Jason Boatman sits nervously on the couch, his shoulders slightly turned in as he prepares to talk about the unimaginable tragedy that happened to his family earlier this year.
The Texas father clasps his hands in his lap as he tries to get comfortable, but his grip never really loosens.
As we chat, a polite smile creeps across his face but it’s difficult for him to hide the sadness he feels after the grief he’s endured.
Mr Boatman lost his nine-year-old son, Jason Jayden — or JJ as he’s affectionately known — to COVID-19 when the virus was again surging across Texas in January.
“It’s a struggle to even want to live. He was literally the life of the house,” he says.
“He was just so full of energy, so loving, so caring. It’s just hard to see someone like that go. He really liked living life to the fullest.
Two photos of JJ are mounted proudly on the wall behind him and from time to time Jason glances back towards them as he reflects on the child he was.
JJ went to bed with mild sore throat
Mr Boatman describes minute-by-minute how coronavirus took a hold of JJ’s body practically overnight.
Three weeks after celebrating his ninth birthday, JJ went to bed with a bit of a sore throat. He woke up screaming that he couldn’t breathe.
Mr Boatman had already left for work that day when his wife phoned him in distress.
“She said he was turning blue. She said she’d never seen him turn like that. It was scaring her to death,” he says.
“He’s panicking more, he ends up falling over and starts bleeding from the mouth and nose.”
Mr Boatman’s wife called an ambulance and JJ was rushed to a rural hospital outside Dallas.
“When I get there, he’s awake. They put a mask on him, but he keeps spitting up blood,” he says, hanging his head low.
“They were going to have to sedate him and that’s about the last thing I remember.”
Doctors discovered his lungs were full of fluid. They tried to place a tube into his throat to help him breathe, but it was too swollen to get the tube down.
Medical staff decided he needed to be shifted to a larger hospital immediately.
However, morning fog prevented the chopper from getting airborne straight away, and they lost precious time.
“They did CPR on him for 32 minutes,” he says.
“They said his brain had failed so much it’s putting pressure on his spinal cord and there’s no coming back from this.”
Mr Boatman says the doctors let him lay with his son all night as he prepared to say goodbye.
“He wasn’t moving,” Mr Boatman says.
“Later that morning, the doctor told me his heart and lungs were getting even worse and he’s going to go on his own.
Within eight hours of showing his first symptoms, JJ had died.
While JJ lived with autism and ADHD, doctors say those are not pre-existing conditions that are known to worsen COVID-19 symptoms.
They don’t know why the virus killed him so quickly, but one theory they have is that he may have been infected by a new variant.
They are now conducting a thorough autopsy to try and determine whether it was a more deadly strain that took his life.
Race to get vaccinated before new strains appear
Variants of the virus are spreading quickly across the US, sparking fears among exhausted frontline doctors and nurses that another wave of infections is on its way
“It’s a race. It’s a race between the virus and getting ourselves vaccinated,” doctor Haytham Adada says as he walks through his intensive care ward in rural south-west Virginia.
The ABC got rare access to Ballad Health’s hospital in the tiny town of Abingdon, nestled deep in the Appalachian Mountains in the south-west corner of Virginia.
It largely escaped the worst of America’s first two spikes of COVID-19 last year. But in the depths of a long, cold winter in early 2021, coronavirus unleashed its full wrath.
The community’s only hospital had a front-row seat to the devastation.
“Every room has memories for me now,” Dr Adada says.
“In Room Three, I remember a 21-year-old passed from COVID-19.”
As he prepares to enter a room with a distressed coronavirus patient in her 60s, he recalls having two married couples in at the same time. One from each couple died.
The hospital only has about 20 per cent of the patients it was treating during the peak in December and January. But there are worries about what the future holds.
“I don’t know if I can handle a fourth wave,” Dr Adada says.
“If another wave is coming, I may need some help. I don’t know if I can handle another wave alone.”
Why America is so far behind in chasing variants
Health authorities expect the UK variant, B117, which is thought to be up to 50 per cent more contagious, to become the predominant source of new infections in the US by the end of March.
It currently accounts for about 10 per cent of new infections in the country — three times as many as just a few weeks ago.
The South African variant, B1351, P1 — first found in Mexico — as well as several homegrown strains are also proliferating. Two concerning variants are spreading fast in New York and California.
Cases of both the UK and South African variants have been found in Virginia and neighbouring Tennessee.
The hospital suspects it has already admitted patients carrying the new strains but has no way of testing for them.
Laboratories are undertaking genome sequencing, the process for identifying mutations of the virus, but health authorities have described the effort in the US as being woefully inadequate by comparison to other countries, such as the United Kingdom.
Ballad Health’s Chief Clinical Officer, Amit Vashist, has been on the front lines of the effort here since the beginning and says despite vaccinations offering a glimmer of hope, this moment is a “good time to be worried”.
“The variant strains exist. The way they replicate, they replicate fast,” Dr Vashist says.
“I call it a cat-and-mouse game. Basically our vaccination in the arms has to exceed the rate of spread of COVID-19 variants.”
Hospitals prepare for fourth wave
From Virginia, we travel across the border to another hospital in rural Tennessee, which was hit even harder. We meet up with nurse Hannah Giles who takes us on a walk through her ward.
“This entire unit was full, 30 patients,” she says.
“It’s been that way for several months, particularly through the holidays.”
Ms Giles treats less critically ill patients, a step down from intensive care. But during the peak surge of cases, her ward was also taking patients from the intensive care unit as they went through their final moments.
“I’ve worked on this unit for five years and I’ve seen maybe five people die in that many years,” she says.
“Death is not a thing on this unit. This is a discharge unit. You come here to go home.”
She has comforted at least 20 COVID-19 patients as they’ve died.
One of her patients is a 49-year-old who had no underlying medical conditions before contracting COVID-19. Now he’s receiving oxygen to help him breathe.
He’s sitting up and responsive, but he looks exhausted. His breathing is laboured as Ms Giles takes him through a routine check-up.
As we step through the intensive care unit upstairs, we notice it’s eerily quiet. There are several critically ill, unresponsive patients hooked up to ventilators.
Like Ballad Health across the border, the hospital has only about a fifth of the patients it had during the last wave.
Ms Giles says she’ll be ready to go back to battle in the event of a “fourth wave”, although the thought frightens her.
“I’m petrified. We don’t want that to happen. We definitely don’t want to go through that again,” she says.
“But I do feel more prepared. I feel like I’ve gained so much knowledge. I did not want to gain it this way by any means.
“We just want everyone to take all the precautions to make sure it doesn’t happen again.”
Variants now discovered in almost all states
It’s a race against time to inoculate enough of the US population before the variants become unstoppable, or one develops which has a greater resistance to the vaccines.
Laboratories are using genome sequencing to find them, but the US is far behind other countries in hunting down new strains.
“Our sequencing of viruses in this country has been woefully inadequate,” infectious diseases physician and researcher Joshua Schiffer says.
He’s modelled each of the virus surges in America with his team at the Fred Hutchinson Cancer Research Centre in Seattle.
“It’s a race against time,” he says.
“The worst-case scenario would be that, for whatever reason, the uptake rate down goes down with vaccines … that could put us in a situation where we would be at risk for a severe wave.”
His model predicts the number of cases of the original coronavirus would go down while new infections of the variant strains would go up.
“We’re now seeing this in the raw data … for example, in Florida the total number of cases is going down but the number of cases of the UK variant is trickling up,” he says.
Despite the potential dangers ahead, Dr Schiffer remains cautiously optimistic.
“I think there will be a fourth wave across the country but hopefully that will be much more manageable than the subsequent three waves we’ve dealt with,” he says.
It’s now been a year since coronavirus breached America’s shores.
There’s room for hope. Infections and deaths have fallen dramatically in recent weeks as the northern hemisphere winter comes to a close.
But the fast-spreading variants are injecting unwanted uncertainty into America’s recovery effort.