COVID patients are flooding this hospital. Again.

Casey Johnson has never let a COVID patient die alone.

In her years as a bedside nurse at St. Bernards Medical Center in Jonesboro, Arkansas, Johnson has watched countless patients pass. But the pandemic — especially the state’s third surge in the final months of 2020 — brought a wave of death unlike any she’d ever seen.

To those who die in her care, she is a stranger, she said. But she can still offer them comfort. She’s caressed patients’ hands, quietly played “Amazing Grace” from her iPhone, gently bathed tired limbs. She sharpened her sixth sense for when someone was about to die — their breathing more sporadic, their mood more restless before becoming solemn and withdrawn. Those who hadn’t been robbed of their voice by the virus would often tell her “‘Today’s the day,’” or “‘I want to go home.’” She’s never gotten used to the conversations with loved ones who have been left behind, she said, and each time, it “takes a little bit out of you.”

Even as parts of the country lift restrictions and celebrate a return to some normalcy — including low levels of new COVID cases — others are experiencing new surges on par with the worst stages of the pandemic, thanks to the delta variant that has mutated to spread the virus more efficiently, as well as large populations of unvaccinated people who remain susceptible to infection and serious illness or death.

During the White House COVID-19 Task Force briefing Friday, Dr. Rochelle Walensky, who directs the Centers for Disease Control and Prevention, said coronavirus infections, hospitalizations and deaths around the country had seen double-digit increases under the rise of the delta variant, and that 97 percent of people hospitalized for the coronavirus were those who hadn’t gotten their shots.

“This is becoming a pandemic of the unvaccinated,” she said.

Arkansas is among the top five states for new infections, and still has one of the lowest rates of vaccination nationwide. Researchers from the University of Washington’s Institute for Health Metrics and Evaluation project that, nationally, this latest surge is only just beginning and may not end until nearly September if no public health measures are taken to blunt the pandemic’s brutal impact.

These circumstances worry health care workers like Johnson, who fear they’re going to experience another rock bottom and are worried about whether they can handle it.

“I don’t know if I’m ready again,” she said, adding that she’s gone into work each day this month a little more anxious than the last.

Several times during the pandemic, St. Bernards Medical Center, a 400-bed facility, has had to expand its 55-bed intensive care unit to accommodate about 30 COVID patients when the worst surges of cases hit. During last winter’s crushing third surge, patients came from as far away as Oklahoma, desperately seeking care, said Dr. Don Howard, a pulmonary critical care physician and intensivist who joined the hospital in 2008. The unit’s use dwindled during the spring, when case numbers dipped. But in early July, Howard said a rise in coronavirus infections once again filled the unit’s spare beds.

“Here we go again,” he said.

Across the country, nearly all of the 173 counties that have reported the nation’s highest rates of new infection also recorded the nation’s lowest vaccination rates, with 40 percent of residents or fewer. Craighead County in Arkansas, where St. Bernards is located, is one of them.

There, tucked away in Arkansas’ northeastern corner, about 10 percent of people lack health insurance, and almost 20 percent live in poverty, according to federal data. And only one out of four residents are fully vaccinated.

Howard said that even with the increased cases his hospital is facing, people he encounters still make snide comments about available COVID-19 vaccines, saying that it’s not safe, or could jeopardize future pregnancy — claims that are not supported by data — or that it’s “tyranny.”

Nationwide, 28 percent of Americans said they do not plan to get vaccinated, according to the latest PBS NewsHour/NPR/Marist poll conducted in late June. Resistance to getting vaccinated has been especially pronounced among Republicans — 44 percent of whom in that same poll said they had no plans to get the shots.

Eighteen months into the pandemic, hospitals like Howard’s in Jonesboro must play a cruel waiting game.

“We’ve sacrificed so many people and so many families — to get that sense that some people just don’t give a damn — it’s very deflating, and it hurts you.”

’Everyone’s too exhausted’

For years, veteran respiratory therapist Brett Vinson learned how to stay gentle in the face of danger. He worked with newborns struggling to draw their first breaths in St. Bernards Medical Center’s neonatal ICU. During the pandemic, Vinson earned the reputation as the “family whisperer,” knowing how to break the worst news to a family about to lose a loved one — a job for which he volunteered, grounded in more than three decades of experience.

Vinson worked grueling 13-hour days, waking up at 4 a.m. to check ICU patient lists from overnight staff. He noted who was still alive, who was put on ventilators (a term that means little to most families until he said their patient had been put on life support — “they got that”) and who was most likely to die that day (those were the families he prioritized calling).

“I was kind of a Grim Reaper guy,” Vinson said.

Vinson, 58, said he always tried to stay one step ahead of the virus. He still keeps a desk drawer filled with notes he scribbled about each patient whose death — and family — he handled. Each note represents a memory, and those memories haunt him. He still contacts some families, letting them know their loved one hasn’t been forgotten.

As bad as the coronavirus has been for the community, the pandemic has fueled “a remarkably traumatic year” for health care workers, said Dr. Carl Abraham, an infectious disease specialist based in Jonesboro.

“That was really painful for us as much as it was painful for patients and their families,” Abraham said. “It was a really, really difficult time.”

In February, researchers from the Yale School of Medicine published results of a U.S. survey conducted in May 2020 (before the third surge doubled the nation’s death toll) that suggested that two months into the pandemic, nearly a quarter of all health care providers already showed signs of possible PTSD.

After the third surge subsided, the hospital brought in experts who specialized in treating combat-induced PTSD to help their frontline workers recover. Vinson said if he ever sought counseling, he would be diagnosed with the disorder, too.

Chronic burnout is opening gaping holes in the health care industry when communities like Jonesboro need those essential workers the most. Nurses and doctors are leaving the profession and hospitals and clinics are struggling to hire more staff, said Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine. And with three safe and effective vaccines authorized for use in the U.S., this suffering is unnecessary and fueling even more frustration amid health care workers.

“Everyone’s too exhausted right now to handle this next phase,” said Hotez, who co-directs the Center for Vaccine Development at Texas Children’s Hospital.

On July 16, the federal Health Resources and Services Administration earmarked $103 million from the American Rescue Plan to work to scale back burnout and boost mental health services over the next three years.

And as new cases tick upward, Vinson wrestles with all he has seen and knows “because there’s still people who don’t believe, still people who don’t want to get vaccinated.”

“I know this [virus] is new, but it kills people,” he said. “This struggle is real. It’s not a political agenda.”

‘It shouldn’t have to come to somebody almost dying’

Before Patricia Crossno nearly lost her life to the virus, she wondered if something in her blood made her weirdly resistant to the disease. A 45-year-old mother from Blytheville, Arkansas, who worked at a heating and air conditioning company and photographed portraits of graduating high school seniors and happy families on the side, Crossno could walk all over Disney World without getting winded and was never one to go to the hospital. She never smoked, drank or struggled with substance use. To this day, she knows of no pre-existing condition that could have set her up to be as sick as she ultimately was.

In mid-April, a coworker came to the office sick, infecting four people, including Crossno, she said. By April 26, Crossno woke up for work, thought her sinuses were flaring up and went into the office. The next day brought no improvement, and when she called in sick, her boss told her about the coworker who had tested positive for the coronavirus.

In less than a week, Crossno went from feeling fine to coughing so deeply and continuously she didn’t realize she was slowly suffocating. By month’s end, Crossno’s second test result was positive for COVID. Her fever reached 105.8 degrees Fahrenheit and lasted all day. Her coughs were so powerful they gagged her. She could hardly stand and needed help from her fiance, Steve Nations, to walk to the shower. When he saw her face in the light, Nations noticed how her face had drained of color, a blue streak stretching across her nose from cheek to cheek.

On April 26, Patricia Crossno, 45, of Blytheville, Arkansas, thought her sinuses were bothering her and had no known preexisting conditions. Within days, she was diagnosed with COVID-19 and developed a 105.8 degree fever. Ultimately, she was hospitalized with COVID-19 from May 2 to July 2 in Jonesboro, Arkansas, where she was in a medically induced coma. Photos courtesy of Destiny Metheny

Nations, a 39-year-old barge worker who had smoked cigarettes for more than 20 years, had doubted the pandemic was a big deal and thought “it was just the flu.” In October, he caught the virus during Arkansas’ last big surge, developing a 101-degree fever for less than a day and bouncing back. His quick recovery emboldened him, Nations said, and he “doubled down” on mocking people’s concern about the virus. After all, he spent two decades “killing my lungs” with smoking and he turned out O.K. But as his fiancee struggled to breathe in his arms, Nations felt a growing sense of alarm. He borrowed a next-door neighbor’s oxygen sensor, placed it on Crossno’s finger and checked. Her first reading showed 48.

“That’s not right. Forty-eight’s almost dead,” Nations thought. He tried again and again. None of her readings registered above 52.

“My mind went blank,” Nations said. “I didn’t know what to do.”

He called Crossno’s daughter, who relayed the story to a friend, a nurse at St. Bernards, who dispatched an ambulance. Medical staff would later tell Crossno that if she had gone to sleep that night in her own bed, she wouldn’t have woken up.

She stayed in the unit for two months, hooked up to a ventilator and in a medically induced coma. Staff at St. Bernards called her their “miracle patient” when she didn’t die.

Now home, her heart still races, and her lungs will take a long time to heal. She needs a wheelchair to cross a parking lot, and doesn’t know when she will be able to carry camera equipment or squat at the right angle for portraits. She hopes that when others “start feeling bad, they don’t need to go to work” and risk putting others at risk.

“All they’re doing is spreading it and gonna keep on spreading it,” she said.

Crossno’s near-death brush with the coronavirus transformed Nations and how he perceives the pandemic.

“It shouldn’t have to come to somebody almost dying for you to take it seriously,” he said.

Neither of them are vaccinated. Crossno said her body is too weak right now, but she maintains getting vaccinated is a personal choice. Nations said he asked about getting vaccinated when his fiance was in the hospital. He said he even scheduled an appointment to get vaccinated, but was told he had enough antibodies to protect him after he got sick last fall.

“I’ve seen so many different things — ‘Yeah, you still need it,’ or ‘No, you don’t need it,’” he said. “You’ve got people like me. I don’t know whether I need to get it or not because I was told I didn’t need to.”

Carrying the burden for the unvaccinated

In states with deep red politics and widespread vaccine refusal, the catastrophic results are “all predicted and predictable,” Hotez said. In April, he warned about these outcomes in interviews and was later criticized by conservative TV talk show host Laura Ingraham. He added that the most effective thing to do right now — still — is to “vaccinate as many people as possible.”

About a third of Arkansas residents have been fully vaccinated, compared to about half of all Americans, according to the latest CDC data, which has the state’s vaccination rate ranked as third-lowest in the country, behind Mississippi and Alabama.

In early July, Gov. Asa Hutchinson announced plans to launch a statewide series of community conversations to boost Arkansas’ lagging vaccination rate and reverse a rise in COVID-19 infections. But at this point in the pandemic, those measures may not be happening fast enough.

The rejection of science, scientists and the vaccine by skeptics is something that federal disaster preparedness plans failed to take into account but “have driven the pandemic,” Abraham said.

On July 7, Arkansas reported a thousand new coronavirus infections, the state’s largest single-day spike in five months.

“We are losing ground,” Hutchinson said on July 6 during his weekly news address. By mid-July, one estimate from the American Hospital Association suggested that 40 percent of the state’s hospital beds were filled with COVID-19 patients.

Howard still struggles to cope with what he saw last winter. He grows angry when he sees people “posting dumb crap on social media,” such as misinformation about the vaccines and pregnancy. That anger only mounts when he thinks about the fact that so few people are vaccinated in his community while the hospital’s freezer is stocked with 8,000 Pfizer vaccine doses, waiting to be administered, he said. And with the delta variant churning amid vaccine resistance, Howard said he feels the hospital staff is left “carrying the burden” of the pandemic.

“We don’t know if we’re going to get overrun again,” he said.

But if he revealed that simmering rage, Howard could shatter the hard-won trust of families who may already be skeptical of health care providers. So he sets aside judgment and focuses on treating each COVID-19 patient — again.