Across the United States, the latest wave of infections is claiming hundreds of lives each day. Nearly 700,000 individuals have already died as a result of the coronavirus, a figure that surpasses the 1918-19 flu epidemic’s toll.

In Idaho, the number of COVID-19 cases and deaths has reached an all-time high, with 53 people dying on Thursday alone. Due to the huge volume of cases, state officials have been unable to process around 11,200 positive laboratory results.

According to local officials, the current outbreak will not reach its climax until November. Already, doctors have documented an increase in stillbirths among pregnant women who were infected. Certain hospitals are operating at substandard levels of care, cancelling or deferring non-emergency surgeries.

Elke Shaw-Tulloch, the state’s Division of Public Health administrator, wept this week as she expressed powerlessness.

“I worry every single day that we have not done enough as a society to protect our loved ones from needless suffering,” and “we have let a narrative prevail that does not support vaccines and public health mitigation measures,” she said.

According to a Mayo Clinic tracker, Idaho has the lowest vaccination rate in the United States, with only 47% receiving at least one shot. Unvaccinated individuals accounted for almost 90% of hospitalizations and fatalities over the last four months. However, the state’s Republican governor, Brad Little, has refused to require the vaccination.

He has instead threatened legal challenges to the federal vaccine mandate, calling it an “unlawful act of unprecedented government overreach” that amounts to bullying people “into submission.”

“I want people to get vaccinated, but I want them to choose to do it,” he told television station KMVT this week.

Idaho County, which has the state’s lowest vaccination rate, has demonstrated little appetite for that.

The comment pages of the Idaho County Free Press have developed into a clearinghouse for what many regards as a struggle for civic souls rather than public health. Impose a mandatory vaccination programme, suggested Betsey Morris of Kooskia, and the “USA will become just like Nazi Germany, China, Cuba or Australia. Think about it. We are not far from being controlled like them.”

Masks are hardly visible on the streets of Grangeville. An adjacent school district’s board attempted to impose a mask mandate, but it was repealed after a parental revolt. Those who remind hospital visitors to wear masks have come under fire.

Some outright reject the basic science around the novel coronavirus.

“We’ve all been sick here, all got over it. We know it’s [a] cold,” says Barry, a woman who gave only her first name before brushing off a reporter.

“They chose this time to make people mask up, see what they could do as far as control – and it went like wildfire. They succeeded.”

Grangeville, a city of 3,200, sits on the edge of a canola prairie surrounded by elk-dotted mountains and rivers whose two-and-a-half-metre sturgeon and churning rapids make it a recreational draw. Explorers Meriwether Lewis and William Clark passed not far from here in the early 1800s. Two centuries later, the sense of being on the frontier maintains a hold on those who see their home as an emblem of American ideals.

The idea that government would require vaccination is “horrible,” said Fred Stevens, a Bible-college-trained construction worker. He sees individual liberty as a national bedrock, one threatened by mandates for vaccines and masks. “What I’m talking about is our ideals. I’m talking about the foundation of the nation. Which I’m not willing to yield,” he said.

Grangeville is 92 per cent white – it counts nine people who are Black – and, in the 2020 presidential election, Idaho County voted 81.5 per cent for Donald Trump. (The state has not voted for a Democrat as president since 1964.) Grangeville boasts well over a dozen churches.

“There are a lot of people in this region who are God-fearers,” said Mr. Stevens. “They’re not here to tell you how you should live. But they’re certainly not willing to let government tell them how they should live.”

And many aren’t willing to take a vaccine.

Vaccines have been available in Grangeville since the beginning of the year. But after an initial rush of people, it became “very common for us to break open a vial of Pfizer or Moderna during the course of a day, and then have three or four leftover shots,” said Danny Griffis, a doctor who worked at Syringa for 11.5 years, but recently decamped for Alaska.

The ranks of those abstaining from the vaccine include the majority of non-physician staff at Syringa. “And these are the people who are watching these very ill people come in respiratory distress,” he said. “It makes me sad.”

Reluctance among health-care workers has only reinforced a community belief that COVID-19 inoculation is inadvisable.

“You have these front-line medical workers that are saying, ‘no, I’ll lose my job before I get the jab.’ Huh. What does that say about the need to get vaxxed?” said Skip Brandt, a hang glider and aircraft pilot who is chair of the Idaho County Commissioners, and the area’s most prominent politician.

He believes he contracted COVID-19 in August, though he was not tested. “And frankly, I’d rather have it again than the flu,” he says. Mr. Brandt has been contradicted by his own brother, Lucky, who has advocated vaccination after most of his family became sick.

Skip Brandt, however, says he now possesses natural immunity, dismissing vaccines as “experimental. Plain and simple.”

COVID-19 skepticism in Idaho County has been bolstered in part by the relatively slow spread of the virus in a rural setting where social distance is a basic fact of life.

That has begun to change. Last weekend, eight of nine admissions to Syringa had COVID-19. “And the one that wasn’t was a mom delivering a baby,” said Abner King, the CEO of Syringa Hospital and Clinics.

“It’s getting stressful right now,” he said. Having just half of the hospital staff vaccinated is “nothing to be proud of,” he said. But he expressed sympathy with those who feel treated badly for refusing the jab.

And he is no advocate of vaccine requirements. Early in the pandemic, hospitals struggled to get enough personal protective equipment. Today, the greatest difficulty is getting enough nurses.

“Vaccine mandates, especially in rural areas, are going to create more shortages,” he said.

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