West Virginia battles Covid surge after failing to build on early vaccine success

West Virginia was once one of the leading US states in rolling out Covid-19 vaccinations. Now it is one of the least vaccinated, with the fastest-growing rate of infections in the country. Health systems are overwhelmed, with record numbers of patients in hospital, in intensive care units and on ventilators.

What happened?

West Virginia rushed to vaccinate those over the age of 65 and residents of long-term care facilities, reaching good levels of protection among those groups.

But reaching younger West Virginians has been much more of a challenge.

Governor Jim Justice, a Republican, has been a vocal supporter of vaccination, regularly urging constituents to get the jab. The state was among the first to offer vaccination incentives, including $100 savings bonds and a lottery, named for Justice’s English bulldog Babydog, to award scholarships, a car, a pontoon boat and more. He has spoken out sharply against conspiracy theories and criticized health workers who turn down the vaccine, calling the decision “asinine”.

Even so, only 39.9% of West Virginians are fully vaccinated, according to Our World in Data, tying with Wyoming for the lowest rate in the country. According to West Virginia’s health department, that rate is much higher, at 51.7%; the reason for the discrepancy is not clear.

And with the dominance of the Delta variant, West Virginia is experiencing its worst surge yet.

“This has been more severe than we’ve seen at any other point in the pandemic,” Dr Clay Marsh, head of the state’s Covid response, told the Guardian. And the Delta variant is making younger people significantly sicker than in previous waves, he said.

West Virginia has the fastest acceleration of new cases , given its population of about 1.8 million, with a 52% increase in new cases in the past week. The numbers of hospitalizations, ICU admissions and people on ventilators for Covid-19 have all broken previous records and continue rising.

On Saturday alone, the state reported more than 2,200 new cases, with one in 10 tests returning positive.

“I believe more people are getting very anxious over what they’re seeing in West Virginia,” Marsh said, and the recent surge in cases has resulted in an uptick in vaccinations.

The vast majority of hospitalized patients are unvaccinated, Justice said at a news conference on Friday, and that is especially true of those in the ICU and on ventilators.

“We can stop this, West Virginia, we can stop it,” Justice said. “The vaccines are safe. The vaccines are not an invasion on anyone.” Yet he also criticized Biden’s new vaccination mandates, which he says encroach on businesses.

Several major health systems have made vaccination mandatory, and so have certain emergency medical services. At West Virginia University, the faculty voted to mandate vaccines for all students and employees.

In a state with a large rural population, access could be an issue, but Marsh believes that hasn’t been the primary driver of the lackluster vaccination rates. “We have been very aggressive about having access not be an issue,” he said. “We will go to somebody’s home to give them a vaccine.”

Instead, residents tend to be suspicious of the government, the health system and the vaccines themselves. Simply having the vaccines is not enough, even with urging from the state’s top leader.

Justice lifted the state’s mask mandate on 20 June. Although he has said the requirement may return, he has preferred to leave decisions like these up to local jurisdictions. He also doesn’t support a school mask mandate, but 51 of 55 counties have some kind of mask requirement in schools, Marsh said.

Nearly all of the state is in the highest risk category for virus transmission. Justice said there was no indication that West Virginia is close to the peak, saying it could be Halloween or Thanksgiving before the virus is under control.

Marsh said this surge had put a tremendous strain on health systems.

“In Idaho, where we see some rationing starting, that’s what our concern has been,” Marsh said. But the state was “not yet” implementing crisis standards of care, he said. Elective procedures that require a hospital bed have been postponed.

Unlike other surges, the solution isn’t as simple as pulling together ad-hoc field hospitals. “This time, it’s different in that staffing is really the limitation,” he said. Finding trained health workers has been the primary challenge, he said.

Fast action on precautions now would not only help stem this outbreak and keep health systems from collapsing, t would also keep other spikes from happening.

Vaccination would help a great deal, Marsh said, “to slow things down here, not only with the Delta variant right now, but as we go forward in the wintertime with other variants that may emerge”.