If you live in one of the rural communities tucked into the forested hillsides along the Oregon-California border and need serious medical care, you'll probably wind up at Asante Rogue Regional Medical Center. It serves about nine counties on either side of the border.
The Asante system encompasses three hospitals in the Rogue Valley — in the cities of Ashland, Medford and Grants Pass. All three ICU's are 100% full of COVID-19 patients, according to staff.
"We've had two deaths today. So, it's a very grim, difficult time," said ICU Medical Director Dr. Michael Blumhardt on a recent Tuesday in August.
In contrast to earlier phases of the pandemic, the Asante hospitals are now treating COVID-19 patients in their 20s, 30s, 40s and 50s, according to Blumhardt.
"We're seeing clusters of families being admitted. We had a father and an adult daughter admitted to the intensive care unit and he passed away. Right before, I had to put the daughter on life support," he says.
Overall, vaccination rates in many states look pretty good. But zoom in, and you'll see a checkerboard effect with huge differences from county to county. Oregon is no different. In and around metropolitan Portland, two-thirds of all residents are fully vaccinated. But rural counties aren't even close to that; many have vaccination rates that are less than 50% or even 40%. Jackson County, in southern Oregon, is home to the largest number of unvaccinated individuals in the state. That's pushing the local hospitals to the limit.
Asante's Blumhardt blames the current surge on the highly transmissible Delta variant, but also on widespread rejection of the coronavirus vaccine in this area.
"This is far more severe for this region than the prior COVID waves," he says. "The Delta virus is passing through the region like a buzzsaw."
Inside the Asante ICU in Medford, Chelsea Orr, a registered nurse, is closely monitoring patients.
"We're taking care of a lot of ventilated patients here that are super sick," says Chelsea Orr, an ICU nurse.
What feels different about this stage of the pandemic, she adds, is the incredible loss of life.
"It's been really hard. We're working harder than we've ever worked before and still losing," Orr said.
Another ICU nurse, Justin McCoy, agrees.
"I've been an ICU nurse for ten years. I've never seen anything like this," McCoy says. "It's really terrible seeing these patients who can't breathe. That is a very difficult thing to watch. It's really terrifying for them and it's really difficult for us to see day in and day out."
Blumhardt says the vast majority of patients at Asante are unvaccinated.
"We admit nine unvaccinated to every one vaccinated individual. So clearly the vaccine is protecting against hospital admission," he says.
Jackson County is recording record numbers of COVID infections. Within weeks, many of those people may worsen and need hospital care. Unfortunately, a new forecast from Oregon Health and Science University predicts that by Labor Day, the state will face a shortfall of 400 to 500 staffed hospital beds.
Blumhardt says smaller hospitals in Oregon have been trying to transfer their sickest patients to Asante, but so far they've had to turn away around 200 people because they don't have the beds, or the staff.
Even though Asante has already postponed some surgeries, staffers are simply worn out, says emergency room physician Dr. Courtney Wilson.
"I think people are frustrated," Wilson says. "It feels discouraging that we have had a vaccine available for a really long time in this community and we have a really low vaccination rate here."
Earlier this month, Oregon's Governor Kate Brown sent National Guard troops to overwhelmed counties, to help with non-clinical tasks, such as cleaning hospital rooms, moving medical supplies, and traffic control. 150 soldiers were dispatched to southern Oregon. Medical leaders at Asante and Providence, the other hospital system in Rogue Valley, have teamed up to ask the state to set up a 300-bed field hospital. The state has also finalized a contract to deploy hundreds of medical "crisis teams" of nurses, respiratory therapists and paramedics from medical staffing companies to overwhelmed hospitals.
"I don't know how we're going to get everybody taken care of. That's the bottom line. We're all hands on deck at every level of the organization," Blumhardt says.
Residents of Jackson County are starting to respond to the crisis. The rate of new vaccinations here has grown, and is now to about twice that of the Portland area. But thousands of people still need to be vaccinated to catch up.
This story was produced as part of NPR's reporting partnership with Jefferson Public Radio and Kaiser Health News.