Looking forward to the birth of their first child, Ashton Reed and her husband never expected what seemed like a common cold to make their lives a living hell.
Mere days after the expectant 25-year-old from Star City tested positive for covid-19, Reed in May landed in the intensive care unit at UAMS Medical Center in Little Rock.
Doctors told her husband, Charles, that it was not a matter of when his wife might recover but if she would survive at all.
"I got sick really quick," Ashton Reed said. Neither Ashton nor Charles had been vaccinated against the virus.
The Reeds' story is emblematic of a nightmare scenario that is fast becoming a grim reality in Arkansas as a more virulent and possibly more deadly strain of covid-19, called the delta variant, begins to make savage inroads into unvaccinated populations across the state.
After delivering her baby prematurely by emergency cesarean section, Ashton Reed's condition deteriorated again.
Doctors placed her on a ventilator and administered an additional treatment to support her heart and lungs while her husband anxiously waited for news at a hotel.
His wife's chance of survival was about 50%.
"It was the scariest time in my life," said Charles Reed, 27. "I kept asking doctors, 'What is the timeline on this?' And when I was told that we were at 'an if and not a when,' that is when it really hit home."
In and of itself, the delta variant is concerning health experts. It first emerged in India, is now present in over 80 countries and was identified in Arkansas on May 1.
But the delta strain's emergence in a state with some of the lowest vaccination rates in the country is a recipe for disaster.
Many health experts say a third wave of infections is inevitable.
Arkansas already is seeing early signs of what could be to come.
"We are now going in the wrong direction yet again with covid here in Arkansas," Dr. Cam Patterson, chancellor of the University of Arkansas for Medical Sciences, said at a news conference last week. "With July 4 holiday coming up and eventually kids going back to school, we have to be concerned that this would be a trend that could continue."
"And if it does," Patterson said, "it would appear that we may be in the beginning of the third surge of covid-19 here in the state of Arkansas."
Cases have been rising at alarming rates with daily new infections reaching highs not seen since March, when Arkansas was on the downward slope of a second wave of the pandemic that had ravaged the state over the winter. Hospitalizations also are at levels not seen since March.
The state data garnered national attention alongside a handful of other states, like Mississippi and Alabama, where low vaccination rates could create conditions for the delta variant to thrive.
Hospitals across Arkansas are reopening dedicated covid units while exhausted health care workers are girding for the worst.
The tragedy is that critical cases of the coronavirus are almost 100% preventable.
"It is heartbreaking to ask somebody, 'Were you vaccinated?' and them look me back in the eyes and say, 'No,' and start crying," said Dr. Ryan Dare, a UAMS Medical Center infectious-disease expert. "The regret of them now understanding the consequence of not getting vaccinated for the reasons that may or may not have been important to them at the time is heartbreaking."
"I am just begging every Arkansan to get vaccinated," Dare said.
While doctors say it is unclear whether the strain that infected Ashton Reed was the delta variant, they say it is clear that there are new trends emerging in the state in terms of who is catching the virus and how quickly these patients are becoming seriously ill.
The Arkansas Department Health sends out samples weekly to labs across the country for genetic sequencing. It can take several weeks for those results to come back, so it is hard to know how pervasive the delta variant is in the state in real time.
In neighboring Missouri, where some hospitals are overrun with covid patients, the CDC estimates the prevalence of delta cases at nearly 30% -- the highest in the country.
Because the delta and other variants are emerging so quickly, researchers are still learning how they affect patients.
But there are noticeable trends in recent weeks in Arkansas that could be from delta infections, which now make up about 25% of cases in the state, according to the Health Department and UAMS.
Seriously ill patients are younger now, doctors said, and they are showing up in emergency departments with serious illness in a matter of days.
Many seem to be from rural areas where vaccination rates are lower.
"Patients will get sicker faster," said Dr. Dirk Haselow, associate medical director of infection prevention at Baptist Health. "They will come in three or four days after an exposure instead of seven or eight."
"Oftentimes, they will decline more quickly," Haselow said. "With the first variants, often most people took a couple of weeks before their symptoms really hit their height."
Haselow said the "symptom profile" of the delta variant also appears to be different from earlier strains. Those who are infected first notice nasal congestion or a sore throat rather than a cough or loss of taste and smell.
Some people are mistaking these symptoms for allergies and not getting tested for covid, further increasing the risk for transmission, he said.
The sick are much younger than before, said Dr. Jennifer Dillaha, the Health Department's epidemiologist.
At the outset of the pandemic, older populations were disproportionately affected. Dillaha said many older Arkansans are now vaccinated while young people are not, possibly one reason for the demographic change.
"We are seeing a change in the age groups who are being hospitalized," Dillaha said. "The older adults who are well-vaccinated, their hospitalizations have gone down while the younger adults' hospitalizations are going up."
Dillaha also pointed to evidence from Europe that the delta variant does attack younger people more aggressively than earlier strains of the virus.
Another alarming trend is the severity of illness among pregnant women, like Ashton Reed, who contract covid-19.
"We are seeing a lot of pregnant women who are not getting vaccinated who are extremely ill," said Dr. Benjamin Davis, who was on Ashton Reed's medical team at UAMS Medical Center. "We don't have any way to say for sure that it is because of the delta variant, but it seems like this is a more recent development."
Davis said that after Ashton Reed delivered her baby, doctors were relieved, as the new mother seemed to be doing better.
"But within the next 12 hours or so, we went from thinking she was going to be OK to putting her on ECMO," Davis said. "It was an extremely rapid turnaround."
ECMO is a treatment in which a machine pumps and oxygenates blood outside the body, allowing the heart and lungs to rest. It is usually a last resort.
"I have put a handful of pregnant women on ECMO with covid," Davis said. "Nobody has asked me to put anyone on ECMO for vaccine complications."
Before the onset of the pandemic last year, Dr. Charles "Corey" Scott, an emergency medicine physician who works in hospitals in the Little Rock area, already was burned out.
Now with the onset of what appears to be yet another surge of infections, Scott said that he is considering an exit from working in emergency departments.
Not only is he exhausted, but the memory of losing so many patients to the disease is still fresh. It is not something he wants to go through again, especially if the deaths could have been prevented if only the patient had been vaccinated.
He is not alone.
"People are more stressed," Scott said. "People are quitting or are changing into positions that don't have as much interface with covid patients."
Scott added: "If there is a way I don't have to deal with people who cannot be bothered to prevent their own illness. That is pretty much what we have to deal with. It is really tiresome at this point."
Since Jan. 26, 3,765 Arkansans have been hospitalized with the coronavirus, and 98.3% of them were not immunized, Gov. Asa Hutchinson said at a news conference Tuesday. He also said there have been 988 coronavirus-related deaths since Jan. 26 and 99.6% of those weren't immunized.
UAMS Medical Center reopened its covid-19 unit after a 300% increase in covid patients in recent weeks.
Baptist Health also is "preparing to surge," Haselow, the infection-prevention doctor, said.
"The doctors and the nurses are feeling the stress," Haselow said. "Absolutely many of them are having symptoms that are PTSD [post-traumatic stress disorder]. We are not looking forward to this next wave.
"It is coming. I am not looking forward to it."
In Jonesboro, St. Bernards Medical Center is revisiting contingency plans.
Hospital administrators say they are concerned about staffing shortages and bed capacity.
Around the state, many hospitals are already full with patients seeking treatment for other conditions.
"The concern is what is going to happen," said Dr. Kasey Holder, St. Bernards vice president of medical affairs. "We have been working on our contingency plans for how we would handle an increase in hospitalizations."
Hospitals in Northwest Arkansas also are preparing.
"There is concern that we could see a surge like what is happening in Missouri," Dr. David Ratcliff, chief medical officer at Washington Regional Medical Center in Fayetteville, said in an email.
Other facilities, like Mercy Hospital Northwest Arkansas in Rogers, are receiving an overflow of non-covid patients from hospitals in Missouri that are at capacity because of people who are ill with covid.
"The delta variant is definitely making things worse, but we attribute the latest surge 100% to people not getting vaccinated," said Dr. Jason McKinney, medical director for the intensive care unit at Mercy. "If it wasn't the delta variant, it would have been the U.K. variant or the novel strain itself."
"We're going to surge regardless," McKinney said. "If we don't get more people vaccinated, this will not go away."
Dr. Joe Thompson, president and CEO of the Arkansas Center for Health Improvement, said he sees four likely scenarios playing out in the state in coming months.
The first, he said, is more people get vaccinated, and "we slowly gain enough protection so this virus does not find another person to jump to."
The second scenario is where Thompson says he believes Arkansas is now.
"An upslope of a new surge that is spreading faster than we are aware of," causing compounding hospitalizations every few days, he said.
"If we can get enough people vaccinated, we can quench that forest fire as it starts," he said.
The third scenario is where the more infectious variants spread so rapidly that the unvaccinated "really do end up at significant risk, and the hospitals do become heavily burdened again, and potentially overwhelmed," Thompson said.
The final, and worst, scenario is that the variants continue to circulate and mutate within unvaccinated populations, eventually mutating "out from under the protection of the vaccines."
"Which is bad news for all of us," Thompson said. "Even those of us who have done our part to try to be protected could again become at-risk because a mutation of the virus escapes the protection that the vaccine offers us."
State officials have all but ditched incentive programs to encourage people to get vaccinated, largely because they have not worked.
About 34% of all Arkansans are vaccinated, placing the state near the bottom, nationally.
Hutchinson said he does not foresee reinstating emergency orders, such as mandatory mask wearing. People now know what to do to stay safe, he said.
"We do know that vaccinations save lives and reduce hospitalizations and those objectives should motivate everyone," Hutchinson said in an email to the Arkansas Democrat Gazette.
Ashton Reed, whose baby, Celia Ann, remains in the hospital, is now recovering at home.
After a nearly monthlong ordeal, the new mother's oxygen levels started to improve. She regained consciousness and was taken off the ventilator. On June 11, she was able to hold her newborn for the first time.
Since recovering, she and her husband have made it their crusade to tell their harrowing story, hoping to encourage more people to get immunized.
Charles Reed got his shot while his wife was in the hospital. Ashton Reed plans to get hers as soon as her 90-day immunity period from having the virus ends.
Before she became sick, Reed said she was afraid to get vaccinated because she was pregnant, but even then, did not really think it was necessary.
Her husband felt the same way.
"Even if you live in a small, rural town and you think you are safe from it, you are not," Charles Reed said. "Just because you are healthy and think that it is not going to touch you, like I did, it will."
Information for this article was contributed by Bill Bowden and Brianna Kwasnik of the Arkansas Democrat-Gazette.
Reporters: Lara Farrar, Bill Bowden and Brianna Kwasnik
Video: Nick Popowitch and Haley Fuller
Data Visualization: Ginny Monk
Graphic Artist: Carrie Hill
Social Media: Haley Fuller and Brianna Kwasnik
Photography: Stephen Swofford