OKLAHOMA (NYTIMES) - Oklahoma is in the grip of a frightening surge of the coronavirus, the worst it has yet seen and one of the worst in America's winter.
Mercy Hospital Ardmore, in rural Oklahoma, has so many Covid-19 patients that some people are being cared for in curtained-off areas of hallways and the emergency department's waiting room.
It has been this way for weeks.
"The people coming in are very, very sick, and they don't quickly get better," said Ms Paula Pfau, the hospital's nursing director.
Oklahoma is averaging nearly 4,000 new cases each day, an increase of almost 50 per cent from two weeks ago. Rural counties in the southern part of the state, including around Ardmore, are now among the hardest hit in the country relative to their populations.
Family gatherings and parties over the holidays are at least partly to blame, according to hospital officials and the Oklahoma State Department of Health.
Nationally, the country is facing its worst days of the pandemic: There were more than 4,400 Covid-19 deaths reported in the US on Tuesday (Jan 12), a record, according to a New York Times database. Hospitalisations are at a near-record high of 131,326, according to the Covid Tracking Project. And more than 380,000 people in the US have died from Covid-19.
Oklahoma is experiencing the third-worst outbreak in the country, behind Arizona, which is enduring a surge even worse than its summer peak, and California, where a weekslong flood of cases is wearing hospitals and their workers thin.
There is no statewide mask mandate in Oklahoma, although the city of Ardmore has had one since November.
A crush of new Covid-19 patients emerged seven to 10 days after Thanksgiving, and another after Christmas and New Year's Eve.
"In rural Oklahoma, we didn't get our first case for a long time," Ms Pfau said. "We kind of decided the surge couldn't happen here. We don't have public transportation. We don't have Uber. We're in the middle of the country, with all this space. So we kept on with business as usual. And now it's just a full-force hit."
Coronavirus cases were relatively low in Oklahoma until the summer, when the daily number of new cases spiked in June, then surpassed 1,000 each day in September.
An indoor rally in July held by President Donald Trump in Tulsa was linked to a spike in cases there by the director of the Tulsa Health Department, Dr Bruce Dart, who had pleaded with attendees to wear face masks, which were not worn by most at the rally.
Now, pretty much everyone in the state knows someone who has been sick, said Dr Jennifer Clark, a physician and former hospital administrator who is helping lead an effort by Oklahoma State University to keep rural healthcare providers updated.
"There's a heavy sense of grief," she said.