MARY LOUISE KELLY, HOST:

It does seem there's been a lot of good COVID news lately, if that's not an oxymoron. Kids aged 5 to 11 are now getting vaccinated, and since September, infections nationwide have been going down. But - and it seems there is always a but with COVID - several states are now seeing surges in new infections. Hospitals are filling up, particularly in southwestern states. So what is going on? We've got two reporters here to help us answer that question - NPR's Will Stone and John Daley, the health reporter at Colorado Public Radio. Welcome to you both.

WILL STONE, BYLINE: Good to be here.

JOHN DALEY, BYLINE: Thanks. Hi there.

KELLY: I want to start a big picture, so, Will, I guess that means you. I mean, it's true, right? It does feel as though things had been looking up, at least in many parts of the country.

STONE: Yeah. Well, that's because they were. This summer was bad, of course. Delta hit the U.S. hard. At one point, we had 100,000 people in the hospital for COVID. But for about two months, cases had been on a steady decline. And a lot of that was driven by big improvements in the South. So that decline in the national numbers, you know, wasn't really capturing some growing problems in other places, especially in the West. And as we got further into fall, we basically stalled out at about 70,000 cases of the day nationwide. And now cases are just starting to go up again. I spoke to Dr. George Rutherford about this. He's an epidemiologist at the University of California, San Francisco.

GEORGE RUTHERFORD: We still have large swaths of the country underimmunized. Even among states that are relatively well-vaccinated, like Colorado and New Mexico and Minnesota and Vermont, we're seeing sustained transmission.

STONE: Now, it's not looking bad everywhere. The number of people in the hospital for COVID is under half of what it was at the end of the summer. But when you look at new cases, more than 20 states are trending in the wrong direction.

KELLY: We just heard Dr. Rutherford in his list there mention Colorado. So John Daley, you're in Denver. Let me bring you in. What is happening where you are?

DALEY: Well, you know, by virtually every measure, things are not looking good - really as dire situation as Colorado has seen in a year. Cases, hospitalizations and deaths have all been rising since late summer. And, you know, that's pretty much statewide. And the pace seems to be accelerating. The state has really high levels of transmission driven by the delta variant. The state's epidemiologist is warning that the pandemic is likely to worsen in Colorado in the coming months, with hospitalizations topping last year's high of more than 1,800. And she says that the modeling shows that those hospitalizations could exceed hospital capacity in December.

KELLY: How is the vaccination rate in Colorado?

DALEY: You know, decent. About 62% of the state's population is now fully vaccinated. That's in the top 20 among states, but that still leaves a lot of vulnerable people. Right now, 80% of hospitalized coronavirus patients in Colorado are unvaccinated.

KELLY: Right. Well, for those who are vaccinated, the governor there wants to make it easier for them to get booster shots. He's now saying - what? - pretty much anybody 18 or older can get them in Colorado.

DALEY: Yeah, that's right. Governor Jared Polis - he's a Democrat. Yesterday, he expressed frustration with federal agencies, who he said had bungled the messaging on the booster. The federal guidelines now limit boosters to those older than 65 or considered at high-risk. But Polis said it's already unofficial state policy in Colorado to not turn people away who think they should get boosters. And Polis said he would make it official with an executive order that says...

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JARED POLIS: Colorado is a high-risk institution, and everyone is eligible in Colorado on the argument that you are part of a high-risk environment by nature of being in Colorado.

DALEY: And he signed that order today. Polis said that the move made sense both from a legal framework and a communications strategy. It's not clear what the federal regulators will make of this, but the FDA is now considering a request from Pfizer to start giving boosters basically to anyone over the age of 18 who wants one.

KELLY: Right, which if they do, that would be, you know, for people all over. I mean, that speaks to prevention, hopefully driving down new cases. What about this immense pressure right now it sounds like hospitals there are under?

DALEY: Well, this week, the state reactivated a key emergency measure - crisis standards of care for staffing. Now, this is not rationing of care, but what it does is it gives hospitals more leeway to deal with staff shortages and illness and workload, burnout, those things. It also allows for workers to be moved around and, in some cases, to care for a sicker level of patient than they normally would. And it also gives hospitals and doctors emergency protection from liability. This is welcome news for frontline providers like Dr. Lily Cervantes. She's a hospitalist at Denver Health.

LILY CERVANTES: It's a message to the state that we're taking this seriously because our health care workforce is burned out.

KELLY: So she's speaking to health care workers. What about for patients? What would that mean for them, John?

DALEY: I spoke with another doctor, Denver Health pulmonologist Anuj Mehta. He says hospital patients may experience slower or delayed care.

ANUJ MEHTA: You may wait a lot longer for a nurse to come to you when you're, like, in the emergency room or on the hospital floor. One nurse may be taking care of a lot more patients.

DALEY: And Dr. Mehta fears that if the current spike in cases doesn't improve, the state may have to activate the full crisis standards of care, essentially a rationing of care.

KELLY: So a snapshot there of what is happening in one state, in Colorado. Will Stone, as you listen to that, compared to what's happening elsewhere in the West - because there are several neighboring states in tough shape, too.

STONE: That's right. Basically, it's looking bad all throughout the Mountain West, from Idaho to Wyoming, stretching north, even into the Upper Midwest. Also, the Southwest is really struggling. New Mexico activated its crisis standards of care plan weeks ago. Arizona is seeing rising cases. And then there's Utah. I spoke to Dr. Kencee Graves. She's with the University of Utah Hospital. She says they've been stuck at these very high COVID numbers for weeks, and in some ways, it's actually worse than last winter.

KENCEE GRAVES: Now we are in this really high plateau of a surge where we have a lot of people with COVID-19 in our state, a lot of people with COVID-19 in our hospital and fewer resources to be able to take care of them.

STONE: And she says they had to close down their surge ICU because they couldn't staff it anymore. And recently, it's been taking three to five hours to find an ICU bed for a patient. And part of the reason is, like much of the country, hospitals there have all these other very sick non-COVID patients who also need care.

KELLY: Can I just stop you for a second? Because the hope at this point in the pandemic was really that as the number of vaccinations continues to grow, the U.S. wouldn't deal with a big winter surge again. Has that hope faded, vanished?

STONE: So that optimism hasn't totally vanished, but none of the experts I talked to feel confident about that. Nick Reich says we have about 60% of Americans vaccinated. He does COVID modelling at the University of Massachusetts Amherst.

NICK REICH: Frankly, I wouldn't be surprised by anything right now. I wouldn't be surprised if we kept at a slow burn trajectory over the winter. I wouldn't be surprised if we continued to decline, if the childhood vaccinations really were able to help continue to push the curve down, and I wouldn't be surprised if we saw continued growth.

STONE: Reich says, remember, this delta variant is just a lot harder to contain, and it's - we have the winter ahead of us with holiday season, people traveling, so...

KELLY: Right.

STONE: ...It's a time to be careful.

KELLY: All right. NPR's Will Stone and Colorado Public Radio's John Daley, thank you.

STONE: Thank you.

DALEY: You bet. Transcript provided by NPR, Copyright NPR.