Dave Salove has watched his morgue fill with bodies. Covid-19 victims have poured into the funeral home he runs in Boise, Idaho, in recent weeks, as the state contends with an unprecedented spike in deaths driven by the delta variant of the coronavirus. His 16-slot refrigeration room is over capacity. Other funeral homes have neared a tipping point, too.
Intent on avoiding the makeshift morgues that cropped up in the Northeast during the pandemic's first wave, Salove this week brought in a refrigerated trailer to hold the growing number of dead. By Friday, there were seven corpses inside, up from two the day before. Six more were on their way from another facility.
"I'd barely gotten it installed, and we had to start using it," Salove said. "Right now, we are seeing that spike."
As covid-19 deaths reach record highs in the state of 1.8 million, hard-hit areas are struggling to keep pace with the surge in victims. Some hospitals, funeral homes and coroners say they've been pushed to the limit. Some morticians have even started embalming bodies that wouldn't normally need the procedure so they don't have to refrigerate them, the Idaho Statesman reported.
The backlog is so bad in some places that people have had to wait weeks to cremate their loved ones.
"We're so far behind on cremations," said Lance Cox, owner of Bell Tower Funeral Home in Post Falls, Idaho. "That's really how it impacts the families the most. You can bring in backup refrigeration options in an emergency, but you can't bring in a backup crematory."
The dire situation in Idaho, one of the least vaccinated states in the country, is another grisly illustration of what happens when a state fails to contain infections.
Others faced similar crises before the vaccines became widely available. Images of refrigerated trailers parked outside hospitals and funeral homes were seared into the nation's memory last spring when New York City, then America's disease epicenter, deployed them by the dozens to help make room for the victims. Nearly 18 months later, in Idaho, the containers are again becoming a visible sign of the mounting death toll as the state battles one of the country's worst outbreaks from the hyper-transmissible delta.
"Idaho is having its viral tsunami at the moment," said Robert Kim-Farley, a infectious-disease expert at UCLA Fielding School of Public Health. "I anticipate that we'll see even more deaths coming in the near future because of the fact that cases are still increasing. It's going to get worse before it gets better."
Statewide, hospitalizations have shot upward since early summer, leading officials to authorize rationing of medical care for the first time in Idaho's history. Intensive care unit admissions are at their highest level, exceeding the worst of the winter wave, data from the health department shows.
Unvaccinated patients account for the vast majority of the state's latest deaths, which have risen sharply since the beginning of September, according to tracking by The Washington Post. Idaho's rolling average for daily deaths peaked at 23 this month - a high number for the sparsely populated state, where just 41 hospitals have emergency rooms, according to the Idaho Hospital Association. The state is logging 68 new daily cases per 100,000 residents, the sixth-most in the country, The Post's analysis shows.
Neighboring Oregon and Washington state grappled with their own viral resurgences over the summer as delta took hold. But high vaccination numbers have helped those states and others keep infection and death rates far below the levels Idaho is experiencing now, Kim-Farley and other health experts say.
To combat the virus spread, Idaho Gov. Brad Little, a Republican, recently mobilized the National Guard to help overwhelmed hospitals. The state has also expanded access to monoclonal antibody treatment and sent money to providers to help alleviate staffing shortages. But Little has resisted issuing a statewide mask mandate - his lieutenant and political rival, Janice McGeachin has tried to ban them entirely - and has threatened legal action against the Biden administration's vaccine requirements for businesses, even while describing the shots as "our ticket out of the pandemic." His office didn't immediately respond to a request for comment.
In the state's major hospitals, the outbreak shows little sign of slowing.
St. Luke's Health System has seen a tenfold increase in covid-19 patients since the end of July, according to Frank Johnson, chief medical officer for St. Luke's in Boise, Elmore and McCall. The system is often recording a half-dozen or more deaths a day. Morgues at some facilities have exceeded capacity, prompting executives to turn to local coroners to take some of the bodies, he said.
"It's a terrible situation," Johnson said in a call with reporters Thursday.
The crush of fatalities has fallen especially hard on Ada County, the state's most populous and home to the capital. Coroner Dotti Owens said her office handled 18 coronavirus deaths Wednesday, the most they've seen in a single day. September has already been worse for the county than the deadliest months last year, and it's weighing on her small staff.
"We're exhausted," Owens said. "I have a feeling moving forward in the next couple weeks we're in trouble. I'm honestly afraid of what's coming."
Owens's office is holding coronavirus victims in an external trailer she bought last fall to ensure they didn't run out of room during the previous covid-19 wave. Hospital officials around the region are now leaning on her for relief.
On Friday morning, Owens said she got a call from a hospital telling her that their morgue was full and that they needed a place to store the bodies of 13 people who died overnight. At the end of the day, she was still trying to help work out a plan for moving the bodies to her facility or a nearby funeral home.
"It's taken us all day to facilitate all this," Owens said. "If the funeral homes can't get them processed and cremated or buried quickly enough, or if they're full, we have to take them. We can't leave them at the hospital."
Transporting the dead is a challenge farther north in Kootenai County, Idaho, as well.
Cox, the Bell Tower Funeral Home owner, runs a transport business that serves coroner's offices and other funeral homes in the region. He said his drivers have bounced from one facility to the other as the bodies have streamed in.
"We're literally shuffling people from hospital to hospital to container to morgue because everybody's looking for space," said Cox, who tripled capacity in his morgue last year. "We're getting lots of calls from other funeral homes asking me to store decedents. As long as I've got space, I say yes."
During previous spikes in deaths, some states and the District of Columbia received trailers from the Federal Emergency Management Agency to help hold the dead. So far, Idaho hasn't had to request them, according to Niki Forbing-Orr, a spokeswoman for the health department.
"Idaho has been supporting the sharing of existing mortuary capacity throughout the pandemic and would submit a request to FEMA after all resources in the state have been exhausted," she said in an email. "We are monitoring the situation very closely."
For Salove, managing partner of the Cloverdale Funeral Home in Boise, the lessons from earlier waves are impossible to ignore.
In the winter, when the nation's daily death toll soared past 4,000, he saw the virus kill scores of seniors in his community. Now, he said, the dead passing through his building are skewing younger, with more victims in their 20s and 30s.
Salove said a recent call with a bereaved family convinced him to order the 53-foot trailer that sits outside the funeral home. The family members told him that Cloverdale wasn't their funeral home of choice, but said they'd been turned away elsewhere. Salove thought back to April 2020, during the initial explosion of cases, when one funeral home in Brooklyn stacked dozens of decomposing bodies into rented U-Haul trucks.
"I can't imagine putting someone's loved one in the back of a U-Haul for storage," Salove said. "I was just determined that we were not going to be those places."
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The Washington Post's Kyle Green contributed to this report.