MISSOURI (BLOOMBERG) - Nestled in Missouri's Ozark Mountains, the city of Branson has long drawn throngs of US tourists with live country music, a replica Titanic, Dolly Parton's Stampede dinner show, an 1880s theme park and an oversized bust of Ronald Reagan.
But Branson now has another, more dire claim to fame as the origin of Missouri's outbreak of the Delta variant - the coronavirus strain that now accounts for more than half of US cases.
Missouri's Delta outbreak has raised alarms nationally as the US races to contain the variant, which is more transmissible than the original strain that ground the world to a halt and killed millions. With large swathes of the country's population declining vaccines, the Delta variant threatens to derail US efforts to return to normal.
Dr Rochelle Walensky, director of the Centres for Disease Control and Prevention, this week singled out south-western Missouri - the region that includes Branson - as one of several hot spots for the variant.
"Low vaccination rates in these counties, coupled with high case rates and lax mitigation policies that do not protect those who are unvaccinated from disease, will certainly and sadly lead to more unnecessary suffering, hospitalisation and potential death," Dr Walensky said in a briefing on Thursday (July 8).
"We are really encouraging people who are not vaccinated yet to get vaccinated and wear a mask until you do."
Branson is an ideal incubator, the sort of place that would worry Dr Walensky. It sits at a crossroads of the US South and Midwest, playing host to big crowds that pack entertainment venues and restaurants. It heaps on feel-good Americana, and mostly caters to conservative regions where the pandemic has become a political litmus test and vaccinations lag the national average.
Trump flags and hats dot the streetscape; almost no one wears masks.
And there appears to be little concern in Branson, where - as in other conservative regions across the US - doubts about vaccines and the virus alike run deep.
The town in April elected Mr Larry Milton as mayor after he ran on an anti-mask platform. Branson is now fully reopened, shows have resumed at full capacity - Dolly Parton's Stampede suggests masks for the unvaccinated, but doesn't require them - tourists line the streets and restaurants are full. Covid-19 restrictions have vanished.
Missouri's Republican governor, Mr Mike Parson, joined revellers for a crowded outdoor July 4th celebration in the town, in the throes of an outbreak.
Mr Parson, who didn't respond to a request for comment, has offered mixed messages on vaccinations - he criticised President Joe Biden for suggesting this week that shots could be promoted door-to-door, before tweeting on Thursday that vaccination is the best way to prevent Covid-19.
Branson was the first place in Missouri that the Delta variant was found. Dr Marc Johnson, a University of Missouri researcher working with the state to track coronavirus variants, first detected it on May 10 in one part of the city's sewer system. A week later, it was found in the other part - and in two other Missouri towns. A week after that, it was in nearby counties. Now it's throughout the state.
"It's everywhere," Dr Johnson said. "And I expect that everywhere that we have not seen a spike yet, we are about to."
Of the counties with the most new cases, 93 per cent are less than 40 per cent vaccinated, Dr Walensky said. These are the locations where hospitalisations and deaths are rising among the unvaccinated, and tend to be where Delta is dominant, she said, stressing that nearly every American who now falls severely ill or dies hasn't been inoculated.
Hospitalisations are rising in southern Missouri - Branson's most serious cases go to nearby Springfield, where one hospital set a record this week for Covid-19 admissions. The hospitals have made public appeals for staff and ventilators.
"All of the sudden everybody said it's done, but it's not," said Mr Tom Keller, president and chief executive officer of Ozarks Healthcare, which runs a hospital and clinics in southern Missouri. "I don't know how the Delta variant got to Springfield, Missouri, and didn't get to the East Coast first."
The health community hasn't been blunt enough in warning how Covid-19 can ravage the body, Mr Keller said. "We're going to be a lot more direct."
Polling has shown that political conservatives are less likely to get the vaccine and more likely to say they think the pandemic is over, a combination that, in the face of Delta, risks fresh outbreaks.
In neighbouring Arkansas, cases and hospitalisations are rising sharply, too. Arkansas Governor Asa Hutchinson said this week that the state saw its largest increase in hospitalisations since January.
"We are losing ground," he said, adding that the Delta variant appears to hitting younger people.
The average age of patients hospitalised for Covid-19 has fallen to 54.7 years from 62.7 in January, he said. "If you don't want to go to the hospital, get vaccinated," he warned.
Across Missouri's western border, Kansas has begun public service announcements to head off what officials there fear will be a spread of the variant stemming from July 4th celebrations. The state has been monitoring rising case loads in neighbouring states for weeks, said Mr Sam Coleman, a spokesman for the governor.
'Lack of proof'
But in Missouri, local health officials say there is still deep scepticism in the region about coronavirus vaccines, and many people are misinformed about the safety of the shot and the danger of the virus.
A political lens is unavoidable for the growing US vaccine gap. The vaccination rate in counties that backed Mr Biden for president is roughly 12 percentage points higher than those that backed Mr Donald Trump, up from 2.2 per cent in April, according to an analysis by the Kaiser Family Foundation.
"I've had people tell me: 'I've had it, it was no big deal, I'm not going to get vaccinated,'" said Dr Craig McCoy, a former paramedic who's president of Mercy Springfield Communities, which operates a hospital in Springfield.
"What they don't realise is that people with antibodies of the Alpha variant are sitting in our hospital with the Delta variant."
In Branson, some lay out broad scepticism with the vaccine - saying they worry it's rushed and potentially unsafe.
"It's lack of proof," said Mr Stephen Pello, 63, a carpenter from Texas, during a recent visit to Branson. "I don't trust the CDC, I don't trust the politicians; I trust what the Bible tells me and what the Spirit puts in my heart."
Mr Pello said his doctor mentioned vaccination to him, but didn't press the issue after he said he needed more information. He suspects others like him might get the shot if Mr Trump more fervently urged them to do so, but he said even that wouldn't change his mind.
Ms Charliese Holder, 61, a Branson visitor from Oklahoma, also expressed scepticism about information coming from government officials, including Dr Anthony Fauci, the nation's top infectious disease expert.
"I think there's been too much wishy-wash from Fauci and the others," Ms Holder said as she ate an ice cream cone outside a packed shop on Branson's main street. She said she hasn't ruled out getting the vaccine, but has doubts about its efficacy.
"Even though they're calling this a vaccine, per se, the way they're making it sound, I don't think it's any different than the flu shot," she said. "There's a lot of questions that aren't answered."
Dr Johnson, the University of Missouri researcher, said that the key unknown about the latest outbreaks is when caseloads will plateau, and how the Delta wave will look in more heavily vaccinated communities.
"We're not done, the virus is not done, there is going to be a wave through the US. It could be that the really highly vaccinated places do okay, but I'm not even really sure about that," Dr Johnson said. "Either way, I am absolutely convinced it's not going to stay in Missouri."