It didn’t need to be this way. This spring, as people lined up for newly available, miraculously effective Covid-19 vaccines, it was easy to imagine a direct and speedy path to a protected society. The curve of administered doses appeared limited only by the supply, and the curve was looking good—perfectly calibrated for things to be normal (at least by some definition of the word) by the end of summer, just in time for schools and workplaces to reopen. So long as the vaccination rate kept pace.

Which, of course, it didn’t. Much too soon, the curve reached its inflection point, shifted from the upswing, and flattened itself out. Add to that a euphoric, masks-off reopening in much of the country. Then add the more transmissible Delta variant. Result: a pandemic of the unvaccinated that, because of its immense scale, now threatens even people with two shots, thanks to the possibility of breakthrough infections.

All of this has added up to a tipping point: The week when the carrot met the stick, when dozens of influential organizations decided it’s time for vaccine mandates.

Many experts have argued that, even with Delta, the United States is unlikely to revisit the horrors of last winter. Even now, the country’s hospitalizations are one-seventh as high as they were in mid-January. But national optimism glosses over local reality. For many communities, this year will be worse than last. Springfield’s health-care workers and public-health specialists are experiencing the same ordeals they thought they had left behind. “But it feels worse this time because we’ve seen it before,” Amelia Montgomery, a nurse at CoxHealth, told me. “Walking back into the COVID ICU was demoralizing.”

Those ICUs are also filling with younger patients, in their 20s, 30s, and 40s, including many with no underlying health problems. In part, that’s because elderly people have been more likely to get vaccinated, leaving Delta with a younger pool of vulnerable hosts. While experts are still uncertain if Delta is deadlier than the original coronavirus, every physician and nurse in Missouri whom I spoke with told me that the 30- and 40-something COVID-19 patients they’re now seeing are much sicker than those they saw last year. “That age group did get COVID before, but they didn’t usually end up in the ICU like they are now,” Jonathan Brown, a respiratory therapist at Mercy, told me. Nurses are watching families navigate end-of-life decisions for young people who have no advance directives or other legal documents in place.

Almost every COVID-19 patient in Springfield’s hospitals is unvaccinated, and the dozen or so exceptions are all either elderly or immunocompromised people. The vaccines are working as intended, but the number of people who have refused to get their shots is crushing morale. Vaccines were meant to be the end of the pandemic. If people don’t get them, the actual end will look more like Springfield’s present: a succession of COVID-19 waves that will break unevenly across the country until everyone has either been vaccinated or infected. “You hear post-pandemic a lot,” Frederick said. “We’re clearly not post-pandemic. New York threw a ticker-tape parade for its health-care heroes, and ours are knee-deep in COVID.”

This kind of makes me sad. You don't have to love Joe Biden to get vaccinated and save your own life, so you can have your cattle, your guns, your big jacked up truck or off grid homestead in Missouri. The shot is a bit annoying with the side effects but it's a temporary nuisance more than anything else. COVID-19 is a nasty way to die, and it's totally preventable even if you are a good ol country boy deep in the pig shit in the back woods of Missouri.