It is easy to forget how badly COVID-19 has savaged the United States since January 2020. Officially, America has had 35,039,644 confirmed cases, which is about 18% of the world total, despite large surges in high-population countries such as Brazil, India and Indonesia. The number of U.S. fatal cases is 618,197, or about 15% of the global figure. Most of the cases came in waves. The first was in April of last year. Another occurred in late summer, and the worst just after the December holidays. A fourth wave apparently has started, and it has been particularly brutal in states with low vaccination rates, several of which have rates of little more than 40%.

As the COVID-19 Delta variant surges across the United States, two factors are the best protection against it: vaccination and mask-wearing. In some states, there is absolutely no mandate to wear masks. In others, vaccination rates are extremely low. In one state, both factors have caused a sharp increase in COVID-19 cases. Recently, one in five new cases across the country has been in Alabama.

The most critical measure of the rise in cases and deaths is hospitalizations. This figure is increasing particularly fast in states and counties with low vaccination rates. Public health officials trace cases, deaths and hospitalizations by 100,000, which allows comparisons of large counties and states with those that are much smaller.

Hospitalizations in Lauderdale County, Alabama, are 594% higher over the past 14 days. Its vaccination rate is a low 34%.

Demographically, Lauderdale County is like many other counties with high hospitalization numbers. About 85% of the county’s population of 92,729 is white, which is well above the national number. The median value of an owner-occupied home is a low $145,000.

People over 25 with a bachelor’s degree make up 25.5% of the population, compared to the national figure of 32.1%. The median household income figure is $48,094, in contrast to the U.S. figure of $34,103. The 15.7% poverty rate is above the national number of 10.5%.

As long as counties like Lauderdale have low vaccination rates and surging hospitalizations, the country, particularly in those places, will be subject to the fourth wave of COVID-19.

Click here to see which city in each state has the most COVID-19 cases.

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