MOUNTAIN HOME, Ark. — When the boat factory in this leafy Ozark Mountains city offered free coronavirus vaccinations this spring, Susan Johnson, 62, a receptionist there, declined the offer, figuring she was protected as long as she never left her house without a mask.
Linda Marion, 68, a widow with chronic pulmonary disease, worried that a vaccination might actually trigger Covid-19 and kill her. Barbara Billigmeier, 74, an avid golfer who retired here from California, believed she did not need it because “I never get sick.”
Last week, all three were patients on 2 West, an overflow ward that is now largely devoted to treating Covid-19 at Baxter Regional Medical Center, the largest hospital in north-central Arkansas. Mrs. Billigmeier said the scariest part was that “you can’t breathe.” For 10 days, Ms. Johnson had relied on supplemental oxygen being fed to her lungs through nasal tubes.
Ms. Marion said that at one point, she felt so sick and frightened that she wanted to give up. “It was just terrible,” she said. “I felt like I couldn’t take it.”
Yet despite their ordeals, none of them changed their minds about getting vaccinated. “It’s just too new,” Mrs. Billigmeier said. “It is like an experiment.”
While much of the nation tiptoes toward normalcy, the coronavirus is again swamping hospitals in places like Mountain Home, a city of fewer than 13,000 people not far from the Missouri border. A principal reason, health officials say, is the emergence of the new, far more contagious variant called Delta, which now accounts for more than half of new infections in the United States.
The variant has highlighted a new divide in America, between communities with high vaccination rates, where it causes hardly a ripple, and those like Mountain Home that are undervaccinated, where it threatens to upend life all over again. Part of the country is breathing a sigh of relief; part is holding its breath.
While infections rose in more than half the nation’s counties last week, those with low vaccination rates were far more likely to see bigger jumps. Among the 25 counties with the sharpest increases in cases, all but one had vaccinated under 40 percent of residents, and 16 had vaccinated under 30 percent, a New York Times analysis found.
In Baxter County, where the hospital is, fewer than a third of residents are fully vaccinated — below both the state and the national averages. Even fewer people are protected in surrounding counties that the hospital serves.
“It’s absolutely flooded,” said Dr. Rebecca Martin, a pulmonologist, as she made the rounds of 2 West one morning last week.
In the first half of June, the hospital averaged only one or two Covid-19 patients a day. On Thursday, 22 of the unit’s 32 beds were filled with coronavirus patients. Five more were in intensive care. In a single week, the number of Covid patients had jumped by one-third.
Overall, Arkansas ranks near the bottom of states in the share of population that is vaccinated. Only 44 percent of residents have received at least one shot.
“Boy, we’ve tried just about everything we can think of,” a retired National Guard colonel, Robert Ator, who runs the state’s vaccination effort, said in an interview. For about one in three residents, he said, “I don’t think there’s a thing in the world we could do to get them to get vaccinated.”
For that, the state is paying a price. Hospitalizations have quadrupled since mid-May. More than a third of patients are in intensive care. Deaths, a lagging indicator, are also expected to rise, health officials said.
Dr. José R. Romero, the state health director, said he still believed enough Arkansans were vaccinated, or immune from having contracted Covid-19, that the “darkest days” of December and January were behind them. “What I’m concerned about now is we’ll have a rise or surge,” he said, “then winter is going to add another surge, so we’re going to have a surge on top of a surge.”
Dr. Mark Williams, the dean of the College of Public Health at the University of Arkansas for Medical Sciences, said the Delta variant was upending his projections for the pandemic. It is spreading through the state’s unvaccinated population “at a very fast rate,” he said, and threatens to strain the ability of hospitals to cope. “I would say we have definitely hit the alarming stage,” he said.
At Baxter Regional, many doctors and nurses are girding for another wave while still exhausted from battling the pandemic they thought had abated.
“I started having flashbacks, like PTSD,” said Dr. Martin, the pulmonologist, who obsesses over her patients’ care. “This is going to sound very selfish but unfortunately it’s true: The fact that people won’t get vaccinated means I can’t go home and see my kids for dinner.”
The Biden administration has pledged to help stem outbreaks by supplying Covid-19 tests and treatments, promoting vaccines with advertising campaigns and sending community health workers door to door to try to persuade the hesitant.
But not all those tactics are welcome. Dr. Romero said Arkansas would happily accept more monoclonal antibody therapies, a Covid-19 treatment often used in outpatient settings. But Mr. Ator, the vaccine coordinator, said door-knocking “would probably do more harm than good,” given residents’ suspicions of federal intentions.
Both said the Arkansas public had been saturated with vaccine promotions and incentives, including free lottery tickets, hunting and fishing licenses and stands offering shots at state parks and high school graduation ceremonies.
The last mass vaccination event was May 4, when the Arkansas Travelers, a minor-league baseball team, had its first game since the pandemic hit. Thousands gathered at the stadium in Little Rock to watch. Fourteen accepted shots.
Even health care workers have balked. Statewide, only about 40 percent are vaccinated, Dr. Romero said.
In April, the state legislature added yet another roadblock, making it essentially illegal for any state or local entity, including public hospitals, to require coronavirus vaccination as a condition of education or employment until two years after the Food and Drug Administration fully licenses a shot. That almost certainly means no such requirements can be issued until late in 2023.
Only fear of the Delta variant appears to be pushing some off the fence.
When the pandemic hit, Baxter Regional became a vaccine distribution center and inoculated 5,500 people. But only half of its 1,800 staff members accepted shots, according to Jonny Harvey, its occupational health coordinator. By early June, demand had tapered off so much that the hospital was administering an average of one a day.
Now, Mr. Harvey said, he is ordering enough vaccine to deliver 30 shots a day because people are increasingly anxious of the Delta variant. “I hate that we are having the surge,” he said. “But I do like that we are vaccinating people.”
At the state’s only academic medical center in Little Rock, run by the University of Arkansas for Medical Sciences, vaccines are also suddenly more popular. Over a recent two-week period, the share of the hospital’s staff who are vaccinated jumped to 86 percent from 75 percent.
But those encouraging signs are outweighed by the soaring number of Covid-19 patients. On Saturday, the Little Rock hospital held 51 patients, more than at any point since Feb. 2. In April, there was one coronavirus death. In June, there were six.
Dr. Williams, who has been charting the coronavirus’s trajectory, said the rise in infections and hospitalizations mirrored what he saw in October. And there are other troubling signs.
A larger share of those who are now becoming infected, he said, need hospitalization. And once there, Dr. Steppe Mette, the chief executive of the Little Rock hospital, said, they appeared to need a higher level of care than those who were sickened by the original variant. That is despite the fact that they are younger.
The average age of a coronavirus patient in Arkansas has dropped by nearly a decade since December — from 63 to 54 — a reflection of the fact that three-fourths of older Arkansans are at least partly vaccinated. But some patients at the Little Rock hospital are in their 20s or 30s.
“It’s really discouraging to see younger, sicker patients,” Dr. Mette said. “We didn’t see this degree of illness earlier in the epidemic.”
Young, pregnant coronavirus patients were once rare at the hospital. But recently, four or five of them ended up in intensive care. Three were treated with a machine called ECMO — short for extracorporeal membrane oxygenation — a step some consider a last resort after ventilators fail. The machine routes blood from the body and into equipment that adds oxygen, then pumps it back into the patient.
Ashton Reed, 25, a coordinator in a county prosecutor’s office, was about 30 weeks pregnant when she arrived at the hospital on May 26, critically ill. To save her life, doctors delivered her baby girl by emergency cesarean section, then hooked her up to the ECMO machine.
In a public service announcement later urging vaccination, her husband said she went from sinus trouble to life support in 10 days.
“I almost died,” she said. “My thoughts have definitely changed on the vaccine.”
Last month, the hospital had to reopen a coronavirus ward it had closed in late spring. On Monday, it reopened a second.
Many of the nurses there wore colorful stickers announcing they were vaccinated. Ashley Ayers, 26, a traveling nurse from Dallas, did not. Noting that vaccine development typically took years, she said she worried that the shot might impair her fertility — even though there is no evidence of that.
“I just think it was rushed,” she said.
David Deutscher, 49, one of her patients for nearly a week, is no longer a holdout. A heating and air conditioning specialist and Air Force veteran, he said he fought Covid for 10 days at home before he went to the hospital with a 105-degree fever.
The experience has shaken him to his core. He dissolved into tears describing it, apologizing for being an emotional wreck.
When he failed to improve with monoclonal antibody treatment, he said, “that was probably the most scared I have ever been.” He called a friend, the daughter of a medical researcher, from his hospital bed. “Please don’t let me die,” he said.
He said he never got vaccinated because he figured a mask would suffice. In the past 21 years, he has had the flu once.
“Once I started feeling better,” Mr. Deutscher said, “I got on the phone and I just started calling everybody to tell them to go get that vaccine.” He did not even wait to be discharged.
The coronavirus “is no joke,” he told his friends. Three of them got a shot.
Mr. Deutscher went home on July 9, bringing a song for one of his five grandchildren that he had written in his hospital bed. His theme was the value of life.
Robert Gebeloff contributed reporting and Kitty Bennett contributed research.