University of Arkansas for Medical Sciences. In the past two weeks, the proportion of hospital staff who have been vaccinated has increased from 75 percent to 86 percent.
But these encouraging signs are being outweighed by the increasing number of Covid-19 patients. Little Rock Hospital hosted 51 patients on Saturday, more than ever since February 2. There was one coronavirus death in April. In June there were six.
Dr. Williams, who recorded the coronavirus trajectory, said the surge in infections and hospital stays reflected what he saw in October. And there are other worrying signs as well.
A larger proportion of those who are now infected need hospitalization. And there, said Dr. Steppe Mette, the chief of Little Rock Hospital, seemed to need a higher level of care than those who were sick of the original variant. Even though they are younger.
The median age of a coronavirus patient in Arkansas has dropped nearly a decade since December – from 63 to 54 – reflecting the fact that three-quarters of senior Arkansans are at least partially vaccinated. But some patients at Little Rock Hospital are in their 20s or 30s.
“It’s really daunting to see younger, sicker patients,” said Dr. Mette. “We didn’t see that level of disease earlier in the epidemic.”
Young, pregnant coronavirus patients used to be rare in the hospital. But in the end four or five of them ended up in the intensive care unit. Three were treated with a machine called ECMO – short for extracorporeal membrane oxygenation – a step that is seen as a last resort after ventilator failure. The machine directs blood from the body into a device that adds oxygen and then pumps it back into the patient.
Ashton Reed, 25, a district attorney general coordinator, was about 30 weeks pregnant when she was admitted to the hospital on May 26, critically ill. To save her life, the doctors delivered her baby by emergency caesarean section and then hooked her up to the ECMO machine.
In a public announcement later urging vaccination, her husband said she moved from sinus problems to life support within 10 days.
“I almost died,” she said. “My opinion about the vaccine has definitely changed.”
Last month, the hospital had to reopen a coronavirus ward that it closed in late spring. A second reopened on Monday.
Many of the nurses there wore colorful stickers that said they had been vaccinated. Ashley Ayers, 26, a traveling nurse from Dallas, didn’t. Noting that vaccines typically took years to develop, she said she was concerned that vaccination could affect her fertility – although there is no evidence to support it.
“I just think it was rushed,” she said.
David Deutscher, 49, one of her patients for almost a week, is no longer a holdout. A specialist in heating and air conditioning and an Air Force veteran, he said he fought Covid at home for 10 days before going to the hospital with a 105-degree fever.
The experience shook him to the core. He burst into tears describing it and apologized for being an emotional wreck.
When he did not get better with monoclonal antibody treatment, he said, “That was probably the greatest fear I have ever had.” He called a friend, the daughter of a medical researcher, from his hospital bed. “Please don’t let me die,” he said.
He said he never got vaccinated because he thought a mask would be enough. He’s had the flu once in the past 21 years.
“When I started to feel better,” said Mr. Deutscher, “I answered the phone and just called everyone to tell them to get the vaccine.” He didn’t even wait for his release.
The corona virus was “not a joke,” he told his friends. Three of them got a shot.
Mr. Deutscher went home on July 9th and brought a song for one of his five grandchildren that he had written in his hospital bed. His theme was the value of life.
Robert Gebeloff contributed the reporting and Kitty Bennett contributed the research.