For doctors at the University of Arkansas for Medical Sciences, a rush of new Covid-19 cases and a dwindling availability of beds feels like the hospital is backsliding to how it was at the end of 2020.
The latest projections from the school's college of public health suggests statewide Covid hospitalizations will triple in the next two weeks, which would mean a return to a chaotic period when staffing and resources were strained, elective operations were limited and it seemed like there was no end to the crisis in sight.
If that happens, "that will surpass what we saw last winter," said Dr. Steppe Mette, the CEO of the university's Medical Center in Little Rock.
On Monday, the hospital was treating 57 in-patient cases of Covid, up from eight cases six weeks ago, Mette said.
"This is the big concern," he added. "Right now we're managing OK, but we're in surge mode. We're putting patients in physical locations where we weren't putting them normally because of that demand."
While states across the country have had a startling rise in new Covid cases, the South, including Arkansas, Alabama, Louisiana and Tennessee, has re-emerged as a troubling hot spot, driven by the highly contagious delta variant and lax or resistant attitudes toward vaccinations, public health officials say. Some hospitals are bracing for a rise in Covid cases not seen in months.
Mississippi's top health official, Dr. Thomas Dobbs III, tweeted Monday that a "4th wave" of the virus had hit the state, although it "didn't have to be this way."
Dobbs warned over the weekend that beds in intensive care units were "getting tight again" and that 11 major ICU facilities in the state had zero beds available. The number of available adult ICU beds statewide (138) is the lowest since March, according to state health data.
Meanwhile, cases of confirmed Covid patients in hospitals across Mississippi reached 369 over the weekend, a number also not seen since March, with about 34 percent of patients currently in intensive care. Over the past three weeks, the state has grappled with a more than 200 percent rise in hospitalized Covid patients.
Dobbs said Monday on the radio program "SuperTalk Mississippi" that nearly every new case of Covid can be attributed to the delta variant, and the state is reporting a threefold increase in the number of new cases over Friday through Sunday compared to the same period a week earlier, averaging about 800 new cases a day.
"It's all age groups, but we're seeing a lot of growth in children, teenagers and then young adults because summer's opened up, our vaccination rates, our immunity rates are really low in that group of folks," Dobbs said, adding his state has seen "a phenomenal surge of healthy and mostly healthy 40-year-old folks in ICU, on ventilators and dying."
While only three Covid-related deaths were reported over three days last week, Dobbs said that he expected the number to increase as new data rolls in, and that more than 90 percent of those who died had not been vaccinated against the disease.
Dobbs remained a vocal proponent of mask-wearing and avoiding social gatherings in his state even as Gov. Tate Reeves, a Republican, in early March ended pandemic-related restrictions after saying that "hospitalizations and case numbers have plummeted, and the vaccine is being rapidly distributed."
But this month, the Mississippi Department of Health announced new recommendations to help stave off the spread of the delta variant, calling for residents 65 and older to avoid indoor mass gatherings regardless of their vaccination status and for all residents 12 and older to receive a Covid vaccine.
Mississippi's rate of fully vaccinated people is less than 34 percent — the lowest in the country besides Alabama, according to federal health data analyzed by NBC News. Other states with lagging vaccination rates include Arkansas at 35 percent, Louisiana at 36 percent, Georgia at 37.5 percent and Tennessee at 38 percent.
At the University of Mississippi Medical Center in Jackson, the hospital is ramping up its isolation rooms and converting other rooms into "Covid treatment bays" — signaling that the situation is worsening and its case numbers are ticking back up to a level seen a year ago, Dr. Jonathan Wilson, the hospital's chief administrative officer and incident manager for the Covid response, said Monday.
Of the 55 people who were hospitalized at the Medical Center after they were diagnosed with Covid-19 or were suspected of having the disease, five adults were in the ICU. In addition, two of seven children confirmed with Covid were in the ICU.
On Thursday, the hospital announced all employees must get vaccinated or wear an N95 mask if they're on its property, a policy being phased in over three months.
"We take care of the sickest patients that you can imagine, from geriatric patients to neonatal patients,” Wilson said in a statement. "There's just no room for error there. We have to do what's right for the patient, and the best thing we can do is get vaccinated."
The delta variant has been responsible for surges in cases outside the South, as well. In California, where the vaccination rate is above 60 percent, the number of new confirmed cases spiked by 225 percent over the last two weeks.
Studies have shown the Covid-19 vaccines to be highly safe and effective. But misinformation continues to sow doubts about them, especially in conservative and rural areas.
Arkansas Gov. Asa Hutchinson, a Republican, embarked on a statewide tour after taking over as chairman of the National Governors Association and has urged the federal government to give full approval to the vaccines instead of emergency authorization, saying that would address one of the arguments used by opponents that they may not be safe.
"Let me make sure it's clear: I’m not asking you to trust government," Hutchinson told an audience in Texarkana last week, according to The Associated Press. "I'm asking you to look at, do your own research, talk to people that you trust, and that to me is the right approach."
The approach is different from that of other Republicans who are portraying health leaders as adversaries even as they try to tamp down cases.
Florida Gov. Ron DeSantis has been selling shirts and other merchandise emblazoned "Don't Fauci My Florida." In Missouri, Gov. Mike Parson has suggested that some health officials are trying to scare people into getting vaccinated. In Tennessee, the top vaccine official was fired amid GOP anger over her efforts to get teenagers vaccinated.
Mette, of the University of Arkansas for Medical Sciences, said convincing more people to get vaccinated will be key to turning the tide against rising cases. But, he said, mandating vaccinations or guilting people into getting inoculated will only deepen the divide, and it may take one-on-one conversations or the Covid crisis deteriorating in his state before attitudes change.
"People have heard our messages ad nauseam, but to see patients struggling to breathe and wishing they got vaccinated, that may make a difference," Mette said. "Those are real people who are getting real sick."