Never in his three-year tenure at Our Lady of the Lake Livingston has Dr. Charles Nunez seen so many patients.

In the past week alone, he said the emergency department under his purview scrambled to care for a sudden influx of COVID-sick wards. And they had more than coronavirus in common.

“I can say every one of them has been unvaccinated,” Nunez said. “I have not admitted one vaccinated patient.”

As the delta variant tears through Louisiana, sending case counts soaring and packing hospitals to the brink, it’s hitting especially hard in the rural eastern swath of the capital region known as the Florida Parishes, which includes Livingston.

A New York Times database lists Tangipahoa Parish as second in the nation among counties with the most new cases per capita. Livingston Parish ranks sixth. Both recently logged record numbers of new daily cases since the start of the pandemic, according to the Louisiana Department of Health.

More troubling to Dr. Gina Lagarde is what’s not reported. 

LDH numbers that point to a fourth surge are “just the tip of an iceberg,” said Lagarde, the medical director for LDH region IX, which serves Tangipahoa, Livingston, St. Helena, Washington and St. Tammany parishes. And yet, she said, “there is a lot more community spread out there that we know exists.”

Driving the surge is a mix of delta’s heightened contagiousness and lackluster vaccination numbers. The variant is twice as transmissible as earlier COVID strains, health experts say, allowing it to run rampant in unvaccinated areas.

With one of the nation’s lowest inoculation rates, at 36.8%, Louisiana faces some of the worst delta-driven COVID outbreaks in the country, according to the New York Times.

Even by Louisiana's standards, the struggle to get shots in arms in the Florida Parishes has been especially pronounced. Aside from St. Tammany, Region IX has inoculation rates below the state’s.

Scientists overwhelmingly consider the vaccines safe, effective and essential to slow the pandemic. But misinformation, supply-chain shortfalls and politics continue to stall vaccinations in the Florida Parishes, which are populated both by majority-white, staunchly-conservative pockets as well as sizable Black communities that have suffered disproportionately in the pandemic.

Some locals refuse vaccines even after loved ones fall sick and die.

“We’re trying to come up with any strategy we can to convince people the vaccine is safe and to not spread (the virus),” said Dawson Primes, emergency management director for Tangipahoa Parish. “But it’s an uphill battle.”

Back with a fury

The Florida Parishes face what Dr. Lagarde calls a “perfect storm” for a massive surge.

A wildly infectious variant and lagging vaccination rates are daunting enough. Add to the mix traditional summer gatherings, people holing themselves up in the air-conditioned indoors and an imminent return to in-person learning this school year.

It’s all “very concerning,” Lagarde said. 

Hospitals in the region are seeing trends reflected statewide in the latest surge: intensive-care units filled with the unvaccinated, younger people falling critically ill and more overall patients than at any other point in the pandemic.

Delta spread fast in Livingston Parish, where 27.1% of residents are fully vaccinated, forcing officials to close some government buildings. At least 10 workers in the parish president’s office tested positive. “We ran into a severe manpower shortage,” parish president Layton Ricks said.

In Tangipahoa, where the vaccination rate is 30.3%, North Oaks Health System has seen staggering numbers of COVID patients, straining staff and forcing them to open another ICU.

“A good word to use is ‘disappointed,’” North Oaks Chief Medical Officer Dr. Robert Peltier said. “We all hoped that it was over, every one of us. Many of these deaths and hospitalizations are preventable. If we had vaccine rates we’ve seen in other areas of the country and world, maybe we wouldn’t have seen numbers the way they are.”

Medical professionals on the frontline are burned out and frustrated as cases continue to climb more than a year into the pandemic. But the anxiety and grief accumulated over many months have also impacted ordinary people struggling to recover from COVID or mourning a loved one lost to the virus. 

“I know we talk about post-traumatic stress disorder when we talk about this pandemic,” Lagarde said. “But we’re still in the trauma stage right now. We haven’t even reached the (post-traumatic) stage yet.”

Too much to lose

In Livingston parish, unvaccinated residents said fear and mistrust kept them holding out.

Their justifications ran the gamut from concern over how quickly the vaccine was developed to suspicion of government. Many expressed confusion and skepticism over what they saw as conflicting public health messaging about the virus and the vaccine. 

Dana Marie Dier, who lives in Watson, said she fears both.

With asthma and emphysema, the 51-year-old knows she’s prone to serious illness if she catches the virus, so she masks up and keeps her distance from other people. At the same time, she worries about those same health conditions causing an adverse reaction to the vaccine.

“They just made it so fast," she said. "I don’t want to be a guinea pig, I guess. If I get COVID, I’ll probably end up on a ventilator because I can barely breathe now. It’s horrible. It’s like a catch-22 situation.”

Her cousin, 22-year-old Kaley Dowdy, said the only person she knew who got the shot was her aunt, who later died from COVID-19. Dowdy said she believes the vaccine wasn’t studied enough and worries what would happen to her children if the shot put her health in jeopardy.

“I have a 4-year-old and a (one)-year-old, and I wouldn’t risk getting the vaccine,” she said. “I have too much to lose.”

She’s also exasperated with COVID-safety messaging. Public health leaders bungled the pandemic response, she said, calling it "a hot mess from the beginning." As her friends and family contract the virus, she wonders why mask mandates were lifted and safety precautions loosened in recent months.

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"I don’t understand where the protocols and guidelines got lost in translation from last year to now," she said.  

Limited access

In St. Helena, where 52% of the parish’s 10,000 residents are Black, reasons for vaccine hesitancy span race, infrastructure and information shortfalls. Thirty-two percent of the parish has received both doses of the two-part Pfizer or Moderna or the one-shot Johnson & Johnson vaccine.

Decades of disparities in healthcare available to Black people in the U.S. no doubt add to the reluctance, parish emergency preparedness director Roderick Matthews said. But there is “no one reason” why inoculations have stalled, he added. And it should be noted that Black St. Helenans have gotten shots at a higher overall rate than their White counterparts, Matthews said.

Matthews pointed to lack of transportation and spotty internet as an issue, as well as a spread out, tough-to-reach population.

In place of readily-accessible information from scientists, conspiracy theories have been stoking suspicions. That was the case for Kayla Nelson, who lives in Chipola, an unincorporated community near the Louisiana-Mississippi line in northern St. Helena Parish.

Nelson was pregnant around the time the vaccine rolled out. When she heard stories about how vaccine side effects might harm her unborn child — something scientists say is unproven — she felt determined to avoid it.

"There were a lot of different theories about what was going on with the vaccine," she said. "I was worried I'd have worse side effects. If I'd had the same side effects that other people have had, I didn't want that to happen while I was pregnant."

Nelson recently had her child, and recognizes the threat posed by the delta variant. But she has yet to schedule a vaccine appointment because of logistical reasons, she said.

The Parish is trying to remedy information shortfalls by mailing materials with vaccine information to residents’ homes, Matthews said, and by having conversations with trusted local leaders, like pastors and doctors, about encouraging people to get the shots.

Renewed demand

While most people in the Florida Parishes remain unvaccinated, demand for shots is spiking in some places, as the department of health on Friday reported the largest statewide increase in daily vaccinations since April.

At James Drug Store in Denham Springs, the pharmacy has scaled back the days they offer the vaccine to one a week “due to declining interest,” pharmacist Clint Miller said. But just last week they saw the number of people seeking the shot double from the last time they held vaccine appointments earlier in the month.

In Greensburg, St. Helena Parish’s largest town with 800 residents, there was a rush to get the jab when vaccines became available this spring. But demand waned and stayed that way for weeks, Greensburg Family Pharmacy co-owner Kelly Lambert said.

Those numbers have recently ticked back up, she said.

“I think it’s because people kind of got complacent, and then the delta variant reared its head,” Lambert said. “Some people have said, ‘I’ve been meaning to come do this, and I haven’t.’”

The pharmacy is running more COVID tests, too. Around half of the tests the pharmacy gave on Wednesday came back positive, Lambert estimated.

Both tests and vaccinations increased across Region IX this past week as health officials sounded the alarm over the new surge, Lagarde said Friday.

But it’s still not enough with overall vaccination rates so low. "You could still basically trip over a vaccine" in Tangipahoa Parish, Primes said.

In a shift from earlier strains, unvaccinated people face greater risk of contracting delta. That risk rises in areas with low vaccine uptake — like the Florida Parishes, scientists say.

“If you interact in a way with the broad population that's largely unvaccinated in crowded settings for an extended period of time, you may acquire 20 exposures in the course of one evening at a bar,” said Susan Hassig, a Tulane University epidemiologist. “So you know, it's like ... are you feeling lucky tonight?”

‘I don’t know how you battle that’

Primes feels exhausted by offering vaccines to people who keep refusing them as hospital beds fill up.

The biggest challenge, he said, has been battling political objections to COVID precautions. People in Tangipahoa and Livingston tend to vote Republican, mirroring a trend in rural counties across the country where local officials have struggled to sell people on the shots.

People have a choice about which information to heed in deciding whether to get vaccinated, Primes said. He thinks it shouldn’t be a hard one.

“It’s at a point where people know what the right information is. It’s coming from local news, from national news and local government,” he said. “Everybody’s putting out the information, and people are choosing to ignore it. If you’re bombarded with information saying you need to get vaccines to stop this pandemic, I don’t know how people aren’t changing their thought process. I don’t know how you battle that.”

Cash money seems to help.

On Saturday, 500 people lured by a $100 payout lined up for vaccines in Hammond, Tangipahoa Parish’s largest city. The day before, statewide vaccinations rose again, bolstering doctors' belief that a "movable middle" still on the fence about vaccinations can be swayed.

The shots remain the best way for Region IX — and the rest of Louisiana — to emerge from the pandemic still gripping the state, said Lagarde, the regional LDH doctor.

"It’s a task, but it’s not impossible," she said. "This too shall pass, but I want it to pass quickly."

Staff writer Jeff Adelson contributed to this report.

Email Jacqueline DeRobertis at