Once a week, Joseph Chang, the chief medical officer of Dallas’s Parkland Hospital, traverses the entire sprawling medical campus on foot. The stroll breaks up his busy routine and gives him a chance to bump into doctors, nurses, and technicians, and to strike up candid conversations that he wouldn’t otherwise have time for. Typically, these interactions are pleasant, but in the last few weeks Chang has been unable to ignore the looks of frustration, and shock, etched across his staffers’ faces. 

Last year, as COVID-19 patients filled intensive-care units statewide, killing thousands and pushing health-care professionals to their physical and emotional limits, Chang came to know these looks of anguish all too well. Then, once the vaccine arrived this winter, and with it some promise of a return to normalcy, the doctor and most of his coworkers were confident that the worst of the storm, as he calls it, had passed. In the spring, Chang recalled, staffers held elated celebrations, full of laughter and crying, each time one of the hospital’s five COVID wards was shuttered. 

But midway through the summer, as the highly transmissible delta variant of the coronavirus surges across Texas, once again populating ICUs with COVID-19 patients, that confidence is waning. In Dallas County, and much of the state, demand for the vaccine has plateaued. As the delta variant runs rampant, the number of COVID patients at Parkland has increased in the last four weeks from seven to more than forty. Nearly all of them are unvaccinated, as are 57 percent of Texans and 99.5 percent of those who have died of COVID in the state since February. (The few vaccinated COVID patients admitted to hospitals tend to have serious underlying conditions, doctors say.) 

Parkland is about twenty patients away from reopening a second COVID ward months after it was closed. Frontline workers are steeling themselves for longer hours and more exposure to COVID patients, as well as the kind of emotional traumas that plagued health-care workers throughout 2020. “I can’t really describe how disheartening it is, especially for our frontline workers, to have to prepare themselves for a new wave of COVID patients on ventilators and oxygen again, unable to see their families,” Chang said, comparing the virus’s resurgence to a recurring “nightmare.” “On my walk, when I look into their eyes, I can see that the feeling is, ‘How can this be happening all over again?’” 

To the dismay of medical professionals, the same sort of backsliding is being seen in major hospitals across the state. Texas is a long way from the virus’s peak surge, in January, when nearly 30,000 new cases, 14,700 hospitalizations, and as many as 480 deaths were reported each day. But the trend is concerning doctors. On May 16, the state recorded its first day without a COVID death in more than a year. On Thursday, Texas’s seven-day average for new cases was just over 4,500—a 177 percent increase over the past two weeks—and the state was recording 25 deaths per day. Three thousand Texans are hospitalized with COVID, about three times as many as in early June. 

In Austin, public health officials recently raised the city’s COVID threat level, advising even vaccinated residents to wear masks for the first time since May. Over last month’s numbers, hospitalizations have doubled in July in Williamson County, which is home to Georgetown and Round Rock, and in  Dallas County (where Parkland is located), while quadrupling in Tarrant County, whose seat is Fort Worth. Three and a half hours south, Harris County Judge Lina Hidalgo this week upgraded the county’s threat level as public health officials began to issue stark warnings about the possibility of hospitals becoming overwhelmed by COVID patients—a flashback to a year earlier. The virus has been spreading in rural communities as well, some of which had been largely untouched by the virus in recent months. In South Texas’s Dimmit County, which has a population of 10,000, is currently the hardest-hit county per capita and is home to a single regional hospital, health officials are reporting an average of thirteen new cases per day, more than twice as much as a month ago.

Reached by phone, a bewildered Faisal N. Masud, the medical director of critical care at Houston Methodist, compared the surge to “groundhog day.” The hospital’s CEO, Marc Boom, reported in an email that the hospital system is treating 184 COVID-19 patients, more than double the number that were being treated on July 1 and 70 percent more than a week earlier. The feeling of ceaselessness, Masud said, caused some colleagues to opt for early retirement in recent months. Masud called resistance to vaccines “mind-boggling” and noted that in so many other countries around the globe, including in Mexico, citizens are desperate for a safe, accessible vaccine. “The frustrating part for us is that so many people here are not getting the vaccine,” Masud said. “We want people to give a damn about themselves and their loved ones. We want people to grow up and think like adults.” 

Masud frequently encounters patients who tell him they didn’t take the virus seriously or delayed getting the vaccine in hopes of seeing first how it would affect the larger public. The doctor recalled a recent patient who employed that strategy only to find himself in the hospital and in need of a lung transplant, which he eventually received. Though the patient survived, Masud considers his story an easily avoidable tragedy, one that’s repeated daily. “Even yesterday a patient told me they had a big family outing for the Fourth of July and then pretty much everyone got infected,” he said. The virus is an equal opportunity killer and it will eventually find you.”

Masud and Chang said a large portion of their COVID patients arrive in the hospital in a state of disbelief, a temporary mindset that is typically followed by regret, acceptance, and, as symptoms worsen, desperation. Often, somewhere along the way, patients begin asking for the vaccine. At that point, Chang said, doctors are forced to explain to patients that they’re too late—the vaccine cannot prevent the virus once someone has been infected. In many ways, he said, COVID is still in control. “Once you’re in my hospital it’s me supporting your immune system so your body can put up a fight,” he said. “That’s all I can do.”