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Clinicians care for COVID-19 patients in a converted negative pressure room in the Intensive Care Unit at Lake Charles Memorial Hospital, in Lake Charles, Louisiana, on Aug. 10, 2021.Mario Tama/Getty Images

Jody Moreau knows how bad COVID-19 can be.

The administrator of East Feliciana Parish, a farming and logging community in rural Louisiana, Mr. Moreau caught the coronavirus during its second wave in 2020 and suffered a stroke while working at his desk. A friend of his died just last weekend. One member of the parish council is currently off sick, as are several members of Mr. Moreau’s staff.

He’s fought back, organizing mass-vaccination events, personally delivering supplies of masks to schools, and instituting capacity and distancing rules at meetings.

But the vaccination rate has plateaued at 39 per cent in East Feliciana, about 24 percentage points lower than the United States over all. And Mr. Moreau doesn’t believe it’s practical to keep imposing closings.

“Everybody here has seen somebody die,” he said in an interview at his office in Clinton, the parish seat. “I don’t know what else to do. We can’t keep shutting down schools and government buildings every time someone gets sick. I totally expect COVID is going to be part of our lives for a very long time.”

Mr. Moreau, 52, is not in favour of vaccine mandates, wary they would exacerbate the pandemic’s political divisions in a place where most people oppose such a move.

“You can lead a horse to water, but you can’t make it drink. These horses are hard-headed and stubborn. It is not worth the argument. It’s easier at this point just to provide the water,” he said.

As the Omicron wave crests, this is the stalemate facing the U.S.

The vaccination rate is relatively static and officials from the White House to local governments are, like Mr. Moreau, reluctant to impose additional measures. Anti-vaccination sentiment, meanwhile, is firmly entrenched. The Supreme Court this month blocked President Joe Biden’s attempt to require employees of large companies to be vaccinated.

It is places such as East Feliciana that are increasingly suffering the consequences. The parish has seen 154 deaths in a population of 19,500, a per-capita rate more than double those of Los Angeles and Chicago, and triple that of New Orleans. Out of the 100 U.S. counties with the highest death rates, 95 have populations of fewer than 100,000 people. None contain major cities.

In a country that is approaching 900,000 pandemic deaths, many people have accepted that things won’t be getting better any time soon.

Enjoying the afternoon sunshine on Clinton’s main street during a coffee break, bank teller Kathryn Wheeler said her husband had refused to get vaccinated. But she didn’t mind. She was more weary of non-stop talk of case counts and restrictions.

“I don’t judge anybody for their decisions. It’s their body,” said Ms. Wheeler, 43, who is vaccinated. “You get kind of burned out by hearing about it.”

Outside town at an agricultural supply co-operative, clerk Colby Breaux said there had been a run on ivermectin amid the Omicron surge. The medication, used primarily to treat parasitic worms in livestock, is touted by anti-vaxxers as a COVID cure. There is no proof that it works, and medical officials have pleaded with people to stop taking it because of side-effects including seizures.

Ms. Breaux, 46, herself described vaccines as “dangerous” and “poison” and has refused to get inoculated. All scientific evidence shows COVID-19 vaccines are overwhelmingly safe, and enormously cut the risk of hospital admission and death.

One parish over from East Feliciana, Pastor Tony Spell is waging a legal battle over pandemic safety measures. He was arrested in the spring of 2020 for repeatedly holding services at Life Tabernacle Church during the state’s stay-at-home order. His hope is that the case will go to the Supreme Court, curtailing the power of governments to put in place pandemic restrictions. His entire congregation, he said, is unvaccinated.

“Who are you, as the governor or the president, to tell me what is essential and what isn’t?” Mr. Spell, 43, said before heading into a service with about 200 worshippers one evening this week. “Church is more necessary than the food we eat, the water we drink, the money we have.”

In some places, even the authorities do not want to get vaccinated.

Scott Trahan, head of the local council in Cameron Parish on the other side of the state, said he only got his shots because he wanted to see his grandchildren, and being inoculated would put his son and daughter-in-law at ease. Cameron has a vaccination rate of 17 per cent, among the lowest in the country.

“I really didn’t want to get it,” Mr. Trahan, 57, said. “I don’t trust the government.”

Mr. Trahan, who has lost a cousin to the pandemic and contracted COVID-19 himself during the second wave, said he takes ivermectin weekly. Using a preparation intended for cattle, he initially drank it mixed with chocolate milk. He now applies it topically to his shoulders and legs.

Even officials who wholeheartedly support vaccination balk at further rules. Mr. Biden, for instance, has not implemented vaccine or testing requirements on domestic air travel. Despite case and death rates in Louisiana far higher than Canada’s this month, Democratic Governor John Bel Edwards avoided the vaccine mandates and business closings that Canadian politicians have championed.

Susan Hassig, an epidemiologist at Tulane University in New Orleans, said the U.S. can expect further waves of infections to swamp hospitals and push the death toll ever higher if nothing changes. “I don’t know what it’s going to take for people to recognize that continuing to do the same thing is not going to change the outcome,” she said.

New Orleans is one of the few places to recently tighten its rules. Mayor LaToya Cantrell this month ordered that restaurants, bars, theatres and sporting venues require patrons to show proof of vaccination or a negative test. The city also has an indoor mask mandate.

In the buzzing French Quarter one chilly night this week, neither the pandemic nor the new rules seemed to be keeping people away.

Kelsey Wolf, 27, said letting businesses stay open while requiring vaccinations and masks was the right approach. It allows the leather store she runs to keep operating while ensuring her staff and customers are protected. The vaccination mandate, she said, had already pushed people she knows to get inoculated.

But she wasn’t holding her breath for the end of the pandemic.

“People have such a goddamn hard time being considerate. They don’t want to think about another person,” she said. “I’m believing in nothing right now. I’m just going one day at a time.”

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