As the Delta variant of the coronavirus continues to spread across the United States, many of the country's hospitals are struggling to cope.
So are the people who staff them.
Jen Sartin is an ICU nurse at Singing River Health System, a hospital in Ocean Springs, Mississippi. Just 35 per cent of Mississippians are fully vaccinated – well below the national average of 51 per cent – and as a result, it is currently one of the hardest-hit states.
Covid vaccines are free and widely available in the United States, but millions of Americans are declining to use them. This hesitancy is particularly concentrated in the South, and it's a source of building despair and frustration for doctors and nurses who have been toiling tirelessly to save lives for the past 18 months.
Now they are dealing with a flood of unvaccinated patients, and hospitals are swiftly running out of ICU beds. In the past month, unvaccinated people accounted for 97 per cent of newly identified cases in Mississippi, 89 per cent of hospitalisations and 85 per cent of deaths.
(If you're wondering why vaccinated people account for a higher proportion of deaths than cases, it's because covid typically gives them only mild symptoms, or no symptoms at all. So the few who do suffer bad enough symptoms to get tested are more likely to be suffering from a particularly severe infection.)
Back to Sartin. She spoke to MSNBC on Wednesday, giving voice to the exhaustion she and her colleagues are feeling.
"We have the solution, by getting the vaccine and wearing our masks and doing what we need to do," she said.
"We're tired. Nurses are so tired. It's getting to the point where we need help. We've been helping as much as we can, and we need help from our community.
"I respect everybody's choice to get vaccinated or not, but when it comes down to it, it's going to just continue to get worse. And it's going to get to a point where it affects our kids. That's my biggest fear, that it's going to keep mutating, and we could have done everything in our power to stop it and eradicate disease, like vaccines are supposed to do. And if it keeps going like this then it can get to a point where it hurts our kids.
"We already have our kids on ventilators in different parts of the state, and you know, we won't be able to say we did everything to protect our children. The people that would take a bullet for their kid – it can be as easy as taking a shot.
"As nurses, it does wear on you, to feel like it's not coming to an end any time soon."
Asked how she finds "the strength to keep doing this again and again", Sartin revealed she had decided to leave the ICU for another department.
"I don't have any strength left," she said.
"Honestly, I've given so much I can't keep going. That's why I decided to move to a different department, because it's affected me in ways I never thought possible. And it is not going to get better, and I have to protect myself and my family and my sanity.
"Because if people aren't doing what they need to do to protect us – and you know, we're human. We're not robots. We're not machines. We can't continue to do this forever at this capacity.
"I can't. I can't do this anymore. I've seen more death than I ever thought I would see in my entire life. I've held more hands of patients in their last moments when their families couldn't be by their side. More than I ever thought I would.
"And I know this is the ICU, and people pass. It shouldn't be to this level though.
"You know, when I chose to be an ICU nurse, I knew this is what I signed up for. But I don't think anybody really realised that this was going to be part of the deal. That this was going to be this exhausting, in every way.
"It's just heartbreaking in every way. I don't even know how to describe it. It's overwhelming, and I just, I can't even really speak about it anymore. I'm so exhausted from the mental strain of the process of this.
"Just, it's all you hear, it's all you see, you know, this whole debate about vaccines. And then coming in here, and you wake up every morning, and you know that it's just going to be the same devastation as the day before.
"It's always a win when somebody leaves and goes home. But they never go home the same way they came in."
MSNBC anchor Rachel Maddow teamed up as she reacted to the interview, urging her viewers to "think about what we can do to support health workers".
"The first thing they'll tell you is to get vaccinated, and get everybody in your life vaccinated. That's the best thing you can do for them," she said.
"But beyond that, doctors and nurses and respiratory therapists, people who work on the front lines in these now increasingly swamped hospitals, they are a group of our fellow Americans who are going to need not just, you know, recognition and thanks, but they are likely to need help from the rest of us, given this superhuman thing we are asking them to do.
"Now, piled on top of it, the additional frustration and heartbreak and anxiety, knowing this could be preventable if there were greater uptake of vaccines."
Sartin is not the only nurse to have spoken out in recent days. Another Mississippi ICU nurse, Nichole Atherton, opened up about her decision to resign.
"People want to argue about masks and vaccines and freedom. I just don't want to watch anyone else die," Atherton wrote on Facebook.
"I see their faces in my nightmares. And it feels like it is never ending."
"We've had to watch a lot of people die," she said in a subsequent interview on CNN.
"Mississippi has such a low vaccination rate, and our covid hospitalisations are through the roof. It just, it feels like we're fighting an unwinnable war.
"What I really want people to understand is that it's truly the unvaccinated people who are sick enough to need critical care. It is the unvaccinated people that are on ventilators, who do not survive. If they do survive they leave the hospital with a breathing tube in their throat, a feeding tube in their stomach.
"I work in a 12-bed ICU. All 12 patients right now are covid, they are all unvaccinated. And they are young. We are watching, not grandparents this time around, parents. Parents with young children. We have a mother right now who has never held her newborn baby.
"We're trained to deal with death, and to help people die with dignity when that time comes. But seeing this much death, day in and day out, for this extended period of time, it becomes unbearable.
"I wish people would choose to wear masks and get vaccines and keep their neighbours safe.
"Your older nurses are retiring earlier because they don't want to be another statistic. And your experienced nurses can't continue to deal with trauma at this level indefinitely. And your nursing staff will be less and less experienced, and it will become extremely unsafe.
"To call us heroes, but not do what you can to protect yourself and to protect us, it's just words. And words don't save lives. Actions save lives. People say, 'I want my freedom, and I'm going to live how I want to live.' And I respect that, but please know, you are exposing all of our staff to this deadly virus as well.
"They are jeopardising our lives as well, and we have children to go home to. There is a whole generation of children right now, hundreds of thousands of kids in the United States, that will grow up without grandparents because of the first wave.
"And now we're seeing parents. There are going to be children, children in my community, that are orphans. And it could have been prevented."
Mississippi is currently averaging 2700 new infections per day, up from 132 a month ago. That's an increase of almost 2000 per cent. On Tuesday it recorded 3488 cases, its highest figure of the pandemic.
Deaths always lag a few weeks behind cases, but have risen from an average of two per day a month ago to 17 now.
And the state is genuinely running out of room in its hospitals. More than 1500 people are currently hospitalised, and almost 400 ICU beds are filled with covid patients. About 90 per cent of ICU beds are already in use.
Meanwhile the positivity rate – i.e. the percentage of people who get tested for covid and return a positive result – has spiked from 2.7 per cent in mid-June to 22 per cent now.
Dr Alan Jones is Associate Vice Chancellor for Clinical Affairs at the University of Mississippi Medical Centre, the largest hospital in the state, which has announced it's converting the bottom floor of its parking garage into an extra covid ward.
On Wednesday, he warned that Mississippi's strained hospital system was days away from "total failure".
"If we track back a week or so and we look at case positivity rate, the number of new positives we're seeing, and then the rate of hospitalisations – if we continue that trajectory, within the next five to seven to ten days I think we're going to see failure of the hospital system in Mississippi," Dr Jones said.
"You know, school's gone back. If there were a bus wreck of kids, we would not be able to take care of all those kids at this hospital. We're in a pretty serious situation.
"We're hopeful that we can get people to wear masks and get vaccinated and stay away from each other, and that this rapid rate of rise that we're seeing will peak or plateau pretty quickly here, so we don't get into a situation where there is nowhere to transfer a patient at all, and we have to stop ambulances.
"That is our nightmare. We do not want to do that. Because we know, when we do that, not the covid patients but all the other patients – the heart attacks and the strokes and all these other things that have time sensitive care issues – we're not going to be able to take care of. And that's not what we got into healthcare for.
"So I hope people can just understand that it is a very serious situation. I don't want to say dire, and I don't want to say that we have reached the point of failure, but we are definitely headed that way."