New York held a ticker-tape parade Wednesday for the health care workers and others who helped the city pull through the darkest days of COVID-19, while authorities in Missouri struggled to beat back a surge blamed on the fast-spreading delta variant and deep resistance to getting vaccinated.

The split-screen images could be a glimpse of what public health experts say may lie ahead for the U.S. even as life gets back to something close to normal: outbreaks in corners of the country with low vaccination rates.

"We've got a lot to appreciate, because we're well underway in our recovery," declared New York Mayor Bill de Blasio, who rode on a parade float with hospital employees down the Canyon of Heroes, the skyscraper-lined stretch of Broadway where astronauts, returning soldiers and championship teams are feted.

In Missouri, meanwhile, the Springfield area has been hit so hard that one hospital had to borrow ventilators over the Fourth of July weekend and begged on social media for help from respiratory therapists, several of whom volunteered from other states. Members of a new federal "surge response team" also began arriving to help suppress the outbreak.

Missouri not only leads the nation in new cases relative to the population, it is also averaging 1,000 cases per day — about the same number as the entire Northeast, including the big cities in New York, New Jersey, Pennsylvania and Massachusetts.

California, with 40 million people, is posting only slightly higher case numbers than Missouri, which has a population of 6 million.

Northeastern states have seen cases, deaths and hospitalizations plummet to almost nothing amid widespread acceptance of the COVID-19 vaccine.

Vermont has gone 26 days with new case numbers in single digits. In Maryland, the governor's office said every death recorded in June was in an unvaccinated person. New York City, which was the lethal epicenter of the U.S. outbreak in the spring of 2020, when the number of dead peaked at over 800 a day, regularly goes entire days with no reported deaths.

The problem in Missouri, as health experts see it: Just 45% of the state's residents have received at least one dose of the vaccine, compared with 55% of the U.S. population. Some rural counties near Springfield have vaccination rates in the teens and 20s.

At the same time, the delta variant is fast becoming the predominant version of the virus in Missouri.

Epidemiologists say the country should expect more COVID-19 outbreaks in areas with low vaccination rates over the next several months.

"I'm afraid that that is very predictable," said Dr. Chris Beyrer, an infectious disease epidemiologist at the Johns Hopkins University. "If politician seize on this and say, 'Who could have predicted this?' The answer is every licensed epidemiologist in the country."

Republican Gov. Mike Parson said Wednesday that his administration has done "everything possible" to fend off outbreaks.

"Right now, the vaccine's out there," he said. "I mean, people walk past it every day, whether they're in a pharmacy, whether they're in a Walmart, whether they're in a health center."

Mercy Hospital Springfield reported Tuesday that it had more than 120 patients hospitalized with COVID-19 — the highest total since the pandemic began. Seventeen people died in the latest two-week reporting period in the county that surrounds Springfield, the most since January. None were vaccinated, authorities said.

Erik Frederick, Mercy's chief administrative officer, said staff members are frustrated knowing that "this is preventable this time" because of the vaccine.

"We try to convince people, but it is almost like you are talking a different language," he lamented. "There is no way they are going to get a vaccine. Their personal freedom is more important."

The Mercy system announced Wednesday it is requiring vaccinations among staff at the hospital in Springfield, as well as at its hundreds of other hospitals and clinics in Missouri and neighboring states. It said about 75% of its more than 40,000 employees are vaccinated.

Missouri also never had a statewide mask mandate. The sentiment against government intervention is so strong that Brian Steele, mayor of the Springfield suburb of Nixa, is facing a recall vote after imposing a mask rule, even though it has long since expired.

At Springfield's other hospital, Cox South, several patients are in their 20s and 30s, said Ashley Kimberling Casad, vice president of clinical services. She said she had been hopeful when she eyed the COVID-19 numbers in May as she prepared to return from maternity leave.

"I really thought when I came back from maternity leave that, not that COVID would be gone, but that it would just be so manageable. Then all of a sudden it started spiking," she said, adding that nearly all the virus samples that the hospital is sending for testing are proving to be the delta variant.

Citing the rise in cases, the Springfield school district reinstated its mask requirement for its summer program starting Wednesday.

The contrasting scenes in the U.S. came as the worldwide death toll from COVID-19 closed in on 4 million, by Johns Hopkins University's count. COVID-19 deaths nationwide are down to around 200 per day from a peak of over 3,400 per day in January.

In New York, those honored at the parade included nurses and doctors, emergency crews, bus drivers and train operators, teachers and utility workers. The crowds along the route were thin, in part because many businesses are still operating remotely.

"What a difference a year makes," said parade grand marshal Sandra Lindsay, a nurse who was the first person in the country to get a COVID-19 vaccine shot.

"Fifteen months ago, we were in a much different place, but thanks to the heroic efforts of so many — health care workers, first responders, front-line workers, the people who fed us, the people who put their lives on the line, we can't thank them enough."

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Tom Murphy contributed to this report from Indianapolis.

For weeks, CDC Director Dr. Rochelle Walensky has been warning Americans about a potential new surge in COVID-19 cases. But during a Monday morning briefing of the White House COVID-19 response team, she gave her most alarming warning to date.

“I'm going to lose the script, and I'm going to reflect on the recurring feeling I have of impending doom,” Walensky said. “We have so much to look forward to, so much promise and potential of where we are and so much reason for hope. But right now, I'm scared.”

According to the CDC Director, cases have begun to tick up in the U.S. after about two straight months of steady decline. Just two weeks ago, the 7-day weekly average in daily cases sat at about 53,000 a day. As of yesterday, that figure was above 61,000.

While deaths are hovering at about 1,000 each day, they are no longer declining steadily as they had in recent weeks.

Last week, Walensky noted that seeing another surge in cases was completely “avoidable,” given that the vaccination rate in the U.S. is expanding every day. On Monday, she urged Americans to remain vigilant for just a few more months.

“I'm speaking today not necessarily as your CDC director, not only as your CDC director, but as a wife, as a mother, as a daughter, to ask you to just please hold on a little while longer,” Walensky said. “I so badly want to be done. I know you all so badly want to be done. We are just almost there, but not quite yet."

Last week, the White House COVID-19 response team said the current uptick in cases was likely due to Americans who are dropping public health guidelines like wearing masks and social distancing — particularly in places like Miami Beach, where videos have shown large crowds of spring breakers congregating in bars without masks.

While the CDC has urged states to keep mask mandates and other COVID-19 restrictions in place, some states like Texas and Mississippi have chosen to roll back measures. The CDC still advises all Americans to continue to wear masks when in public, despite guidance from state and local governments.

“I'm calling on our elected officials, our faith-based communities, our civic leaders, and our other influencers in communities across the nation, and I'm calling on every single one of you to sound the alarm to carry these messages into your community and your spheres of influence,” Walensky said Monday. “We do not have the luxury of inaction. For the health of our country, we must work together now to prevent a fourth surge.”