MIAMI >> Florida Gov. Ron DeSantis snapped this week at a reporter who asked if masks might help keep children safe in a state that now has more COVID-19 hospitalizations, including for pediatric patients, than anywhere else in the nation.

He blamed President Joe Biden’s purported failure to control the spread of the virus across the border after the president suggested that governors such as DeSantis should either “help” fight the coronavirus or “get out of the way.”

And he touted a new state rule, adopted Friday, that will counter local school mask mandates by allowing parents to request private school vouchers if they feel that the requirements amount to “harassment.”

DeSantis has been unyielding in his approach to the pandemic, refusing to change course or impose restrictions despite uncontrolled spread and spiking hospitalizations — an approach that forced him to undertake the biggest risk of his rising political career.

The governor reopened his state’s economy in the spring and kept it that way, defying coronavirus surges that filled hospitals, and then celebrated as a statewide vaccination campaign took hold and life in Florida began to look normal.

Now DeSantis is gambling again. A new virus spike has led to a record number of COVID hospitalizations that have undone some of Florida’s economic and public health gains and again raised the stakes for DeSantis.

If the latest surge overwhelms hospitals, leaving doctors and nurses unable to properly care for the younger, almost entirely unvaccinated people packing emergency rooms and intensive care units, DeSantis’s perch as a Republican Party front-runner with higher aspirations could be in serious trouble.

If, however, Florida comes through another virus peak with both its hospital system and economy intact, DeSantis’ game of chicken with the deadly pandemic could become a model for how to coexist with a virus that is unlikely to ever fully vanish.

DeSantis successfully sued the Centers for Disease Control and Prevention over its requirement that cruise ship passengers be vaccinated, although some of the cruise lines were keeping the mandate anyway. He opposes mandating vaccines for hospital workers, saying that would result in worsening staff shortages.

“We can either have a free society, or we can have a biomedical security state,” DeSantis said this week in Panama City, Florida. “And I can tell you: Florida, we’re a free state. People are going to be free to choose to make their own decisions.”

Florida has the country’s highest hospitalization rate and second-highest rate of recent cases, behind Louisiana. Infection levels have been rising in every state, with especially alarming rates in the South. Many of those governors have also been reluctant to impose new restrictions or require masks.

Nationally, hospitalizations and deaths remain well below past peaks, in part because 80% of Americans ages 65 and older are fully vaccinated. Deaths in Florida have so far remained much lower than past peaks, but mortality data can lag cases and hospitalizations by weeks.

“Nobody knows where this is going to end,” said Dr. Marissa Levine, director of the Center for Leadership in Public Health Practice at the University of South Florida. “The approach has almost been one of denial that this is a big deal.”

DeSantis has argued that prioritizing vaccinations for older people, as his administration did, has reduced the death toll. So has the availability of treatments for some patients, such as monoclonal antibodies, which DeSantis spent part of this week promoting. He has consistently urged Floridians to get vaccinated, although he no longer holds public events at vaccination sites as he did earlier this year.

About 49% of Florida residents are fully vaccinated and about 59% have received at least one dose, rates that are roughly in line with the national average and far better than most other Southern states.

Florida never instituted a statewide mask mandate. Mayors imposed local ones a year ago; a new state law prohibits them now, but some municipalities have reinstated mask rules in government buildings and mandated vaccines for their employees. The state of emergency that DeSantis initially declared to deal with the pandemic expired in late June, and he has declined calls to bring it back, although doing so could make it easier for hospitals to hire more doctors and nurses.

In short, DeSantis said, life will go on even as the pandemic does, too.

“We knew this is something that you’re going to have to live with,” DeSantis said Friday, articulating a sentiment that many public officials are beginning to express, publicly and privately, as the pandemic powers through its second summer.

DeSantis’ resistance to new mandates, even for children returning to school who are too young to get vaccinated, prompted a testy back and forth this week with Biden. The governor accused the president of “helping facilitate” the virus’s spread by not securing the U.S. border with Mexico. “Until you do that, I don’t want to hear a blip about COVID from you,” DeSantis said.

Asked about DeSantis again, Biden quipped: “Governor who?”

Democrats have assailed the governor, calling him irresponsible and accusing him of trying to shift blame over the handling of the pandemic. Last summer’s surge hurt DeSantis in public-opinion polls, although his approval rating mostly rebounded afterward.

DeSantis, who faces reelection next year, has used the tit for tat with the president in campaign fundraising pitches. (He fundraised in Michigan on Monday, The Detroit News reported.) Later, he decried “media hysteria” over the rising COVID case numbers and downplayed the dire situation in hospitals — even as the Florida Hospital Association warned about overcrowding as a result of the virus.

“Hospitals are eliminating right now any procedure services that can be scheduled and postponed that are not emergent,” said Mary Mayhew, the association’s president and CEO. She previously worked as a member of DeSantis’ administration overseeing nursing homes. “They’re doing that in order to redeploy staff” to COVID cases, she said.

Of particular concern has been the Memorial Healthcare System in Broward County, north of Miami. This week, it had more than 1,600 patients, a record, nearly 600 of them with COVID. The hospital system usually does not care for more than 1,400 patients at a time.

The crush of sick people forced Memorial hospitals to make room for beds in a cafeteria, a conference center and an auditorium, Dr. Marc Napp, chief medical officer, said in a news conference. “So far, I’m happy to say that we’ve been able to provide that care, but it’s not without a stress on the system,” he said.

Four conventions have already canceled their plans to meet in Orlando, said Orange County Mayor Jerry Demings, an economic impact of nearly $44 million.

The reports about overwhelmed hospitals and the more contagious delta variant have at least moved more people to get vaccinated, according to state and local officials. In Jacksonville, the region hit hardest by the latest surge, Berlinda Gatlin, 55, got her first dose Thursday, worried that one of her three children could bring the virus home once they start school next week.

“I’m not happy with the governor,” she said about DeSantis’ opposition to masks in schools.

Gabriel Molina, 30, said he waited for others in his family to get vaccinated first. Once he saw that they experienced no side effects, he got the shot himself so that he would lower the risk of getting his young son sick.

“I have a 3-year-old boy I’m concerned about,” he said.

He was also concerned by other people’s growing antipathy toward masks, and he fears now that the virus is not going away.

“I think this is going to be a new normal,” he said.

This article originally appeared in The New York Times.