By Peter Slevin

On February 18th, deep in a deadly covid-19 winter at Cox Medical Center South, in Springfield, Missouri, the last patient was moved from the treatment ward they called the Tower, a large shell space hurriedly outfitted with beds, I.V. poles, oxygen, and beeping monitors. Hospitalizations were declining rapidly, and much of the front-line medical corps had access to vaccines that would soon be available to millions of Americans.

In the empty Tower, nurses giddily removed their protective masks and gowns, and laughed and danced, mimicking the moves from Pharrell Williams’s “Happy.” Soon, Kali Blair, a nurse at Cox South, was referring to covid in the past tense. “We were just really hopeful,” she said the other day, four floors down from the Tower, where dozens of new patients were severely ill. “I feel like some of us have lost that hope now.”

Seventeen months ago, Blair raised her hand to volunteer when the CoxHealth hospital system admitted its first covid patients. When the initial covid crush arrived, it swept her into a realm that required extraordinary strength and resilience. As patients neared death and relatives were unable to be with them, Blair often shared the final moments with families via video call. “Can we sing something? Do you want me to stroke their hair? Do you want me to hold their hand?” she recalled asking them. “Of course, you’re wearing a mask yourself, and you can’t wipe your eyes, and there’s tears.” And now, to her frustration, those times are back. On a single day in July, she told six different families that there was nothing left to do to save their loved ones.

When I met Blair last month, Springfield’s covid hospitalization numbers were rising; they soon topped their winter peaks. She had worked eight twelve-hour covid shifts in the previous two weeks, many of them in the Tower, which was open again and nearing capacity. I asked her to describe her days there. “It’s generally very loud in there,” she said. “Alarms are going off. A patient wailing or screaming or yelling. It’s just kind of complete chaos.” It’s crowded. It can take a half-dozen or more staff members to insert a breathing tube. Blue tarps fastened to frames of PVC pipe separate beds that stretch in long rows. For sick patients being wheeled onto the floor for the first time, the cacophony can induce panic. “We get asked by many patients, ‘Am I going to live? Am I going to make it out of here?’ ” Blair said. “You don’t know how to answer that question, because a lot of them don’t.”

By a recent estimate, the Delta variant now accounts for eighty-three per cent of sequenced cases in the United States. It is not only more contagious than the original strain of covid-19, it is also more aggressive. “Sicker, younger, quicker,” Steve Edwards, the CoxHealth president, tweeted. Yet, Delta is eminently stoppable, and that’s the confounding thing for the health-care workers who must deal with the fallout. Though some uncertainty remains about the long-term prognosis of patients with breakthrough cases, the vaccines largely prevent serious illness.

Since June 1st, CoxHealth has admitted nearly a thousand covid patients, roughly ninety-five per cent of them unvaccinated. In Greene County, where Springfield is located, fifty-six per cent of eligible residents have chosen not to get a shot. The numbers are even worse in surrounding counties. Blair said, “There’s people that will tell you on their deathbed, with their dying words, that covid’s not real, that this is all a conspiracy theory, this is a money-making scam. We really, truly do exhaust everything that we have in us to keep these patients alive. You already feel defeated, because most patients don’t make it. You feel a different kind of defeat, because you’re doing everything in your power to keep somebody alive, and they don’t believe in what you’re doing.”

The results of newly urgent vaccination efforts have been mixed, as I learned when I visited the working-class neighborhood of Westside. On West Madison Street, I met Tommy Freshour, a long-retired travelling ironworker, whose well-tended gray beard reached halfway down his chest. Sixty-eight years old, a heavy smoker, his muscles weakened by multiple sclerosis, he had finally had his first shot, after local-television news captured his attention. His reasoning was simple: “I just got tired of being scared.”

Freshour thinks that people have “started waking up,” but John Buck, who lives across the street, is not one of them. Buck, who is thirty-nine and works nights as a driver for an Amazon contractor, describes himself as “healthy as a horse.” He reasoned that he had grown up playing outside in the woods and that the immune system works like a muscle: “the more you exercise it, the better it works.” He doubts that six hundred thousand people have died of covid in the United States, and he considers mask rules “a government scare tactic to keep people under their thumb.” In case none of that made it clear, he said, “There is absolutely no need to expose myself to a vaccine I don’t need. You could offer me a million dollars, and I wouldn’t take it.”

In conversations with patients and their families, nurses and doctors hear echoes of messages spread by mainstream conservative media outlets such as Fox News, talk radio, and Web sites that occupy the fringe. Two nurses told me that some patients were suspicious of retractable needles. After the nurses administered the shot, the syringe made a clicking sound, and the patients asked whether that was the sound of a microchip being implanted in their arms. In the hospitals, some patients still demand to know why doctors don’t treat them with hydroxychloroquine, an antimalarial and immunosuppressant drug that was touted by Donald Trump and Fox News personalities but found to make no meaningful difference for covid patients. Blair recalled a patient who had been taking hydroxychloroquine and ivermectin—a typical treatment for parasitic worms. As his condition worsened, he belatedly went to the hospital, and was soon on a ventilator and a dialysis machine, with “very, very poor prognosis,” she said.

In late July, the Biden Administration made ninety-eight million dollars available to rural health clinics—including a hundred and twenty-three clinics in Missouri—to build confidence in the vaccine. According to Xavier Becerra, the Secretary of Health and Human Services, the money will support “trusted messengers,” whose mission will be “to counsel patients on how covid-19 vaccines can help protect them and their loved ones.” But, earlier in July, when President Biden suggested going “community by community, neighborhood by neighborhood, and oftentimes, door to door” to spread information about vaccines, Republican politicians in Missouri erupted. The congressman Jason Smith, whose district is just east of Springfield, tweeted, “The Biden administration wants to knock down your door KGB-style to force people to get vaccinated. We must oppose forced vaccination!”

In fact, the Springfield-Greene County Health Department has been knocking on residents’ doors for months to offer information about vaccines. On a Monday morning, two community-health advocates for the department, Annaliese Schroeder and Jordana Vera, allowed me to tag along as they visited residents on the city’s west side. If no one answered the door, and many didn’t, they left a door hanger with information about free vaccine clinics. “Walk-ins Welcome,” it read in bright yellow type. When someone did answer, Schroeder took a cheerful tone. She said to one resident, “We’re just spreading information that we’ve got two health clinics going on this week. Do you have any questions?”

Most of the people who chatted with Schroeder and Vera had been vaccinated or had made appointments. One woman, seated in a cluttered garage, said that she could not get the vaccine for health reasons, but that she wanted her children, who were living at home and currently had covid, to be vaccinated as soon as they recovered. Rosalee Greninger said that she had scheduled a shot just the day before, at her daughter’s insistence. She had hesitated, she said, because “I’ve been feeling really good. Why go get a shot that makes you feel puny?” Larry Watson, wearing a Cheech and Chong T-shirt, had been vaccinated, even though an acquaintance at church had told him that the vaccine was “poison,” and one of his sons tried to talk him out of it. The Delta spike worries Watson, because few people in Springfield wear masks. “You just don’t know who’s gotten the shot,” he said.

The health department has given shots at libraries, parks, churches, grocery stores, bars, the jail, and the zoo. At one brewpub, everyone who got vaccinated could claim a free beer. I met Jan Atwell, a registered nurse who came out of retirement to help, at a pop-up clinic held at a call center, where each person who was vaccinated received two tickets to see the Springfield Cardinals, the Double-A affiliate of the St. Louis Cardinals. She told me that at a recent clinic at a fire station, she saw a pack of young men striding across the street to get their shots. They were Missouri State football players, who said that their coach had not required them to get the shot but had made clear what he wanted them to do. At the call-center clinic, the nurses administered only ten shots in two hours. One young worker strolled past and said to a friend, who was getting a shot, “You’re tripping, bro.”

Lori Painter had been on the fence about getting the vaccine, but when she heard about the pop-up clinic, she signed up. She hoped that her decision would inspire her children to follow suit. Her teen-age daughter was reconsidering, she said, but one of her sons “listens too much to his dad,” who doesn’t believe that covid exists. Jennifer Ingram, who also works at the call center, was still nervous after receiving an injection. She scrolled through her phone, searching for reassuring Bible verses. Two of her seven siblings are apprehensive about the vaccine, saying that the rollout was too “rush-rush,” Ingram told me. She, too, was doubtful, but one day, she was listening to NPR and she heard Rochelle Walensky, the director of the Centers for Disease Control and Prevention, call the current surge a “pandemic of the unvaccinated.” That, along with talking to a nurse she trusts, informed her decision. “It would be a help if I die tomorrow and not today, for my children,” she told me.

Though many colleges across the country are mandating vaccination, Drury University, a liberal-arts college in Springfield, is relying on incentives. Students getting shots at Drury will be eligible for prizes such as a thousand-dollar tuition discount, iPads, campus parking permits, and a seat in the president’s suite for a home basketball game. If seventy per cent of students are vaccinated, Drury will add a day to fall vacation. Mike Brothers, the executive director of university relations, told me that the college had considered and rejected imposing a mandate. He noted that people who are from more rural communities, more politically conservative, and more evangelical are less likely to get the vaccine. “That is our area,” he said.

In the end, covid surges always flow to hospitals, where health-care workers have little choice but to cope. But this time, the fact that the worst symptoms are almost entirely preventable casts an enduring shadow. “I would be dishonest if I said I wasn’t a little bit angry,” Tracy Hill, a nurse at Mercy Medical Center, told me, nine hours into a twelve-hour shift, her third in three days. “You remember Frogger, that video game?” she asked. “That’s how I feel people who are unvaccinated are. You’re running out in traffic every day trying to dodge the covid bus. And when you get hit, you end up on the other side of my mask.” The day before, an elderly patient, who had been in her care for weeks, called his significant other to say goodbye. “It was a fifteen-second conversation. I just think what that must feel like, to be that person on the other end of the phone,” Hill said. As she described the moment, she was sobbing. The man died a few hours later.

Hill, who is fifty-two, began keeping a diary last year. She called it “My covid Journal.” During a particularly rough spell, she renamed it “My covid Is Killing Me Journal.” One of her siblings had cut off contact because Hill urged her relatives to wear masks. Her twenty-six-year-old daughter was suffering from long-haul symptoms; she had texted, seven months after coming down with covid, that she felt exhausted even after sleeping eighteen hours straight. The day we spoke, Hill had treated a panicked patient in his forties who had arrived at Mercy in such poor shape that he was intubated within fifteen minutes. She said that she would never forget the look he gave her. “Just the desperation in his eyes, pleading silently. He was squeezing my hand so tight.” Hill recalled that last winter, she was one of the first two people in Springfield to be vaccinated. “I couldn’t stop smiling,” she said. “I really, really thought this was the beginning of the end.”