Shoppers fill Detroit’s Eastern Market on a recent Sunday even though the number of coronavirus cases in Michigan is rising. (Elaine Cromie/for The Washington Post)

When Laura Forman arrived at work a few weeks ago, something was missing. The refrigerated truck for bodies that had overflowed Kent Hospital’s morgue during the covid-19 surge was gone.

“Coming up to the hospital and seeing that space where it had been, I cried,” said Forman, the physician who heads the Warwick, R.I., hospital’s emergency department. “It was the most powerful symbol of hope.”

But this week, hope gave way, yet again, to concern. The number of coronavirus infections is rising again — in Rhode Island and across the nation. It is clouding the success of the U.S. vaccination program and the welcome announcement Friday that fully vaccinated people can travel with little risk to themselves.

“We’ve been watching the numbers really carefully, and the difference over the last week has been palpable for us,” Forman said. “It’s worry at this point. It’s worry about our community. It’s worry about our families, because most of us have unvaccinated kids and family at home.”

A confusing vaccination rollout in Missouri has residents signing up for multiple lists and driving long distances away from urban areas like Kansas City. (Video: Lee Powell, James Cornsilk/The Washington Post)

The virus that has kept an entire planet toggling between hope and dread for the past 14 months is having one last go at the United States. The spread of highly contagious new variants of the virus, coupled with prematurely relaxed safety precautions in some places, has set off new alarms, all the way up to President Biden.

U.S. coronavirus cases and state maps

“You look out the front window and it’s raining,” said Nirav Shah, director of Maine’s Center for Disease Control and Prevention, “but from the back window, it’s sunny. And your house is literally on the cusp of the storm and you don’t know which way it’s going to go — stormy, or is it going to be sunny? That’s sort of where we are in covid.”

The virus that has cleaved us into categories of vulnerability has found one more division in society — the vaccinated vs. the unvaccinated. More than 100 million Americans are enjoying the relative security that comes with at least one dose of a coronavirus vaccine. The rest are still waiting.

Three days after Texas Gov. Greg Abbott (R) lifted his state’s mask mandate and restaurant occupancy limits in early March, Houston waitress Tracy McKenna said she served a customer who complained about her soda and food tasting odd. Problems with taste and smell are telltale signs of covid-19, the disease caused by the coronavirus.

Four days later, McKenna, who is not vaccinated, had trouble breathing and tested positive for the coronavirus. The symptoms advanced to a severe cough and fatigue. McKenna’s partner and toddler also contracted the virus.

“What little protections we had were out the window,” McKenna, 41, said in an interview conducted over Twitter because of her symptoms. “I was/am incredibly frustrated, because I was already putting myself at risk dealing with people who couldn’t care less about me, and now there would be a lot more of them.”

In Wellington, Fla., nurse and lactation consultant Deborah Montgomery has no such frustration. She was fully vaccinated in early February.

“I kind of felt a little guilty that I was able to get it so easily because I’m a health-care worker,” said Montgomery, who is also a union delegate at her hospital, Palms West, in Loxahatchee, Fla. “I have 100 percent relief. Knowing that I’m not going to transmit this to any of my little, itty-bitty patients that I take care of, or that I’m going to take it from one room to another room. I don’t worry about taking it home to my family.”

On Friday the Centers for Disease Control and Prevention said it had concluded that people who are two weeks beyond their final shot of vaccine can travel with little risk of covid-19 infection. But because of the rising case load, the health agency said it still is not recommending that people do so.

Tracking the coronavirus vaccinations

It was inevitable that some people would receive vaccinations ahead of others, even with the shots now being distributed at a rate of about 2.9 million per day. A panel of experts, the Advisory Committee on Immunization Practices, recommended the priorities adopted by the federal government, pushing health-care workers and vulnerable nursing home residents and staff members to the front of the line.

But it was not a given that, with the end so tantalizingly near, the country would face the possibility of another major surge in infections. That is the result of the growth of highly transmissible variants of the virus, including one first detected in Britain that is now responsible for 26 percent of U.S. infections, along with some governors’ decisions to throw open places where people can gather indoors and rescind mask requirements. Those moves came despite numerous pleas from federal officials that it was too early.

“This is a pivotal moment for our country,” CDC Director Rochelle Walensky said at Friday’s White House coronavirus briefing. “As I said before, we are taking unprecedented actions to vaccinate the public as quickly as possible, and millions are being vaccinated each and every day. We are better equipped than ever before to take on this serious challenge, but we must remain vigilant.”

As that progress occurs, infections and hospitalizations are increasing. The seven-day rolling average of cases, considered the most reliable barometer of infections, reached 66,009 on Thursday, according to reports from state health departments analyzed by The Washington Post.

On Friday, Walensky said the seven-day average of new hospital admissions in the United States was nearly 4,950 per day.

Miami Beach officials declared a state of emergency and implemented a curfew on March 20 in response to large crowds of spring break visitors. (Video: Joy Yi/The Washington Post, Photo: Marco Bello/The Washington Post)

Case counts are rising sharply in New York, New Jersey, Connecticut, Minnesota, West Virginia and elsewhere. In Rhode Island, where Forman is preparing for another spike, the rate of positive tests ticked up from 2 percent last week to 2.4 percent this week, according to state data. That is still well below the crisis level the state reached in December, but the numbers are heading the wrong way.

Other states, including California, Texas, Georgia, Arkansas and Arizona, are experiencing declines in case counts, some of them substantial.

Almost nowhere is the crisis worse than in Michigan, which has seen its seven-day average rise from 1,030 on Feb. 21 to 5,663 on March 31. Gov. Gretchen Whitmer (D) recently asked the Biden administration to surge vaccine doses to the hard-hit state and other hot spots. One local official said the vaccination effort is lacking in intensity.

“This is the worst emergency crisis that we’ve been in in our lifetime,” said Pamela Pugh, who was the chief public health officer for the city of Flint during the height of the city’s water crisis and is a longtime resident of Saginaw. “They say that we’re in a race for time, [but] we can’t say that, we can’t know that and then distribute the vaccine in the way that we have.”

Likewise, Austin Mayor Steve Adler, a Democrat who has been in a legal brawl with Texas Attorney General Ken Paxton (R) to preserve his city’s mask mandate, said Abbott, the governor, is confusing the public.

“Communication and messaging is really important, and that’s why I was real frustrated when the governor said. ‘We have to remove our mask mandate, but I still urge everyone to wear masks,’ ” Adler said. “In my mind, that’s a contradictory message to people. They don’t know what to believe at that point.”

A spokeswoman for Abbott, Renae Eze, said in a statement, “People have ‘learned and mastered’ how to protect themselves and loved ones from coronavirus and ‘do not need the government to tell them how to do so.’ ”

Jody Lanard, a physician who worked for nearly two decades as a pandemic communications adviser to the World Health Organization, said public health authorities need to acknowledge that they are sending mixed messages, some good and some bad.

“If they refuse to bless any normal behavior, people are either going to make it up for themselves, or go to the weird side,” she said, referring to conspiracy theories. “For CDC to have some authority, they should be the ones who give everyone a Plan B.”

“One way to frame that message is to say, ‘We wish everybody would do x y z, but since people, even our own friends, are not going to go along with that, we have to have ways to do that as safely as possible,’ ” Lanard said.

‘Am I making the right choice?’

Glen Nowak, director of the Center for Health and Risk Communication at the University of Georgia and a former media relations director at the CDC, said that in public health, one foot is always on the gas pedal and the other on the brake.

“There’s a lot of caution about what to say, and that’s probably driven by fear,” Nowak said. “If you’re not cautious, and something bad happens, people will hold you responsible for that. If I warn you and something doesn’t happen, that’s not as bad as if I don’t warn you and something bad does happen.”

Walensky acknowledged the difficulties Friday.

“Providing guidance in the midst of a changing pandemic and its changing science is complex,” she said.

In Rhode Island, Forman said she will watch closely and hope for vaccinations to outrun the virus. At this point, she believes, no one can be blamed for the way they respond to a grueling, once­in-a-century crisis.

“A year into this, we’ve spent so much time, all of us, trying to be thoughtful and [respect] the need to balance safety with the need for connection and the need for sanity. So I think one of the things I’ve learned for myself is I can’t judge anyone else for the decisions they are making.”

Jacqueline Dupree contributed to this report.

Coronavirus: What you need to know

End of the public health emergency: The Biden administration ended the public health emergency for the coronavirus pandemic on May 11, just days after WHO said it would no longer classify the coronavirus pandemic as a public health emergency. Here’s what the end of the covid public health emergency means for you.

Tracking covid cases, deaths: Covid-19 was the fourth leading cause of death in the United States last year with covid deaths dropping 47 percent between 2021 and 2022. See the latest covid numbers in the U.S. and across the world.

The latest on coronavirus boosters: The FDA cleared the way for people who are at least 65 or immune-compromised to receive a second updated booster shot for the coronavirus. Here’s who should get the second covid booster and when.

New covid variant: A new coronavirus subvariant, XBB. 1.16, has been designated as a “variant under monitoring” by the World Health Organization. The latest omicron offshoot is particularly prevalent in India. Here’s what you need to know about Arcturus.

Would we shut down again? What will the United States do the next time a deadly virus comes knocking on the door?

For the latest news, sign up for our free newsletter.