Two brothers in rural Virginia were hospitalized within days of one another, their airways inflamed. A barber in southeast Washington went on life support as his lungs and kidneys failed. And a grandfather in suburban Maryland, the stoic breadwinner for his large immigrant family, wept when the paramedics took him away.

Fueled by the highly transmissible omicron variant, the coronavirus infected more than 29 million people in the United States over the past three months. It reached individuals across race, class and location. But data showed that it hit unvaccinated and under-vaccinated people hardest, wounding communities with inadequate access to health care and where officials have failed after a year to stamp out vaccine misinformation and distrust.

“I know for most of the country, people were saying it was mild. I can’t say that we saw that here,” said Teresa Tyson, chief executive of the Health Wagon, a mobile clinic that serves the most rural and least-vaccinated counties in Virginia. In January and February, Tyson said, she was forced to rent additional space to accommodate the flood of covid-19 patients, dozens of whom ultimately begged for vaccine doses as they were loaded onto ambulances.

When omicron arrived, covid-19 was a largely preventable disease, health experts said. And yet in the past three months, more than 150,000 people in the United States have died of it, the vast majority of them from underserved pockets of society.

In January, Black U.S. residents were hospitalized for covid-19 at a rate higher than any other race or ethnicity at any point in the pandemic, according to data from the Centers for Disease Control and Prevention. Southern California recorded a covid-19 death rate triple that of the Bay Area due to lagging vaccination rates, the Los Angeles Times reported. In the District and surrounding states, one of the most vaccinated regions in the nation, about 7,100 people have lost their lives since Christmas.

While data from the surge is still being compiled, analysis conducted by The Washington Post found that rural communities in Virginia suffered a mortality rate double that of urban communities. In Maryland, poor families of color bore the brunt of the omicron wave. And in the District, Black residents account for 84 percent of covid-19 fatalities since the start of the year, despite making up less than half the population.

With new variants of the coronavirus on the horizon, this pattern of harm will soon repeat itself, experts warn.

“You see someone recognizing in real time that their own illness could have been prevented” and “you feel remorseful with them,” said David Marcozzi, an emergency medicine physician at the University of Maryland Medical System, which was overwhelmed with covid-19 patients during the omicron surge. “You want to go upstream to all of the misinformation out there and stop the story there.”

Reed Tuckson, a founder of the Black Coalition Against Covid, said officials and advocates tried for months to overcome distrust of the vaccines, but misinformation “put gas on a fire that was already out of control.” He added, “I cannot think of anything more that could have been done that was not done. Contemporary history, combined with past history, we were pushed back on our heels. ”

It started at a rich person’s bungalow in Northern Virginia. He was there to paint the walls, and she was there to clean the mess. He was 55, tall and handsome with paint splattered across his shirt. She was 40, smiling and radiant even though it had been only two days since she had arrived in the United States from Honduras. They flirted in Spanish. She called him “papi.” A month later, they were married.

By the time Javier Ramirez Reyes met Maria Rodriguez, he had lost most of his family. Her children and grandchildren became his own, and together they settled down in the Maryland suburbs, first in Langley Park, then in Gaithersburg.

The couple earned just enough, $900 a week, to support themselves and six relatives in a two-bedroom rental apartment. They bickered sometimes, such as over his smoking habit, but it was hard for either of them to stay upset for long. He loved the look on her face when he brought her flowers. She loved the sound of him singing mariachi songs after dinner.

When the pandemic hit, Rodriguez pushed everyone who was eligible in her family to sign up for vaccinations, though she knew her husband, like many other Latino immigrants, hated seeing the doctor. He once pulled out a rotting tooth on his own instead of visiting a dentist. “When you go to the doctor, that’s when they find something wrong with you,” Reyes, a native of Mexico, would say. And besides, he would add, doctors were expensive.

Reyes eventually agreed in July to get the Johnson and Johnson vaccine, part of a larger success story in Montgomery County, a wealthy but inequitable suburb just outside the District. While vaccine uptake among Latino residents in the county initially trailed that of White residents, outreach from local officials, nonprofit groups and individuals such as Rodriguez helped turn the tide. By August, the vaccination rate among Latinos in Montgomery was higher than any other demographic group, including White residents.

As the pandemic dragged on, however, immunity waned. Guided by the CDC, county officials initially offered optional booster shots to the elderly and the infirm before shifting tack and pushing to get everyone boosted. Barely a third of Latino residents in Montgomery had gotten their additional shot when omicron arrived.

In later months, the county would blame the federal government for “counterproductive” messaging that made the booster seem less important than it was. At the most recent peak of covid-19 deaths, the mortality rate among residents who had not been boosted was seven times that of those who had.

Grace Rivera Oven, a founder of a nonprofit that serves immigrant communities in Montgomery, said many of the poor residents she works with haven’t gotten boosted because they can’t afford the time or are unconvinced it’s worthwhile. “Imagine you’re working two jobs and driving Uber on your time off,” she said. “To find time in the day for a shot” is “just not doable.”

Reyes was due for his booster in December when he developed a persistent cough. Rodriguez asked him to see a doctor, but he resisted. “Latino men are always like that,” Rodriguez thought to herself at the time. “Stubborn.”

She kept trying until one afternoon in January when she was cleaning a client’s home and saw Reyes lean against a wall, his eyes closed. She asked if he was okay, and he shook his head. By the time the ambulance arrived, Reyes was weeping. He couldn’t see, he told his wife.

“I don’t know why she called you,” Reyes said to the medics as they heaved him onto a gurney. “I don’t want to go, please.” He reached for Rodriguez. “Don’t let them take me,” he said.

In the months before he fell sick, Reyes had talked about retiring in a village outside Choluteca, the place in Honduras where Rodriguez grew up. They saved up money and bought a small piece of land there. It was a place they owned for the first time in their lives. They could raise goats and grow avocados, they told their children.

But Reyes didn’t make it to Choluteca. By the time he got to the hospital, inflammation from covid-19 had started to cripple his vital organs, doctors said. Reyes was brain dead within hours. Two days later, Rodriguez watched from behind a glass panel as nurses unplugged his life support. He was 72.

Rodriguez sold the land in Choluteca and emptied her savings to pay for a funeral and a gravesite. She no longer plans to move to Honduras or to retire anymore. Without Reyes, she said, she sees no point.

When a radio show host asked Leonder “Rico” Jerome for his thoughts on the vaccines during a roundtable with Black barbers and health experts in June, Jerome answered honestly that he was conflicted.

Although he was there to discuss an initiative to encourage Black people to take the shot, Jerome, 48, was torn between the news he consumed on vaccine efficacy and his distrust of the pharmaceutical companies that developed the shots.

“Being a man of ebony hue, you’ve seen the Tuskegee experiments, you’ve seen so many different things. To tell me you’re not going to be paranoid is a lie,” Jerome said on the program, adding that he was not vaccinated. “My percentages have been getting higher to get” vaccinated, he added, “but I’m still deep in prayer.”

Three months later, his symptoms emerged. As slight discomfort devolved into a fever, his loved ones urged him to seek medical help. Within weeks, Jerome was placed on life support for pneumonia complications from covid-19.

As District lawmakers and residents tangled over the merits of masking and vaccination mandates, Jerome spent the next three months in different hospitals, healing from surgeries on his lungs and kidneys. Even though he had no underlying health conditions, doctors told his sister, Ebony Ellison, that she should start making end-of-life plans. Jerome had a 3 percent chance of survival.

“They said if he was vaccinated, he would not be on life support,” Ellison said, remembering the conversations she had with her brother about vaccination. “He would talk about syphilis and Tuskegee, but I didn’t go into it with him. Trying to convince someone, especially when you’re the youngest sibling, you give up the fight.”

Health experts and advocates in the District say the case of Jerome is emblematic of the vaccine hesitancy and distrust they’ve frequently encountered among Black residents, who have been disproportionately affected by the pandemic at every stage.

Black residents accounted for an overwhelming majority of the more than 100 coronavirus deaths over the last three months in the District, said Wayne Turnage, deputy mayor for health and human services. Of those, 3 in 4 were unvaccinated, 1 in 5 had some doses but lacked a booster shot, and 9 in 10 suffered from an underlying condition, such as chronic kidney disease, diabetes or high blood pressure.

“When omicron came, and we found you needed a booster, you had to almost start over,” said Tuckson of the Black Coalition Against Covid. “There was not only hardening of misinformation in too much of Black America and the anti-vaccine community, but we also had people that were tired.”

For some Black residents, he said, vaccine distrust is intertwined with frustration over other issues such as police brutality, racism and voter disenfranchisement. For Jerome and some of his friends, that hesitation stems from the country’s racist history, including leaders who once considered his ancestors to be three-fifths of a person and the Tuskegee study. That trepidation has only been intensified by posts on TikTok, Instagram and Facebook that raise doubts over the safety of the vaccines.

The District has used a mix of financial incentives and interventions to reduce gaps in vaccination rates. But Turnage warned of a “tremendous level of misinformation” across social media that continues to influence Black residents.

“There are great reasons to be angry and bitter about Tuskegee, but the issue was people denied access to drugs that could have saved them. In this case, for some odd reason, we deny access to ourselves to the drug that would save us, as some type of protest,” Tuckson said.

In December, as the omicron variant sent more unvaccinated residents into city hospitals, Jerome was released. Doctors described his recovery as a miracle. He feels more pressure now to get vaccinated, he said, but is still undecided.

Larry Sturgill, 62, knew many in his town who had died of covid-19, but even as cases surged in his part of southwest Virginia, it never occurred to him to get vaccinated. Like he did with other things beyond his control, he put his trust in God.

He barely had time for his family, working 12-hour days as an accountant, and his primary-care doctor had retired years ago. Some of his friends had tested positive even after getting vaccinated, which made Sturgill skeptical of the effectiveness of the shots. And when he was on YouTube listening to gospel music or to sermons from the late Christian evangelist Billy Graham, videos sometimes popped up of users swearing that the vaccines had dangerous side effects.

Many others shared his view in Wise County, where less than half the population was vaccinated when omicron arrived. Sturgill’s wife hadn’t gotten the shot and neither had his younger brother, who lived across the border in Tennessee but worked with him in Wise.

Scott Sturgill, 49, used Twitter to follow news on Tennessee football and occasionally came across tweets that made him question the coronavirus vaccines. The users behind these tweets weren’t people he knew and didn’t seem like medical professionals. But what they said stuck in his head anyway. Whenever his wife, who has asthma, tried persuading him to get the shot, he gave the same response, “I’ll think about it.”

Virginia officials have struggled over the last year to shore up vaccination rates in the rural southwest region of the state, where residents tend to be sicker, more skeptical of government and harder to reach. Some have responded to appeals from local health workers, said Beth O’Connor, chief executive of the Virginia Rural Health Association. But such spokespeople are rare. Swaths of the region, including all of Wise, are federally considered “health professional shortage areas.”

The Sturgill brothers waited until their coughs got too severe to work before visiting the Health Wagon, a mobile clinic. When they tested positive for the coronavirus, they tried to recover on their own until Tyson, who leads the clinic, called them each an ambulance and insisted that they go.

It was the first time either of them had ever been hospitalized. Scott stayed in isolation at Pikeville Medical Center in Kentucky for 16 days. Larry stayed for 10. Drifting in and out of consciousness, Larry said he thought about his grandchildren, ages 4 and 2. “Knowing that I might not be there for them,” he said one recent afternoon, his voice still hoarse, “I can only describe as tough.”

Scott came out of the hospital in worse shape than his brother. He struggled for weeks to walk and speak, and doctors told him the scarring on his lungs was so severe that he might have trouble breathing for the rest of his life.

“It’s really messed me up. It really has,” he said in February, wheezing as he took breaths from an oxygen machine. If he could go back in time, he said, he would get vaccinated. He planned to do so once doctors said he could. His brother, however, hadn’t made up his mind.

Even though southwest Virginia saw more coronavirus deaths in February than in any other month during the pandemic, vaccination rates in the region continue to show only incremental increases.

“At this point, everyone here knows somebody who has died of covid,” said Tyson, who has been pleading with her patients to get vaccinated. “I’m at a loss of words to explain why people are still so resistant.”

One afternoon in March, Scott Sturgill got a text message from his brother’s wife. Larry Sturgill’s oxygen levels had plunged again, she told him. They were on their way back to the hospital.

Teo Armus contributed to this report.

Design by Marissa Vonesh. Photo editing by Mark Miller.