Dr. Angelique Ramirez, the chief medical officer of the main health care system in Fairbanks, Alaska, started the monthly coronavirus briefing in April by saying that she thought March’s meeting would be the last. But amid a new surge of cases in the state, one of the country’s worst surges, Dr. Ramirez was blunt about her past assessment.

“I was wrong,” she said.

With nearly 100,000 people, the Fairbanks metropolitan area is Alaska’s second largest and the largest in the state’s vast interior. According to a New York Times database, the number of new coronavirus cases in the borough of which Fairbanks is the seat, North Star, has risen by 253 percent over the past two weeks. The positivity rate has doubled since March, to about 10 percent from 5 percent, and hospitalizations at Fairbanks Memorial Hospital, the area’s only hospital, have hit a record number.

low vaccination rate certainly plays a role. Thirty-six percent of Alaskans are fully vaccinated, and in some boroughs that number is over 50 percent, but in the Fairbanks area just 29 percent of the population has been fully vaccinated.

“There is no big outbreak or two big outbreaks that are really driving this,” said Dr. Joe McLaughlin, the state epidemiologist for Alaska. “We have cases and clusters being associated with a wide range of different settings.”

With two-thirds of the older population in Fairbanks having received at least one dose

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