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GULF SHORES, Ala. (AP) — Tourists and servers alike dance atop tables and in the aisles at one restaurant on the “Redneck Riviera,” a beloved stretch of towns along the northern Gulf Coast where beaches, bars and stores are packed. Yet just a few miles away, a hospital is running out of critical care beds, its rooms full of unvaccinated people fighting for their lives.

On maps that show virus “hot spots” in red, this part of the U.S. coast is glowing like a bad sunburn. And a summer of booming tourism that followed the lockdowns and travel restrictions of 2020 is making the turn toward fall with only a few signs of slowing down.

Health officials believe the spike is due to a combination of some of the nation’s lowest vaccination rates, unabated tourism, a disregard for basic health precautions and the region’s carefree lifestyle, all combining at a time when the mutated virus is more contagious than ever and conservative states are balking at new health restrictions.

On a recent afternoon, one shopper after another walked through the mouth of a giant, fake shark into a Gulf Shores souvenir shop. Mini-golf courses, bars, go-kart tracks, hotels and condominium towers were full. The National Shrimp Festival, which draws as many as 250,000 people to the Alabama coast, is set for October despite the COVID-19 explosion.

Inside The Hangout restaurant, where dancing on tables is encouraged, “Cotton Eye Joe” received a raucous reception from the largely unmasked customers.

“Where did you come from, where did you go? / Where did you come from, Cotton Eye Joe?” the speakers blared.

The revelry came as just 12 miles (19 kilometers) to the north, South Baldwin Regional Medical Center was treating more than three dozen COVID-19 patients, nearly 90% of whom weren’t vaccinated, said spokesperson Taylor Lewis.

“After Memorial Day it was, ‘Everything is back to normal, go to the beach, take off your mask,'” said Dr. Bert Eichold, the chief public health official of Mobile County, just west of Gulf Shores. Mobile County’s COVID-19 positivity rate has skyrocketed to nearly 30%, and the county has the most new cases in the state.

Lisa Hastings, a Louisiana native and nurse visiting the Alabama coast with her two sisters, looked at the situation in two ways. She was a little unsettled by the wide-open scene from a professional standpoint, but she also doesn’t hold it against anyone who wants to get out and have fun, vaccinated or not.

“I think people are kind of over being afraid and so they’ve got to live their lives,” said Hastings, who is vaccinated. Nearby, a tourist from Illinois railed that the pandemic is fake and vaccinations are just another method of government control.

Some have decided against both getting vaccinated and wearing face masks, choosing instead to party without precautions at places like the Flora-Bama, a massive beachfront bar on the Alabama-Florida line. There, bands play to big crowds fueled by alcoholic drinks including the sugary Bushwacker, a coastal favorite.

Lulu’s, a popular Gulf Shores restaurant owned by Lucy Buffett, the sister of singer Jimmy Buffett, is among those that recently had to shut down for a week because the virus was racing through workers.

At The Dock, a beachfront restaurant that serves cold beer and seafood beside the public beach in Pensacola Beach, Florida, manager Justin Smith said the tourist season has been busy and his staff has managed to stay healthy, at least so far. While more vaccinations could help, Smith said he’d never require his staff to get inoculated.

“I’ve been here 18 years. It ain’t gonna happen,” he said.

Outbreaks caused by the coronavirus are threatening to overwhelm the region’s health care system and traditions. Panama City Beach, Florida, cited the pandemic in canceling an annual country music festival set for early September, and New Orleans has clamped down on mask-wearing and called off multiple events.

While urging people to get vaccinated, state leaders including Florida Gov. Ron DeSantis and Alabama Gov. Kay Ivey have resisted imposing new restrictions, even as hospital beds fill up. On Monday, officials said 1,560 patients needed intensive care treatment in Alabama, where hospitals have just 1,562 ICU beds.

Hospital executives joined together in Pensacola last week to plead for more vaccinations while also knocking down false rumors about vaccines and masks. In an area dominated by Christian conservatives, Mayor Grover C. Robinson IV made a direct appeal for churchgoers to get shots.

“Two of our hospitals are Christian affiliated,” he said. “One of the first things it says all throughout the Bible is, ‘Do not be afraid.'”

More people are getting initial vaccine doses than a few weeks ago, but it hasn’t been enough so far to stop the spread of COVID-19. Of 11 coastal counties in Mississippi, Alabama and Florida, Okaloosa County in Florida has the region’s highest share of fully vaccinated residents at 41.3%, statistics show. Many are around one-third, and all are below the national average of nearly 51%.

Natalie Fox, a nursing executive with USA Health in Mobile, said medical workers are tired after more than a year of fighting the pandemic. Still, people sick with COVID-19 — the vast majority of them unvaccinated — keep arriving.

“We’re kind of getting patients from all over because everybody’s dealing with this increased strain,” she said.

It didn’t take a mandate for Rhonda Landrum, a 50-year-old health care worker from near Mobile, to get a shot recently after watching all three of her unvaccinated daughters contract COVID-19. People aren’t taking the pandemic seriously, she said, and it’s just not safe to be out in public without the vaccine.

“I won’t travel nowhere,” she said. “I stay home.”

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