WASHINGTON: COVID-19 deaths in the US have climbed to an average of more than 1,900 a day for the first time since early March, with experts saying the virus is preying largely on a distinct group -- 71 million unvaccinated Americans.
The increasingly lethal turn has filled hospitals, complicated the start of the school year, delayed the return to offices and demoralized health care workers.
"It is devastating," said Dr. Dena Hubbard, a pediatrician in the Kansas City, Missouri, area who has cared for babies delivered prematurely by cesarean section in a last-ditch effort to save their mothers, some of whom died.
For health workers, the deaths, combined with misinformation and disbelief about the virus, have been "heart-wrenching, soul-crushing."
Twenty-two people died in one week alone at CoxHealth hospitals in the Springfield-Branson area, a level almost as high as that of all of Chicago.
West Virginia has had more deaths in the first three weeks of September, 340, than in the previous three months combined.
Georgia is averaging 125 dead per day, more than California or other more populous states.
"I've got to tell you, a guy has got to wonder if we are ever going to see the end of it or not," said Collin Follis, who is the coroner in Missouri's Madison County and works at a funeral home.
The nation was stunned back in December when it was witnessing 3,000 deaths a day.
But that was when almost no one was vaccinated.
Now, nearly 64 per cent of the US population has received at least one dose of the COVID-19 vaccine.
And yet, average deaths per day have climbed 40 per cent over the past two weeks, from 1,387 to 1,947, according to data from Johns Hopkins University.
Health experts say the vast majority of the hospitalised and dead have been unvaccinated.
While some vaccinated people have suffered breakthrough infections, those tend to be mild.
The number of vaccine-eligible Americans who have yet to get a shot has been put at more than 70 million.
"There is a very real risk you'll end up in the hospital or even in the obituary pages," Dr. Bruce Vanderhoff, chief medical officer for the Ohio Department of Health, said to the unvaccinated.
"Don't become a statistic when there is a simple, safe and effective alternative to go out today and get vaccinated."
Many low-vaccination communities also have high rates of conditions like obesity and diabetes, said Dr. William Moss of Johns Hopkins.
And that combination, along with the more contagious delta variant, has proved lethal.
"I think this is a real failure of society and our most egregious sin to be at this stage where we have hospitals overwhelmed, ICUs overwhelmed and hitting this mark in terms of deaths per day," Moss lamented.
New cases of the coronavirus per day in the US have dropped since the start of September and are now running at about 139,000.
But deaths typically take longer to fall because victims often linger for weeks before succumbing.
In Kansas, 65-year-old cattleman Mike Limon thought he had beaten COVID-19 and went back to work for a few days.
But the virus had "fried" his lungs and he died last week, said his grandson, Cadin Limon, 22, of Wichita.
He said his grandfather didn't get vaccinated for fear of a bad reaction, and he hasn't gotten the shot either for the same reason, though serious side effects have proved extremely rare.
He described his grandfather as a "man of faith."
"Sixty-five is still pretty young," the young man said.
"I know that. It seems sudden and unexpected, but COVID didn't surprise God. His death wasn't a surprise to God. The God I serve is bigger than that."
Cases are falling in West Virginia from pandemic highs, but deaths and hospitalizations are expected to continue increasing for as many as six more weeks, said retired National Guard Maj. Gen.James Hoyer, who leads the state's coronavirus task force.
Dr. Greg Martin, who is president of the Society of Critical Care Medicine and practices mostly at Grady Hospital in Atlanta, said the staff is buckling under the strain.
"I think everyone in 2020 thought we would get through this. No one really thought that we would still be seeing this the same way in 2021," he said.
In Oklahoma, Hillcrest South Hospital in Tulsa is among several medical centers around the country to add temporary morgues.
Deaths are at an all-time high there, at three to four times the number it would see in a non-COVID-19 world, said Bennett Geister, hospital CEO.
He said the staff there, too, is worn out.
"They didn't sign up to be ICU nurses only to have people pass away on them," he said.
"They signed up to be ICU nurses to take people to recovery and heal people from the brink of death."
President Joe Biden is betting on millions more rapid, at-home tests to help curb the latest deadly wave.
But the tests have already disappeared from pharmacy shelves in many parts of the US, and manufacturers warn it will take them weeks to ramp up production, after scaling it back amid plummeting demand over the summer.
The latest shortage is another painful reminder that the US has yet to successfully manage its COVID-19 testing arsenal, let alone deploy it in the type of systematic way needed to quickly crush outbreaks in schools, workplaces and communities.
Experts say encouraging signs last spring led to false confidence about the shrinking role for tests: falling case numbers, rising vaccination rates and guidance from health officials that vaccinated people could largely skip testing.
Officials recently reversed that advice as cases and deaths driven by the delta variant surged anew.
"For all of us, there was a combination of optimism and hubris in the June timeframe that led us believe this was over," said Mara Aspinall, a health industry researcher at Arizona State University who has become a leading authority on COVID-19 testing supplies.
Colorado's Mesa County is among the local governments that have stopped offering rapid tests as part of their free testing programs for the general public.
"We were seeing shortages in the tests across the county, so we are really prioritizing supplies for our school districts to have quick turnaround for testing, to help them if needed," said Stefany Busch, a county spokeswoman.
She noted that tests that are processed in laboratories, which take longer to give results, remain plentiful.
Indeed, parts of the US testing system are faring better than during prior surges.
The large commercial labs that process the majority of tests performed at hospitals and testing sites still report plenty of capacity.
Labcorp, one of the biggest laboratory chains, said last week it was delivering results for 1,50,000 tests daily, with the ability to double that number.
Still, rapid tests have a clear advantage in that they can be done anywhere and have a 20-minute turnaround time, but most school testing programs still rely on tests processed in labs, which return results in a day or two.
In general, the US has been far more cautious about embracing rapid, at-home testing technology compared to countries like Britain that have rolled it out widely.
The Food and Drug Administration has authorized only about a half-dozen such tests, compared with more than 400 laboratory tests.
Many experts, including FDA regulators, still consider laboratory technology the gold standard for accuracy because it can detect even minute levels of virus in the nose.
But in his speech this month announcing sweeping new vaccine mandates, Biden highlighted rapid tests, saying the government would purchase 280 million of them, as he also called on all schools to set up regular testing programs.
Biden said the federal government will use the Defense Production Act to ensure manufacturers have the raw materials they need to make tests.
If those plans sound familiar, it's because they were part of Biden's original strategy for dealing with COVID-19 released in January.
A spokeswoman for the Department of Health and Human Services said the latest actions "build on earlier initiatives" as the delta variant-driven surge boosts testing demand.
HHS has announced few details of the USD2 billion-plan to purchase rapid tests.
For now, retail chains like CVS and Walgreens have placed limits on how many at-home tests customers can buy.
Abbott Laboratories, the country's largest rapid test maker, said it is currently producing "tens of millions" of its BinaxNOW tests per month and working to increase capacity in coming weeks.
The New York Times recently reported that over the summer Abbott shut down one of its factories, laid off employees and destroyed some testing components.
Abbott said those decisions came after vaccinations climbed and demand for testing plunged.
The destroyed supplies had limited shelf life and were not viable for sale in the US or for donation overseas, according to Abbott.
"It is now very clear that testing is a necessary companion to vaccines and Abbott is ramping up again," said a company spokesperson.
The Biden administration's purchase plans should help stabilise supplies.
But testing experts said the government could have stepped in months ago.
"We can't let the market determine our testing supplies, which is what happened here," said Scott Becker of the Association of Public Health Laboratories.
"These tests are essential for public health purposes, so we have to have supply at all times."
Becker's group and others have seen testing demand increasing for weeks.
And while labs are still operating well below levels seen last winter, there are unknowns, including how Biden's push for increased testing at schools and workplaces will impact them.
Testing policies vary widely by schools and states.
Some districts regularly screen all students, including in Los Angeles, Baltimore and San Antonio.
But many more districts do no testing at all.
A recent survey of 100 large districts found fewer than 15 per cent required any testing for students.
That's despite USD10 billion in federal funds made available last spring to set up testing programs.