It felt like Covid-19 was closing in around us during the five days in August this CNN crew spent in Carter County, Missouri. In Van Buren, the county’s biggest town, we were sitting next to a 16-year-old when she got a text that masks would be mandated at school because about 20 kids had tested positive after just two days of class. One person we’d wanted to interview had to go to the hospital with a breakthrough infection. Another person found out the night before our interview she’d been exposed to coronavirus by a sick kid at church. People were gossiping about who had it and where they got it and whether there was someone in town who knew they had it but refused to isolate. “Everybody’s scared. Everybody’s coming down with it. And it’s almost like a plague,” Brandon Helvey said. Helvey had had Covid-19 three weeks earlier, but he didn’t want to get the vaccine yet, he said. He thought it was still unproven. CNN had come to Carter County, in the Ozark Mountains, in October 2020, when coronavirus was starting to hit rural America. At the time, the debate was over masks, and it was very political. “We sit in the coffee shop and we see someone wearing a mask and we think: Democrat,” Brian Keathley said last fall, weeks before he got the virus. Carter County has just 6,000 people. Van Buren has about 820 residents. It’s the kind of place where everyone knows everyone – and everyone knows everyone who has Covid-19. We came back in August to see what had changed since last fall and what hadn’t – and why, if people here personally knew so many people who got sick, just 27% of the county is fully vaccinated. “I had both shots of the vaccine, and people just acted like, ‘Oh, it doesn’t help,’” Cheryl Wetton said. “It bothers me sometimes that people act like Covid is a big joke. I always want to say, ‘Well, why don’t you just come right up here to the cemetery, and I’ll show you my husband’s grave? And I can show you it’s no joke.’” Wetton actually did say that to a guy in town, she later confirmed. “He just got real quiet.” “If you have it, everybody knows it. And they’re talking about you,” Tara Chitwood said. She was working behind the register at a souvenir shop, subbing in for her mom, who’d gotten sick a few days earlier. It was “more than likely” Covid-19, Chitwood said, because one of her mom’s friends tested positive. But her mom probably wouldn’t get tested, she said. It was scary, Chitwood said. Her own little girl had to quarantine. But there was “no way” she’d get the vaccine. Her mom had gotten vaccinated, she said, and got sick anyway. “I’ve survived this long,” Chitwood said, and then expressed a fatalism we heard a lot: She was going to die of something, eventually. The latest wave is the worst one yet This Covid-19 wave in Carter County is much worse than last year, its public health center said. August was the county’s worst month ever. The health center announced new cases on Facebook, in between pleas for patience because it was dealing with so many calls. August 20: 4 new cases. August 21: 4 new cases. August 22: 3 new cases. August 23: 17 new cases, 1 death. August 24: 16 new cases. August 25: 18 new cases. August 26: 16 new cases. August 30: 30 new cases. August 31: 22 new cases. September 1: 18 new cases, 1 death. The case counts were split between confirmed and probable because the health center didn’t have enough PCR tests, the most sensitive available. On August 31, the health center announced the state health department would send a team to do free PCR tests weekly. When we called Cricket Kester, the phone had a bad connection, and she couldn’t hear us: “If this is family, call back. Otherwise we’re too sick to talk to anybody.” We did call back, and Kester said she was glad. She and her husband were both vaccinated this spring and got breakthrough infections. She thought they’d be dead without the vaccine, and told us to put the word out that everyone should get it. The coffee shop we’d filmed at in 2020 had just closed for two weeks, and everyone we talked to in town had heard people who worked there had gotten sick. The health center said the rumor had pushed a wave of people to get tested for Covid-19. Some in town knew the owners personally and were worried about them, but the owners did not respond to CNN’s request for comment. Most people we spoke to knew exactly the last time they’d eaten there. Delta variant fuels the death toll – and the anxiety The Current River runs through Van Buren. It’s swift and clear, and every summer, thousands of tourists come to boat or float down it on inner tubes. It’s three miles of a joyful, often-drunken party drifting past picnics on gravel bars and kids jumping off cliffs. That means a lot of jobs are in the service industry, and few people can work from home. “They want to hide the fact that they’re sick so they can work,” Debbie Turley said. “You don’t get vaccinated. You don’t get tested. You hide your symptoms if you’re able to. And you just go out in the community and spread the virus.” Sometimes a rumor would spread that Covid-19 was running through a restaurant, Turley said. The locals would stay away, but the tourists wouldn’t know. Turley already had Covid-19, and she was vaccinated, and she wore masks, too. “I was actually exposed this week by someone who didn’t know they had it, but they did have a cough, and they didn’t stay home,” she said. She’d also been in the coffee shop a few times not long before it closed. “Nobody died for a long time, so it’s taken a while for people to get serious,” Jim Rodebush said. The Delta variant is what made it more serious. “It spread so fast. We’ve had, I guess, 15 people die here.” (It is now 16 in Carter County.) Rodebush’s wife Ruth fought cancer for 12 years, he said. Covid-19 killed her in eight days. She died July 20, 2021. “I talked to her up until the Sunday before she died,” Rodebush said. “She said, ‘This is bad, I think you all need to get the shot.’ And I think she’s right.” Neither had been vaccinated. Ruth had said her doctor had told her not to get the vaccine because of her chemo, Rodebush said. “I was pretty skeptical of it until I watched all this happen,” he said. Now, he plans to get the shot. When Ruth was dying, the hospital called at about 2:30 a.m., so Rodebush and his son went to see her. The Covid-19 ward was eerie – dark, everyone in protective gear, the patients on ventilators, which he knew was the end of the line. “There’s nothing good about it,” he said. “I don’t ever want to go back in one.” They’d watched our 2020 story for CNN, and he thought it was “bullsh*t.” He knew everyone in the video – every single one of them. At the time, he thought they were wrong about masks, but now it was more visceral. “Those boys sitting in the coffee shop don’t know what they’re talking about when they’re talking about Covid. They need to walk through the Covid ward. That’ll change your mind. Just stay a day there. See how you like it. It’s a different story then.” Too ‘bullheaded’ to take the vaccine This is not a place that gets a lot of national news coverage. And it’s hard to break into socially. People take care of each other in times of joy and crisis, but newcomers could be there 10 years without really fitting in, Rodebush said. This meant just about everyone had seen our last story. Rodebush wanted us to talk about it with his buddy, Wayland Bland. He called him, and after a little convincing, Bland zoomed into the driveway in his pickup and called out to us to film the blue bandana on his face. He wanted us to film him saying, “I’m a Republican, and I’m wearing this mask.” Last fall, Bland spent seven days in the hospital with Covid-19. He’d had a kidney transplant, and knew he was high-risk. Last year, Rodebush said, “Me and him and Ruth sat here and talked about it, and they both said, ‘If we get it, we’ll die from it.’” But Bland lived. “What’d you tell ‘em, that I’m the toughest bastard there ever was?” Bland said. It was exactly what his friend had said. “I was on everything they had – steroids, full drip, plasma from people that’d had Covid, drugs that they gave my President, (Donald) Trump. And they finally burned it out of me,” Bland said. But he would not get the vaccine. “I ain’t taking that sh*t. I ain’t taking it!” Bland said. He didn’t want to detail why until he was pushed to explain why he’d trust drugs like Regeneron’s antibody cocktail but not the vaccine. He turned to Rodebush and asked, “Am I going to have to tell her?” Rodebush laughed and shrugged. “They shafted my President,” Bland said. He thought the vaccine was delayed intentionally to hurt Trump, a baseless claim. “They wouldn’t give it to him because they know damn good and well he’d be reelected, and there’d be nothing nobody could do. So, they had to swindle around and scheme around and keep it from him, and just as soon as the election was over, Bam! There we got it.” “I’m so bullheaded. You shafted me out of my President. I ain’t taking your medicine,” he said. “I’ll take what they gave him, but I’m not taking yours.” When reminded Trump had actually urged people to get the vaccine, Bland said he hadn’t seen that. Indeed, Trump himself got the vaccine, and while he had teased there could be a shot by the 2020 election, vaccine developers and federal officials were always clear that the timeline depended on when the data came in. “I don’t watch the news because you’uns have all pissed me off so bad,” Bland said. Still, he was down to hang out with our CNN crew over a few beers on Rodebush’s front porch. Vaccine doubts fester among those who feel ‘lost,’ a doctor says Public health officials need to understand the culture here, said Dr. Chris Cochran, an internist at a hospital just over an hour away in West Plains. There are no hospitals in Carter County, and West Plains is one of the places people drive to for health care. Cochran was raised in Mammoth Spring, Arkansas, with a population of about 1,000, and he doesn’t really have a first name there anymore, he said. People just call him “Doc.” “I don’t want to ever give anybody an excuse for doing something like not getting vaccinated. But the reasons do harken to someone who has been told that they’re a dumb hillbilly all their life by the rest of the country,” Cochran said. “I don’t know that we are oppressed or disenfranchised. And I don’t know if we deserve to even feel that way here. But we are a flyover state. … We are a people who consider ourselves lost to the rest of the world.” We heard that a lot – that the news media called people dumb hillbillies. But we didn’t say that, and our bosses at CNN didn’t either, or our friends back in New York. Even so, people here still feel singled out, treated like a population separate from the rest of the country, Cochran said. In Missouri, as well as in Arkansas and Tennessee, many people have said they’re at peace with the possibility they could die from Covid-19 because they know they’re right with God. “If I lose the battle to it, I know where I’m going. I get to go the heavens,” Helvey said. And Tom Wilder said, “I believe if the good Lord wants me right now, it doesn’t matter if I take a vaccine or I don’t. If he wants me to go, he’s going to take me.” Vaccines are offered in secret as peer pressure gnaws This kind of “fatalism” usually melts away, Cochran said, with the intimacy of a one-on-one visit to his office, Cochran said. But what remains is peer pressure to not get vaccinated. “People have banded together for security, like people do in any crisis,” he said. But bad information had been introduced to those circles, and attempts to correct it had made them close tighter. “It’s a real, severe, heavy peer pressure in their church, in their family, in their friend group, in their Facebook friend group, whatever,” Cochran said. “People are so pressured not to get vaccinated by their by their group that it is, to them, somewhat of a treasonous act.” Patients have asked if they can get vaccinated in secret. “We can sneak one in your arm wherever you need to do it,” Cochran said. The hospital has them drive over to its pharmacy parking lot, as if for something else, and staff “jab them in the arm while they’re sitting in their car.” “When I tell people that are having trouble admitting that they were wrong about the vaccine and the disease, I preface it with, ‘I was wrong, too,’” Cochran said. At the beginning of the pandemic, he knew Covid-19 was serious, but he underestimated its power to spread. In spring of 2020, a woman stopped him in the grocery store parking lot. “She said, ‘Doc, what do you think about this Covid thing? Do you think it’s going to make it to us?’ And I said, ‘Ma’am, I really don’t think it’s going to make it here, just like a lot of things, it burns out before it ever makes it to the middle of nowhere like us.’” She said she was glad to hear that. “Well, about six months later, her mother died of Covid,” Cochran said. “It wasn’t my fault that she died of Covid, but I can’t forgive myself for what I said to that woman. And so it’s my job now to move on and make sure that I help as many people as I can that are having trouble coping with and coming to grips with the fact that we’ve all got this wrong to some degree.” One man finally fesses up about his own vaccine choice And it’s hard for people to change their minds in a place with no anonymity. It had been a little bit weird for Keathley after our October 2020 interview. People stopped him as far away as Branson and asked if he was the guy in the CNN video. Some said it was awesome, he said. One lady yelled at him because her friends had died of Covid-19. And people watched him closely. Chitwood said Keathley came into the souvenir shop all the time. She quoted his line about Democrats being the only ones who wore masks. “I’ve seen him at a game with one on,” she said. “I was like, hahaha.” Word spread quickly when he got Covid-19. On our second night in town in August, we joined Keathley at the Mexican restaurant and heard later that after we left, he’d told the whole restaurant we were journalists with CNN and he wasn’t going to talk to us on camera this time. When we ran into him a second time at a diner, it seemed like fate. He was getting breakfast with Aly Morris, his 16-year-old niece. Morris said random people would shout from across the room that they recognized Keathley from TV. She thought it was cool. Aly didn’t like wearing a mask, and she thought her teachers had been harsh about it. But she got the vaccine, she said. Aly wants to be a doctor, and she couldn’t imagine telling patients to get a vaccine when she hadn’t herself. Keathley watched as Aly talked. He said he didn’t want to talk on camera. But he relented. He’d been pretty cavalier in 2020. “I guess if I get it and it kills me, then it’s slow walking and sad singing for the family,” Keathley said then. What would he want on his tombstone? “Didn’t wear a mask.” Now, Covid-19 isn’t as political as it was in the fall of 2020, but it’s “still a bit political,” he said. “The No. 1 reason nobody wants to take this vaccine is because the government lies absolutely, constantly. And no one feels like they can trust our government. It’s not my fault no one’s wearing a mask. And it’s not my fault no one’s taking the vaccine. It’s the government’s fault.” But did he get the vaccine? Keathley sat with his arms crossed and made a face. Our CNN crew was not above pleading. “Please, Brian, did you get the vaccine?” “Whether or not I got the vaccine should not dissuade someone else from getting it. If they feel they need it, then they need to get it.” People feel like they have to get the vaccine in secret, we told Keathley. He’s a big, tough guy, works on the railroad, has big mouth – and everyone knows it. Maybe it would mean something, even to one person, coming from him. “Corona doesn’t care who you are,” he said. “Whether you think you’re a big, tough guy or whether you’re – anything – it doesn’t matter. If you get it, it can kill you.” People have to decide whether they wanted to be in a hospital bed and be told they’re going to be put on a ventilator and might never wake up, he said. And hear that their family could never say goodbye. He’d thought about it: “I don’t want my wife to have to wonder … is he going to come back out?” “That’s why I got a vaccine,” Keathley said.