KANSAS CITY, Mo. -- The number of new coronavirus cases is increasing in every state, setting off a growing sense of concern from health officials who are warning that the pandemic in the United States is far from over, even though the national outlook is far better than during previous upticks.
Nineteen states are reporting at least twice as many new cases per day.
The 160 million people across the country who are fully vaccinated are largely protected from the virus, including the highly contagious delta variant, scientists say. In the Upper Midwest, the Northeast and on the West Coast -- including in Chicago, Boston and San Francisco -- infections remain relatively low.
But the picture is different in pockets of the country where residents are vaccinated at lower rates. Hot spots have emerged in recent weeks in parts of Arkansas, Missouri and Nevada, among other states, leaving hospital workers strained as they care for an influx of patients. Less than a month after reports of new cases nationally bottoming out at about 11,000 a day, cases are increasing again, with about 26,000 new ones per day. Hospitalizations are on the rise as well.
Deaths have increased 28% in the past week, and medical experts say they are almost entirely among unvaccinated Americans.
The country is at an inflection point, and experts said it was uncertain what would happen next. While nationwide cases and hospitalization numbers remain relatively low, more hot spots are appearing and the national trends are moving in the wrong direction. Many of the oldest, most vulnerable Americans are already inoculated, but the vaccine campaign has sputtered in recent weeks.
"This will definitely be a surge," said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. "It won't be as big as what happened in January. But we still have 100 million people in the United States who are susceptible to covid-19."
Intensive-care beds have become scarce in parts of Missouri, where officials in Springfield on Wednesday asked for an alternative care site. In Mississippi, where cases are up 70% over the past two weeks, health officials have urged older adults to avoid large indoor gatherings even if they have been vaccinated. And in Los Angeles County, officials said Thursday that masks would once again be required indoors, regardless of vaccination status, because of the spread of the delta variant.
The slowdown of the vaccination effort has amplified concerns. About 530,000 people are now receiving a vaccine each day, a sharp decrease from 3.3 million shots a day in April. Less than half of the United States population has been fully vaccinated.
On July Fourth, President Joe Biden celebrated dramatic progress in the war on the coronavirus, with more than 150 million adults fully vaccinated and infections plunging 93% since Inauguration Day. "Together, we're beating the virus," he said at a party on the White House lawn.
But at the recent Conservative Political Action Conference in Dallas, attendees celebrated a different milestone: that Biden had missed his goal of vaccinating 70% of adults.
"Clearly they were hoping -- the government was hoping -- that they could sort of sucker 90% of the population into getting vaccinated," activist Alex Berenson told the crowd Saturday, seeming to inflate Biden's target. "And it isn't happening."
The crowd clapped and cheered at that failure.
What began as "vaccine hesitancy" has morphed into outright vaccine hostility, as conservatives increasingly attack the White House's message, mischaracterize its campaign and, more and more, vow to skip the shots.
The notion that the vaccine drive is pointless or harmful -- or perhaps even a government plot -- is increasingly an article of faith among many supporters of former President Donald Trump.
Appearing at the conference, such lawmakers as Reps. Madison Cawthorn, R-N.C., and Lauren Boebert, R-Colo., took aim at Biden's push for "door-to-door" vaccine outreach, framing efforts to boost inoculations as a creeping menace from big government.
"We're here to tell government, we don't want your benefits, we don't want your welfare, don't come knocking on my door with your Fauci ouchie," Boebert said, referring to Biden's top medical adviser, Anthony Fauci, her voice rising as she paced the stage and shook her finger. "You leave us the hell alone!"
On television and online, conservative media outlets are amplifying fears.
"Vaccine door-knocking instructions revealed," read one headline Tuesday on One America News' website, with an accompanying video that grappled with what to do if "Big Brother comes knocking." Newsmax host Rob Schmitt suggested last week that vaccines go "against nature," though the network later said it supports Biden's efforts to distribute the vaccine.
And Fox News' Tucker Carlson, who at times has backed the vaccine, has also said, "Maybe it doesn't work, and they're simply not telling you that."
The message is resonating and the resistance solidifying. The trend is unsettling public health experts, particularly as the outbreak worsens again.
"We always ask, what will be the last straw? What will be the moment that we lose the ability to communicate and cooperate and get things done?" said Frank Luntz, a longtime GOP pollster who's been working to encourage vaccinations. "Well, we've reached it. This is it."
He added, "Now decisions are being made not because of evidence or facts or statistics, but strictly on political lines. And now people are going to die."
For months, public health experts have been hammering on one big message: Vaccines are safe, effective and the best way to stamp out the pandemic. But red and blue America have responded in different ways to these exhortations, leaving Trump country particularly vulnerable to the coronavirus, those experts say.
The Kaiser Family Foundation found last week that nearly 47% of residents in counties won by Biden were fully vaccinated, compared with 35% of residents in Trump counties. And that has pitted some traditional Republican lawmakers against those in the populist, Trump-aligned wing.
"I don't know how many times you all heard me say this, but I'm a huge fan of vaccinations," Senate Minority Leader Mitch McConnell, R-Ky., told reporters Monday, citing his own experience surviving polio. He said he was "perplexed" by the slowdown in coronavirus shots.
Asked about GOP lawmakers like Sen. Ron Johnson of Wisconsin who are raising doubts about the vaccines, McConnell demurred. "I can only speak for myself," he said.
On Sunday, onstage at the conservatives' conference as the final speaker, Trump bragged of pushing federal health agencies to make the vaccines a reality. "Thanks to the relentless efforts of my administration -- and me," he added after a slight pause -- "we got miraculous therapeutics straight to patients with historic speed, and we produced three vaccines to end the pandemic in record time."
The audience cheered. But in interviews, some attendees still said nothing could persuade them to get shots.
Gregory Chittum, a 58-year-old from Port Aransas, Texas, said he admires Trump and blames Fauci rather than the former president for the vaccine. "He depended on Fauci!" Chittum exclaimed.
Chittum, who rattled off misinformation about the coronavirus -- claiming that it has killed only 12,000 people in the United States, not 608,000 as Johns Hopkins says -- vowed that his opposition to the vaccines would not melt away with more time and testing.
"You're going to have to bury me to get it," he said.
As controversy raged on over the firing of Tennessee's vaccination leader after state lawmakers complained about efforts to promote vaccination among teenagers, state officials released documents Thursday that for the first time offer other reasons for her dismissal.
Tennessee's chief medical officer reasoned that the state's vaccination leader should be removed partly because of complaints about her leadership approach and how she handled a letter about vaccination rights of minors that incensed some Republican lawmakers, state records show.
In a letter dated July 9 and obtained through a public records request, Chief Medical Officer Dr. Tim Jones wrote that Dr. Michelle Fiscus deserved to be fired because of "failure to maintain good working relationships with members of her team, her lack of effective leadership, her lack of appropriate management, and unwillingness to consult with superiors and other internal stakeholders."
In rebuttal, Fiscus' husband Brad circulated three years' worth of performance reviews deeming her work "outstanding," most recently for October 2019 through September 2020.
"Dr. Fiscus has been attentive to her team," the review says. "She has exceed(ed) expectations in managing all programmatic activities while being fully immersed in (COVID-19) response efforts. She has appropriately and effectively advocated for her team. Her program has had some key transitions during this evaluation period which have been managed well."
Fiscus continues to speak widely after her firing Monday, which she has said was a political move to appease lawmakers who disapproved of the Department of Health's outreach to get teens vaccinated. Additionally, the department acknowledged in email records that it has halted all outreach efforts around any kind of vaccines for children, not just covid-19 efforts.
Tennessee, meanwhile, continues to rank in the bottom 10 of vaccination rates among states, at 38%. Covid-19 cases there have begun rising again, with the state's rolling average of daily new cases up by 451 over two weeks, an increase of 681%, according to Johns Hopkins University researchers.
Surgeon General Vivek Murthy on Thursday called for a national effort to fight misinformation about covid-19 and vaccines, urging tech companies, health care workers, journalists and everyday Americans to do more to address an "urgent threat" to public health.
In a 22-page advisory, his first as Biden's surgeon general, Murthy wrote that bogus claims have led people to reject vaccines and public health advice on masks and social distancing, undermining efforts to end the pandemic and putting lives at risk.
Murthy noted that surgeon general advisories have typically focused on physical threats to health, such as tobacco. Misinformation about covid-19 -- deemed an "infodemic" by the World Health Organization -- can be just as deadly, he said.
"Misinformation poses an imminent and insidious threat to our nation's health," Murthy said in remarks to reporters at the White House. "We must confront misinformation as a nation. Lives are depending on it."
Given the role the internet plays in spreading health misinformation, Murthy said technology companies and social media platforms must make meaningful changes to their products and software to reduce the spread of misinformation while increasing access to authoritative, fact-based sources.
Too often, he said, the platforms are built to encourage, not counter, the spread of misinformation.
"We are asking them to step up," Murthy said. "We can't wait longer for them to take aggressive action."
Murthy's recommendations went further. Teachers, he said, should expand lessons on media literacy and critical thinking. Journalists, he suggested, should work to responsibly debunk health misinformation without inadvertently spreading it further. And public health professionals, he added, should do a better job answering questions and explaining why public health guidelines sometimes change based on new information.
As for everyday Americans, Murthy urged them to verify questionable health information with trusted sources like the CDC and to exercise critical thinking when exposed to unverified claims. If people have loved ones or friends who believe or spread misinformation, he said, it's best to engage by listening and asking questions rather than by confronting them.
Information for this article was contributed by Mitch Smith and Julie Bosman of The New York Times; by Dan Diamond, Hannah Knowles and Tyler Pager of The Washington Post; and by Jonathan Mattise, Adrian Sainz, Travis Loller and David Klepper of The Associated Press.