As spring turned to summer in the United States, the staff of CoxHealth South, one of the main hospitals in Springfield, Missouri, dared to hope.
COVID-19 cases in the state had dropped from more than 5,000 a day at the peak last November, to a few hundred by June.
Medical staff began to think the end of an exhausting and heartbreaking ordeal was in sight.
Then came Delta.
In just two months, case numbers have risen more than tenfold, and hospitalisations are up again too, as the highly infectious variant spreads throughout the US.
“This Delta variant is a game changer,” Dr Howard Jarvis, CoxHealth South’s emergency room director, says.
“It’s just made things much worse.”
At CoxHealth South they are also noticing a difference in the patient profile.
On average, those being admitted are getting sicker more quickly, and they’re younger.
On the day the ABC visited the hospital, 20 of the 150 patients admitted with COVID-19 were under 30.
And there’s another stark contrast to what was happening in winter: the vast majority of those turning up at hospital are unvaccinated.
“In these past couple of months, I haven’t admitted anybody who has been vaccinated,” Dr Jarvis says.
“Nobody has been sick enough.”
That can be hard to swallow for those on the front line.
“It is somewhat frustrating that people haven’t chosen to get vaccinated,” Dr Jarvis says.
Plentiful supplies and low vaccination rates
Despite having abundant supplies of Pfizer, Moderna and Johnson & Johnson jabs, America’s vaccination rollout has been a patchwork.
In Missouri only 42 per cent of the population is fully vaccinated. That compares to almost 70 per cent in Vermont, 65 per cent in Massachusetts and 58 per cent in New York.
It’s not that there aren’t enough vaccines here. Missouri now has ample supply, like everywhere else in the US.
In most places, you can simply walk into a pharmacy or a supermarket and get vaccinated for free.
The shots are so plentiful that states have become increasingly concerned about wastage, with the Federal Drug Administration and manufacturers now looking into how to extend their shelf life to avoid throwing them away.
Faced with slowing rates of vaccination, local authorities are offering cash incentives, lottery tickets and even free drinks to try and entice people to get the shot.
Hold Fast Brewing in Springfield, Missouri does a steady trade, not just in drinks, but in vaccinations.
Anyone who comes to the pop-up clinic at the brewery for a jab gets a free beer as a reward.
“Alcohol breaks down a lot of barriers,” explains Dr Matthew Stinson from the Jordan Valley Community Health Centre.
Health workers from Jordan Valley administer the shots at the brewery.
“I do think it’s been successful,” Dr Stinson continues.
Shelby Riddle and her partner came for their second shot.
“I was a little anxious about getting it,” Ms Riddle, a school counsellor, admits.
The pub also draws a younger crowd — a demographic authorities are desperate to reach.
Marisa Solensky, 19, cannot really explain why she did not get the vaccine earlier.
“I don’t know. I just kind of got busy, honestly, this summer.
“But I had COVID and I don’t want to get to it again. So I decided now’s the time.”
Delta threatens America’s fragile recovery
There could not be a worse time for vaccine uptake to plateau in the US.
Three months after telling vaccinated people they could remove their masks, the rise of the Delta variant has forced the US Centers for Disease Control (CDC) to reverse that advice.
A leaked CDC document that describes Delta as more transmissible than the common cold, chickenpox and Ebola warns officials that they must “acknowledge the war has changed”.
Emerging data shows a direct correlation between areas with low vaccination rates and rising case numbers.
Authorities warn that those who choose not to get the jab — variously referred to as the vaccine hesitant, vaccine holdouts or simply anti-vaxxers — are threatening the country’s recovery from the pandemic.
But the warnings don’t faze Cade Tremain, a political science student on holidays in the tranquil Ozark region.
“[The pandemic] never really affected me too much in the first place,” he says.
He is not thinking of getting vaccinated anytime soon.
“I don’t think I’m going to bother with anything like that. A big part of me doesn’t know if I really trust it.”
Armand Spurgin, who owns and manages a canoe business, is also holding out.
He wants to see how those who have had the shot fare before getting one himself.
“It just is kind of one of those things — anytime it comes around that quickly, to me, it makes me nervous,” he says.
Some of those floating down the river are vaccinated, among them Nate Chaudoin, a vet visiting with some mates from Kentucky.
“I believe in the vaccine. I’ve been fully vaccinated,” he says.
The rise of Delta hasn’t dissuaded him from going on holidays in a neighbouring state.
“I believe COVID is a real threat, but I don’t think it’s going do me in,” he explains.
“We like living our lives, and we like our freedoms. And I’m doing my thing.”
The red-blue divide in America’s vaccination rollout
Another striking finding around vaccination rates is the way political affiliation appears to be affecting people’s decisions.
Uptake is higher in areas that voted for President Joe Biden and lower in areas carried by former president Donald Trump.
Mr Trump won Missouri by 15 points.
And next door in Arkansas, which Mr Trump won by 27 points, vaccination is hovering at about 38 per cent.
The state’s Republican Governor Asa Hutchinson must walk a fine line on the issue of personal freedoms and vaccinations.
“Sure, whenever you’re a conservative, you have less trust of the government,” he tells the ABC.
“You ask a lot of tough questions. You have some scepticism. And that’s what’s reflected.
“Hopefully that will lead to the conclusion that this is really important for the right public health outcome.”
Mr Hutchinson has held about a dozen town hall meetings that he calls “community COVID conversations” to answer questions about the vaccine.
“There’s no state requirement, it’s just simply your choice,” he tells a packed town hall in Siloam Springs in the state’s north-west.
“But I also have to address it from a public health standpoint, knowing that we’re going to be living with people dying if we do not increase our vaccination rate,” he continues — to loud jeers from the crowd.
Many of those who turn up to these meetings have not had the vaccine.
Polling suggests many of them wrongly believe it is a greater risk to their health than the virus.
“What’s in the vaccine?'” one participant yells.
“Explain to me why there are so many that have the vaccine that are getting the virus,” shouts another man, to loud applause.
The Governor fields the questions with polite forcefulness for 90 minutes.
It’s hard to imagine many minds have been changed, but the Governor believes the event has been a success.
“I think that it’s the silent people in the room that are open and listening, so hopefully, this was helpful,” he reflects.