Monthly Archives: July 2021

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Gov. Jay Inslee today gave advance notice of the termination of two proclamations related to the COVID-19 pandemic. Advance notice is provided to give stakeholders time to adjust their procedures.

Proclamation 20-51

This proclamation waives/suspends laws that created barriers to holding community association meetings remotely and also waives/suspends statutes that permit the imposition and collection of fees for late payment of community assessments. This proclamation will expire at 11:59 PM on July 24.

This session the Legislature passed SB 5011 which will allow electronic meeting and notice provisions for community associations. The bill goes into effect on July 25.

Read the full proclamation here.

Proclamation 20-82

This proclamation delayed implementation of SB 5323, which passed the Legislature in the 2020 session and established a statewide prohibition on retailers issuance of single-use plastic bags. The delay was necessary due to supply issues caused by the COVID-19 pandemic.

This proclamation will expire at 11:59 PM on September 30, upon it's expiration the plastic bag ban as passed the legislature will go into effect.

Read the full proclamation here.

Public and constituent inquiries | 360.902.4111Press inquiries | 360.902.4136

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Inslee rescinds two proclamations related to the COVID-19 pandemic | Governor Jay Inslee - Governor Jay Inslee

Castor lvarez, a Catholic priest, has been looking for toothpaste and ground beef for weeks in Camagey, a colonial city in central Cuba. The last time he bought soap, he had to wait in line for four hours.

I was lucky. Since I didnt buy shampoo, I was given four bars instead of the two that Im usually allowed to buy, said the 50-year-old Father lvarez, who has been the parish priest in the communities that surround Cubas third-largest city for more than two decades.

Camagey residents are used to long lines and recurring shortages of products in a country where the Communist government exercises near-total control over the economy. But the damage brought by the coronavirus pandemic has inflicted an economic disaster, slashing the flow of tourists and remittances from Cubans living abroad. About four of every 10 dollars in Cuba come from those two sources.

The pandemic turned into a pressure cooker, and there was no safety valve, said Father lvarez. We now have widespread shortages of food and medicine. There is no fuel or public transport. There are constant blackouts now in summer, the heat is extremely harsh and food spoils.

Like hundreds of Cubans across the island, Father lvarez was detained by police on Sunday, when thousands of protesters spontaneously took to the streets to demand food, medicine and the end of six decades of dictatorship.

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In Cuba, Covid-19 Stress Pushes Unrest to the Edge - The Wall Street Journal

The West Virginia Department of Health and Human Resources (DHHR) reports as of July 14, 2021, there have been 3,056,269 total confirmatory laboratory results received for COVID-19, with 164,763 total cases and 2,916 deaths.

DHHR has confirmed the deaths of a 75-year old male from Barbour County, a 68-year old female from Raleigh County, an 82-year old female from Kanawha County, a 63-year old male from Kanawha County, a 72-year old female from Mercer County, a 64-year old male from Nicholas County, and an 80-year old female from Jefferson County.

Each death reported is a solemn reminder of the seriousness of this disease, said Bill J. Crouch, DHHR Cabinet Secretary. We send our sympathy to these families and urge all West Virginians to receive their COVID-19 vaccine to protect one another.

CASES PER COUNTY: Barbour (1,517), Berkeley (12,913), Boone (2,185), Braxton (1,023), Brooke (2,250), Cabell (8,935), Calhoun (398), Clay (544), Doddridge (647), Fayette (3,563), Gilmer (889), Grant (1,319), Greenbrier (2,913), Hampshire (1,933), Hancock (2,846), Hardy (1,586), Harrison (6,226), Jackson (2,270), Jefferson (4,812), Kanawha (15,539), Lewis (1,313), Lincoln (1,608), Logan (3,308), Marion (4,669), Marshall (3,542), Mason (2,072), McDowell (1,639), Mercer (5,219), Mineral (2,997), Mingo (2,778), Monongalia (9,410), Monroe (1,226), Morgan (1,245), Nicholas (1,914), Ohio (4,319), Pendleton (726), Pleasants (959), Pocahontas (684), Preston (2,965), Putnam (5,366), Raleigh (7,110), Randolph (2,863), Ritchie (763), Roane (668), Summers (866), Taylor (1,291), Tucker (548), Tyler (751), Upshur (1,986), Wayne (3,187), Webster (561), Wetzel (1,400), Wirt (465), Wood (7,967), Wyoming (2,070).

Free pop-up COVID-19 testing is available today in Barbour, Berkeley, Doddridge, Jefferson, Lincoln, Putnam, Ritchie, Tyler/Wetzel, and Wayne counties.

Barbour County

9:00 AM 11:00 AM, Barbour County Health Department, 109 Wabash Avenue, Philippi, WV

Berkeley County

10:00 AM 5:00 PM, 891 Auto Parts Place, Martinsburg, WV

Doddridge County

Jefferson County

10:00 AM 6:00 PM, Hollywood Casino, 750 Hollywood Drive, Charles Town, WV

Lincoln County

Putnam County

Ritchie County

1:00 PM 4:00 PM, Ritchie Regional, 138 S Penn Avenue, Harrisville, WV

Tyler/Wetzel Counties

Wayne County

10:00 AM 2:00 PM, Wayne County Health Department, 217 Kenova Avenue, Wayne, WV

Follow this link:

COVID-19 Daily Update 7-14-2021 - West Virginia Department of Health and Human Resources

Just because Pfizer wants to offer COVID-19 vaccine boosters doesnt mean people will be lining up anytime soon U.S. and international health authorities say that for now, the fully vaccinated seem well protected.

Globally, experts are watching closely to determine if and when people might need another shot. At the same time, many suggest the priority for the time being should be vaccinations, noting that worrisome coronavirus mutants wouldnt be popping up so fast if more of the U.S. and the rest of the world had gotten the initial round of shots.

If you want to stop hearing about the variant of the week, said Jennifer Nuzzo, a Johns Hopkins University public health specialist, we need to do more work to make sure all countries have more access to vaccines.

Here are some questions and answers about vaccine immunity and boosters.

WHATS PROMPTING ALL THE BOOSTER DEBATE?

U.S. health officials have long said that people one day might need a booster after all, they do for many other vaccines. Thats why studies are underway to test different approaches: simple third doses, mix-and-match tests using a different brand for a third dose, or experimental boosters tweaked to better match different variants.

But last week, Pfizer and its German partner BioNTech announced that in August, they plan to seek Food and Drug Administration authorization of a third dose because it could boost levels of virus-fighting antibodies, possibly helping ward off worrisome mutants.

The companies havent publicly released data, and U.S. health officials issued a sharp response that boosters arent yet needed and that the government, not vaccine makers, will decide if and when that changes.

The World Health Organization said Monday there is not enough evidence to show that third doses are needed. It said the scarce shots should be shared with poor countries instead of being used by rich countries as boosters.

WHATS THE EVIDENCE THAT VACCINE PROTECTION REMAINS STRONG?

An Associated Press analysislast month found nearly all COVID-19 deaths in the U.S. are occurring among the unvaccinated.

In the last few weeks, infections and hospitalizations have begun rising as the highly contagious delta variant spreads. But the Centers for Disease Control and Prevention says the surges are driven by the least vaccinated parts of a country that has plenty of shots if people would only take them.

No vaccine is perfect, meaning fully vaccinated people occasionally will get infected, but those so-called breakthrough cases usually are mild. Officials monitoring the need for boosters are watching closely for any jumps in serious breakthrough infections.

So far the news is good: The people first in line for vaccines back in December and January dont seem to be at higher risk for breakthrough infections than those vaccinated more recently, the CDCs Dr. Jay Butler said Tuesday.

IS THE BOOSTER QUESTION ALL ABOUT NEW VARIANTS?

No, scientists also are watching to see how much vaccinated peoples overall immunity to the coronavirus wanes. That, too, could require a booster shot.

Virus-fighting antibodies do gradually wane. Thats normal since the body doesnt need to be on high alert forever.

But antibodies arent its only defense. By the time those levels drop, the body has formed backups. They include memory B cells that, the next time youre exposed, explode, and they start dividing like mad to make new antibodies, said University of Pennsylvania immunologist Scott Hensley.

Another backup: T cells that kill virus-infected cells to help keep a breakthrough case from becoming severe.

Lab studies signal antibodies arent as potent against the delta variant as they are against some earlier versions of the coronavirus but are still protective. Specialists worry more about the prospect of future mutants that might escape todays vaccines, something preventable only by cracking down on viral spread everywhere.

HOW ARE OTHER COUNTRIES DOING AGAINST THE DELTA VARIANT?

Real-world data from England, Scotland, Canada and Israel shows that the vaccines most widely used in Western countries continue to provide strong protection. Researchers in Britain found two doses of the Pfizer vaccine, for example, are 96% protective against hospitalization with the delta variant and 88% effective against symptomatic infection.

Israel recently reported preliminary data suggesting protection against mild delta infection has dipped lower, to 64%. But protection against severe illness remained high.

Theres less information about how well other vaccines hold up against the delta variant. Thailand announced this week that health workers who had received two doses of a Chinese vaccine would be given a booster shot made by AstraZeneca.

COULD SOME PEOPLE NEED A BOOSTER BEFORE THE ENTIRE POPULATION?

Thats possible. Israel just began dispensing third doses of the Pfizer vaccine to transplant recipients and other patients with weak immune systems. The reason: People who take certain immune-suppressing medications dont react as strongly to any vaccinations not just COVID-19 vaccines as healthy people.

France already had a similar third-dose policy for the immunocompromised. And even though its not authorized in the U.S., some transplant recipients seek out a third dose in hopes of more protection.

Its not yet proven if a third dose helps and, if so, who needs one and when. The first large study of the strategy is beginning in thousands of patients in Norway.

___

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institutes Department of Science Education. The AP is solely responsible for all content.

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EXPLAINER: Are we going to need COVID-19 booster shots? - NEWS10 ABC

Several local governments in China are planning to bar residents who havent been vaccinated against Covid-19 from accessing public venues, stirring controversy as the country makes a push for herd immunity.

In recent days, a dozen counties and cities in the eastern provinces of Zhejiang, Fujian and Jiangxi set late-August deadlines for people 18 years or older to complete a two-shot vaccine regimen, according to similarly worded online statements. Many of them also set dates in late July by which unvaccinated people would be barred from entering schools, libraries, prisons, nursing homes and inpatient facilities at hospitals without a valid medical exemption.

Some of the localities attributed their new policies to national, provincial and municipal arrangements, without explaining whether they received a decree from the central government.

China is dealing with sporadic outbreaks of Covid-19 and authorities have been offering homegrown vaccines free of charge since last December.

The government notices have sparked online pushback from some Chinese and triggered a debateas in the U.S. and elsewhereabout whether people should be required to present proof of inoculation to travel, work or undertake other routine activities outside their home.

Read more here:

Covid-19 Vaccines Are Becoming Mandatory in Parts of China - The Wall Street Journal

SINGAPORE, July 14 (Reuters) - Guests began leaving a Genting Cruise Lines "cruise to nowhere" on Wednesday night after nearly 3,000 passengers and crew were confined to their staterooms through most of the day following the detection of a COVID-19 case onboard.

A 40-year-old passenger tested positive onboard and the result was confirmed after the person was taken to hospital once the ship docked early on Wednesday, the Singapore Tourism Board said, following the detection of the suspected case.

"The passenger was identified as a close contact of a confirmed case on land, and was immediately isolated as part of onboard health protocols," the board said in a statement.

Passengers said they found out about the suspected case in an announcement at around 1 a.m. and had been asked to stay in their rooms since.

The global cruise industry has taken a major hit from the coronavirus pandemic, with some of the earliest big outbreaks occurring on cruise ships in Asian waters.

Singapore, which has seen relatively few domestic COVID-19 cases, launched "round trips" on luxury liners in November, with no port of call during a few days of sailing.

Singapore reported 56 locally-transmitted coronavirus cases on Wednesday, the highest number of daily domestic infections recorded in about 10 months. Local media reported that the case on the ship was part of a growing cluster of COVID-19 infections associated with karaoke lounges.

The World Dream cruise liner had 1,646 passengers and 1,249 crew members on board and all, except essential service crew, had been required to remain in their staterooms with contactless meals sent to them, according to Dream Cruises, a part of Genting Cruise Lines.

The guest suspected of having COVID-19 had tested negative in a mandatory, pre-departure antigen rapid test before the ship set sail for a three-night cruise on Sunday.

The infected passenger's three travelling companions tested negative and were isolated while further contact tracing was being done, the tourism board said. Close contacts will be quarantined, it added.

'A BIT RARE TO HAPPEN'

A cruise ship is docked at harbour after turning back due to positive coronavirus disease (COVID-19) case on board, in Singapore July 14, 2021. REUTERS/Chen Lin

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Passenger Rishi Lalwani said he was surprised by the positive case, given the testing and social distancing measures in place for the cruise.

"The COVID situation in Singapore seemed largely contained so, yes, a case in a cruise of 1,700 guests seemed a bit rare to happen. Especially because there haven't been cases on cruises to nowhere for months," said Lalwani.

The cruises to nowhere, restricted to Singapore residents, have become popular during the pandemic with other travel opportunities very limited because of coronavirus restrictions.

Tan Choon Seng, 51, was on his third cruise this year with some friends when the bad news came through, but at least it was nearly the end of the holiday, he said.

"We are thankful that this happened at 1 a.m. so we were done with all the activities," Tan said in an online session with media organised by the operator. Tan said he was worried about any quarantine orders but would still go on a cruise again.

Except for the cancellation of World Dream's two-night voyage for Wednesday, all upcoming sailings were unaffected.

In December, passengers on Royal Caribbean's (RCL.N) Quantum of the Seas vessel were held in their cabins for more than 16 hours in Singapore after a suspected COVID-19 case on board.

But that turned out to be a false alarm.

All guests disembarking from the World Dream will be required to undergo the mandatory antigen rapid test at the cruise centre, Dream Cruises said in a statement.

Anson Lim, 46, who was on board to celebrate his birthday, said he wanted to take more precautions once ashore.

"I will go for an extra COVID-19 test on my own," he said.

Reporting by Chen Lin and Aradhana Aravindan in Singapore; Writing by Ed Davies; Editing by Richard Pullin and Mark Heinrich

Our Standards: The Thomson Reuters Trust Principles.

Excerpt from:

Guests leave Singapore cruise after nearly 3000 confined onboard over COVID-19 case - Reuters

By Jennifer Couzin-FrankelJul. 13, 2021 , 2:35 PM

Sciences COVID-19 reporting is supported by the Heising-Simons Foundation.

Sixteen pandemic months have felt disorienting and arduousbut along the arc of human history, COVID-19 marks just another inflection point. Epidemics have punctuated humanitys timeline for centuries, sowing panic and killing millions, whether the culprit was plague, smallpox, or influenza. And when infections abate, their imprints on society can remain, some short-lived and some enduring.

In a series of news articles over the coming months, Science will consider how a new normal is emerging in the scientific world. Of course, COVID-19 is still with us, especially outside the minority of countries now enjoying the fruits of widespread vaccination. Still, as the pandemic enters a different phase, we ask how research may be changing, how scientists are navigating these waters, and in what directions they are choosing to sail.

Although the past may not presage the future, epidemic history illuminates how change unfolds. Historians often say that what an epidemic will do is expose underlying fault lines, says Erica Charters, a historian of medicine at the University of Oxford who is studying how epidemics end. But how we respond is up to us. When we ask, How does the epidemic change society? it suggests theres something in the disease that will guide us. But the disease doesnt have agency the way humans do.

Past epidemics have spurred scientists and physicians to reconsider everything from their understanding of disease to their modes of communication. One of the most studied, the bubonic plague, tore through Europe in the late 1340s as the Black Death, then sporadically struck parts of Europe, Asia, and North Africa over the next 500 years. Caused by bacteria transmitted via the bites of infected fleas, the plagues hallmarks included grotesquely swollen lymph nodes, seizures, and organ failure. Cities were powerless against its spread. In 1630, nearly half the population of Milan perished. In Marseille, France, in 1720, 60,000 died.

Yet the mere recording of those numbers underscores how medicine reoriented in the face of the plague. Until the Black Death, medical writers did not routinely categorize distinct diseases, and instead often presented illness as a generalized physical disequilibrium. Diseases were not fixed entities, writes Frank Snowden, a historian of medicine at Yale University, in his bookEpidemics and Society: From the Black Death to the Present. Influenza could morph into dysentery.

The plague years sparked more systematic study of infectious diseases and spawned a new genre of writing: plague treatises, ranging from pithy pamphlets on quarantines to lengthy catalogs of potential treatments. The treatises cropped up across the Islamic world and Europe, says Nkhet Varlk, a historian of medicine at Rutgers University, Newark. This is the first disease that gets its own literature, she says. Disease-specific commentary expanded to address other conditions, such as sleeping sickness and smallpox. Even before the invention of the printing press, the treatises were apparently shared. Ottoman plague treatises often contained notes in the margins from physicians commenting on this or that treatment.

Plague and later epidemics also coincided with the rise of epidemiology and public health as disciplines, although some historians question whether the diseases were always the impetus. From the 14th to 16th centuries, new laws in the Ottoman Empire and parts of Europe required collection of death tolls during epidemics, Varlk says. Plague also hastened the development of preventive tools, including separate quarantine hospitals, social distancing measures, and, by the late 16th century, contact-tracing procedures, says Samuel Cohn, a historian of the Middle Ages and medicine at the University of Glasgow. All of these things that a lot of people think are very modern were being devised and developed back then. The term contagio took off, as officials and physicians sought to ascertain how plague was spread.

Cholera, caused by a bacterium in water, devastated New York and other areas in the 1800s. It gave rise not only to new sanitation practices, but also to enduring public health institutions. Statistics had proven what common sense had already known: In any epidemic, those who had the faintest chance of surviving were those who lived in the worst conditions, historian of medicine Charles Rosenberg, now an emeritus professor at Harvard University, wrote in his influential bookThe Cholera Years: The United States in 1832, 1849, and 1866. To improve those conditions, New York City created its Metropolitan Board of Health in 1866. In 1851, the French government organized the first in a series of International Sanitary Conferences that would span nearly 90 years and help guide the founding of the World Health Organization in 1948. Cholera was the stimulus for the first international meetings and cooperation on public health, Rosenberg says now.

Meanwhile, efforts to decipher disease continued: Although physicians who eyed germs as culprits remained a minority in the mid-1800s, disease was no longer an incident in a drama of moral choice and spiritual salvation, but a consequence of mans interaction with his environment, Rosenberg wrote. Fleas were identified as the carrier of plague during a global pandemic in the late 1800s and early 1900s, and the concept of insects as vectors of disease has influenced public health and epidemiology ever since.

A curious mix of remembering and forgetting trails many epidemics. Some quickly vanish from memory, says David Barnes, a historian of medicine at the University of Pennsylvania. The 1918 flu, which killed an estimated 50 million people worldwide but was also overshadowed by World War I, is a classic example of a forgotten ordeal, he says. One would expect that that would be a revolutionary, transformative trauma, and yet very little changed in its wake. There was no vast investment in public health infrastructure, no mammoth infusion of money into biomedical research. Although the 1918 pandemic did help spur a new field of virology, that research advanced slowly until the electron microscope arrived in the early 1930s.

In contrast, the emergence of HIV/AIDS in the 1980s left a potent legacy, Barnes says. A new breed of patient-activists fought doggedly for their own survival, demanding rapid access to experimental treatments. They ultimately won the battle, reshaping policies for subsequent drug approvals. But, It wasnt the epidemic per sethe damage, the death toll of AIDSthat made that happen, Barnes says. It was activists who were organized and persistent, really beyond anything our society had ever seen.

Its through this lens of human agency that Barnes and other historians contemplate COVID-19s potential scientific legacy. The pandemic, like its predecessors, cast light on uncomfortable truths, ranging from the impact of societal inequities on health to waste in clinical trials to paltry investments in public health. Questions loom about how to buttress labsfinancially or otherwisethat were immobilized by the pandemic.

In COVID-19s wake, will researchers refashion what they study and how they work, potentially accelerating changes already underway? Or will what Snowden calls societal amnesia set in, fueled by the craving to leave a pandemic behind? The answers will come over decades. But scientists are beginning to shape them now.

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Will COVID-19 change science? Past pandemics offer clues - Science Magazine

A man receives a COVID-19 vaccine at a clinic in Springfield, Mo., in June. Vaccination rates in southern Missouri are low, a factor officials say is helping drive what's now the nation's largest outbreak. Nathan Papes/AP hide caption

A man receives a COVID-19 vaccine at a clinic in Springfield, Mo., in June. Vaccination rates in southern Missouri are low, a factor officials say is helping drive what's now the nation's largest outbreak.

In Springfield, Mo., firefighters are giving vaccine shots. Churches are scrambling to schedule vaccine clinics. Students and staff at summer school at the public schools are back to wearing masks.

Dozens of traveling nurses are due to arrive at one of the city's two biggest hospitals over the coming weeks; extra ventilators from around Missouri and Arkansas were transported to the other major hospital after it ran short over the July Fourth weekend.

The outbreak of COVID-19 in southwest Missouri and northern Arkansas has become the nation's largest and is mostly driven by the highly contagious delta variant. Officials warn it could continue to grow unchecked if vaccination rates stay low.

"We are truly in a very dangerous predicament," Springfield Mayor Ken McClure said Monday at a press conference. "While we are one of the unfortunate few early hot spots of the delta variant, we are not giving up. It is not too late. We need to stay the course."

In Missouri, the seven-day average of new cases is near 1,400 new positive cases each day, up more than 150% from a month ago. In Arkansas, that number is up 287%.

Caseload and hospitalization rates in the Ozarks region have reached levels not seen since the winter, officials said. In several counties across Missouri and Arkansas, caseloads have now reached or surpassed their winter peaks.

According to the most recent data available from the Centers for Disease Control and Prevention, the delta variant accounts for more than 73% of new cases in Missouri, by far the highest percentage of any state.

The Springfield-Greene County Health Department reported 17 new COVID-19 deaths in its most recent reporting period, which ended July 4. None had been fully vaccinated.

"Begging people to take the vaccine while there is still time. If you could see the exhaustion in the eyes of our nurses who keep zipping up body bags, we beg you," tweeted Steve Edwards, president and CEO of CoxHealth, a six-hospital system in southwest Missouri based in Springfield.

CoxHealth's hospital in Springfield was treating 125 COVID-19 patients as of Monday. The city's other major hospital, Mercy Hospital Springfield, reported 134 patients with COVID-19, including several children. More than 20 were on ventilators.

As a result of the influx, Mercy Hospital announced Sunday it was opening a sixth COVID-19 unit. Last year, it needed only five.

More than half of patients are from the rural counties around Springfield, according to Greene County health data.

There are few pandemic restrictions in place anymore in the southern part of Missouri, which is a haven for tourism in the summer. The lakes and rivers of the Ozarks attract tourists from around the region for camping, boating and lake house vacations. The city of Branson hosts dozens of live music shows every week. Memorial Day and July Fourth draw huge numbers of people to the area.

But many of the rural counties that make up this part of Missouri have among the lowest vaccination rates in the state. Overall, about 45% of Missourians have received their first shot, but in more than 20 counties in southern Missouri, fewer than a quarter of residents have done so.

"I think we were all hoping that we wouldn't see COVID much this summer, but it is definitely not the fact here in Springfield," said William Sistrunk, the lead infectious disease physician at Mercy Hospital, speaking to NPR.

Missouri Gov. Mike Parson signs legislation last month restricting local officials' ability to enact public health restrictions. David A. Lieb/AP hide caption

Missouri Gov. Mike Parson signs legislation last month restricting local officials' ability to enact public health restrictions.

Gov. Mike Parson has encouraged Missourians to get the vaccine, as he has done. He lifted the state's pandemic restrictions in May and has been vocal about Missourians' right to reject the vaccine if they choose. In June, he signed a bill limiting local governments' ability to enact public health restrictions.

Parson said last week he would oppose a door-to-door vaccination campaign by government workers.

"We all should be working together trying to find a solution to get more vaccine in more people's arms, not trying to force people to take it, not trying to scare them into it. Just make sure that they understand the facts," Parson said, speaking to reporters in Kansas City.

Local officials in southern Missouri, especially Springfield, are taking a more active stand in encouraging vaccinations.

On Monday, the mayor and local health officials held a press conference at a church the city has partnered with to distribute vaccines, where they denounced misinformation and politicization about vaccines.

Asked about the cheers over low vaccination rates at the Conservative Political Action Conference over the weekend, the county's acting health director said it was heartbreaking.

"To hear that people are cheering against the tool that can save lives when we're sitting in the middle of a crisis where people are dying it breaks my heart," said Katie Towns, acting director of the county's health department.

Vaccination rates have risen slowly but steadily in this part of Missouri. Mercy Hospital Springfield is seeing more demand for vaccination appointments in recent days, officials said, and is now vaccinating roughly 250 people per day, up from about 150 earlier in the summer.

"Gradually in the past week or couple weeks we have seen a small increase in the number of people who are interested. I think hopefully they're realizing this is a pretty serious situation," Dr. Nancy Yoon, chief medical officer for the Springfield-Greene County Health Department, told NPR member station KCUR.

Now, the outbreak that began in the Ozarks has started to spread around the state. Case data and sewer surveillance are showing an uptick in the Kansas City and St. Louis metro areas, state officials said. In St. Louis County, the county with the state's third-highest vaccination rate, cases are up 63% over the last two weeks.

"Unfortunately, Missouri turned out to be among those several states that do have those vulnerable spots," Dr. George Turabelidze, state epidemiologist at the Missouri Department of Health and Senior Services, told St. Louis Public Radio. "Those are spots where people are under-vaccinated, where people have low natural immunity levels and [where] some communities assumed the pandemic was already behind us."

In Springfield, health care workers have braced for what they expect to be a long and challenging summer, as the number of people hospitalized in the county has persistently trended up.

"You feel like you're kind of beating your head on that proverbial brick wall trying to tell people, understand what we're seeing," Erik Frederick, chief administrative officer at Mercy Hospital, said in an interview with NPR.

"This is real. It's right here in front of us."

St. Louis Public Radio and KCUR contributed to this report.

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COVID Cases In Parts Of Missouri And Arkansas Surge To Levels Not Seen Since Winter - NPR