COVID-19 deaths and cases in the US have climbed back to levels not seen since last winter, erasing months of progress and potentially bolstering President Joe Biden’s argument for his sweeping, new vaccination requirements.
The US is averaging more than 1,800 COVID-19 deaths and 170,000 new cases a day, the highest levels, respectively, since early March and late January.
Both figures have been rising over the past two weeks.
However, the country is still well below the terrifying peaks reached in January, when it was averaging about 3,400 deaths and a 250,000 new cases a day.
The latest cases — driven by the Delta variant, combined with resistance among some Americans to be vaccinated — are concentrated mostly in southern states.
While one-time hotspots such as Florida and Louisiana are improving, infection rates are soaring in Kentucky, Georgia and Tennessee, fuelled by children now back in school, loose mask restrictions and low vaccination levels.
The deteriorating picture nine months into the nation's vaccination drive has angered and frustrated medical professionals who see the heartbreak being felt as preventable.
A vast majority of the dead and those admitted to hospital were unvaccinated, in what has proved to be a hard lesson for some families.
“The problem now is we have been trying to educate, based on science, but I think most of the education that is happening now is based on tragedy, personal tragedy," said Dr Ryan Stanton, an emergency room physician in Lexington, Kentucky.
In that state, 70 per cent of its hospitals — 66 out of 96 — are reporting critical staff shortages that are the highest level yet during the pandemic, Governor Andy Beshear said.
“Our hospitals are at the brink of collapse in many communities,” said Dr Steven Stack, Kentucky’s public health commissioner.
'Pandemic of the unvaccinated'
Every day, the US is dispensing about 900,000 vaccinations, down from a high of 3.4 million a day in mid-April.
The number of people now in hospital with COVID-19 appears to be leveling off, or even declining, at around 90,000, or about where things stood in February.
Last week, the President ordered all employers with more than 100 workers to require vaccinations, or weekly tests, a measure affecting about 80 million Americans.
And the roughly 17 million workers at health facilities that receive federal Medicare or Medicaid also will have to be fully vaccinated.
“We read about and hear about and we see the stories of hospitalised people, people on their deathbeds among the unvaccinated over the past few weeks," Mr Biden said in announcing the rules.
"This is a pandemic of the unvaccinated.”
The requirements have been met with resistance and threats of lawsuits from Republicans and measures aimed at containing the virus have also been opposed.
Virginia Tech professor of civil and environmental engineering Linsey Marr said that, over the summer, the biggest surge occurred in states with low vaccination rates, particularly in southern states, where many people rely on air conditioning and breathe recirculated air.
However, she said, states further north could see upticks as the onset of cold weather sent people indoors.
Vaccination rates were not as low in some northern states, but "there's still a lot of unvaccinated people out there", she said.
"Delta is going to find them," Professor Marr said.
Idaho begins healthcare rationing
Idaho's public health officials said crisis standards of care are imminent for the state's most populated region as hospitals continue to be overrun with unvaccinated COVID-19 patients.
On Tuesday, Idaho Department of Health and Welfare director Dave Jeppesen said that the southwestern and southern Idaho regions that include Boise and Twin Falls might soon get official authorisation to begin rationing health care.
That step, he said, was intended to ensure the patients most likely to survive were given access to scarce resources such as intensive care unit beds.
"We continue to set new [hospitalisation] records each week," Mr Jeppesen said.
"We do not see a peak in sight."
Hospitals in the northern half of the state were given permission to begin rationing care last week, when Kootenai Health in Coeur d'Alene was forced to begin treating some patients in a field hospital set up in a conference centre instead of in regular hospital rooms.
Deputy state epidemiologist Dr Kathryn Turner said "nearly all the metrics we track are trending in the wrong direction" when it came to COVID-19.
On September 11, the state had more than 600 patients admitted to hospital with COVID-19, far beyond last winter's peak, when 466 people were in hospital.
The number of COVID-19 patients in intensive care units and on ventilators were also setting record highs in the state. The vast majority of them — more than 91 per cent — are not vaccinated against COVID-19.
The highly contagious Delta variant is sickening and sometimes killing more younger patients than the original variant, Dr Turner said.
In all of 2020, more than half of the COVID-19 deaths were among Idaho residents who were at least 80 years old, according to the department's numbers.
This year, well over half of the deaths are in people aged 50 to 79, and just over 7 per cent of the deaths were among even younger Idaho residents.
However, even as the state continues to see records in the number of people admitted to hospital or on ventilators with COVID-19, weekly vaccination rates were dropping.
Idaho remains one of the least-vaccinated states in the nation, with just 50 per cent of its residents fully vaccinated against COVID-19.
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