West Virginia, once a vaccination pacesetter, is struggling against the Delta variant.

Coronavirus cases are nearing record levels in West Virginia, and the state’s schools are closing and its hospitals are choked with patients stricken by the perniciously infectious Delta variant.

Just seven months ago, as the Covid vaccine was still being rolled out, the state was a national leader. By late June the state’s governor, Jim Justice, a Republican, had removed a statewide mask requirement.

But West Virginia has since fallen far behind, and its pandemic status has deteriorated, a situation shared with other states with large unvaccinated populations. Just under 48 percent of West Virginia’s 18 and over population is fully vaccinated, the lowest of any state, according to federal data compiled by The New York Times. ...

The latest surge has enveloped West Virginia with a ferocity the virus had not shown before there, said the official running the state’s coronavirus response, Dr. Clay Marsh.

West Virginia’s seven-day average of new reported cases has neared record levels for all of September, hovering above 1,500 per day for most of the past week, according to data compiled by The New York Times. The state recently surpassed a total of 200,000 cases, more than four times the population of Charleston, the capital and largest city.

Hospitalizations are nearing the state’s pandemic high, pushing its understaffed health centers to near capacity, and record numbers of Covid patients are being treated in intensive care units. Dr. Marsh said the state was reducing the number of elective procedures and taking steps to ensure that hospitals were adequately staffed. ...

Governor Justice has been more outspoken about vaccinations than many other Republican governors.

“We can stop this, West Virginia, we can stop it,” Mr. Justice said at a news conference on Friday. “The vaccines are safe. The vaccines are not an invasion on anyone.”

Even though Mr. Justice regularly beseeches his constituents to get a shot, vaccine mandates are “something that I absolutely do not believe in,” he said. Mr. Justice also suggested that Mr. Biden’s announcement of new vaccine mandates was a ploy to try to distract the public from the chaotic withdrawal from Afghanistan and the crush of migrants at the southern border. ...