To describe Dr. Ryan Dare as frustrated would be a gross understatement.
Dare and his colleagues at the University of Arkansas for Medical Sciences in Little Rock are dealing with a surge in extremely ill Covid-19 patients — one that is "nearly 100 percent preventable."
That's because virtually all of their patients are unvaccinated. And now they wish they had gotten the shots when they had the chance.
"It is heart-wrenching to see unvaccinated individuals come into the hospital with regret," said Dare, an infectious diseases physician. They are patients who, "if they could do it all over again, would have had the vaccine in a second."
Arkansas has one of the lowest vaccination rates in the country, with less than 35 percent of adults having been fully vaccinated. Now, the state's low vaccine uptake has crashed headlong into the highly contagious delta variant of the coronavirus, leaving some hospital systems once again teetering on the brink of collapse more than a year into the pandemic.
It's not the only state where progress against the virus has taken a turn.
"We are starting to see some new concerning and emerging trends," Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention, said at a briefing Thursday. "Simply put, in areas of low vaccination coverage, cases and hospitalizations are up."
Many of those areas are clustered in Arkansas and neighboring Missouri, along with a handful of states in the Mountain West.
Less than 40 percent of adults are fully vaccinated in Missouri. At Mercy Hospital Springfield, an influx of more than 125 patients has forced administrators to ask other medical systems for extra ventilators and nurses to handle the extra cases.
"It's just a mess," said Dr. Mayrol Juarez, a critical care physician at the hospital. "Everybody in the hospital is doing extra shifts, calling out for other hospitals to help."
Juarez said many of his hospitalized Covid-19 patients are "shocked" that Covid-19 truly exists and that it can make people very sick and even kill them. "A comment they make all the time is that they wish that they knew they were going to end up in the hospital this sick and they would have made a different choice and got the vaccine," he said.
Eric Frederick, chief administrative officer for Mercy Hospital Springfield, has also encountered patients who are extremely dismissive of or who flat-out deny the existence of Covid-19.
"This isn't the boogeyman. This isn't something we made up to get a rise out of people," he said. "There are 120 real human beings in the hospital right now struggling with this illness. ... And every one will tell you — this isn't fake."
Doctors say the average age of patients has declined since the start of the pandemic. People can still get extremely ill — at Mercy Springfield, 29 of the Covid-19 patients are in the intensive care unit, and 27 have been placed on ventilators.
The younger age reflects the relatively high vaccination rates among older adults, who were prioritized early on — even in states with low vaccine uptake.
"It really does feel like this pandemic is becoming an endemic issue with those that are unvaccinated," said Dr. Andy Dunn, a family physician and chief of staff at Wyoming Medical Center in Casper.
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Dunn said he is "beyond frustrated" at the low vaccination rate in the state, which is about 35 percent. "Whether it's the cowboy way or whatever, the mentality of so much of Wyoming is just 'we're not doing it.' It's really horrible and heartbreaking."
The federal government has deployed surge response teams to areas of the country with outbreaks, including parts of Arkansas, Illinois, Missouri and Nevada, said Jeff Zients, the White House Covid-19 response coordinator.
"These efforts include providing expert support for the CDC on outbreak investigations, working with local health officials, getting more treatments for people with Covid and helping states increase vaccine confidence," Zients said at Thursday's briefing.
Arkansas Gov. Asa Hutchinson said at a news conference last month that since the beginning of the year, at least 98 percent of hospitalized Covid-19 patients were unvaccinated and that more than 99 percent of deaths were among unvaccinated people.
Vaccines are available in the U.S. to anyone ages 12 and up, and studies have shown that they are effective against the delta variant.
"The decision to get a vaccination should not be hard," said Dare of the University of Arkansas. "Patients know that now, but they know it too late."