COLFAX — Mike Campbell wasn’t particularly interested in getting the vaccine.
He’s lived in this central Louisiana town of 2,500 his whole life, and he doesn’t feel obligated to take many precautions. He’s not around people much, except for when he goes offshore for work as an explosion technician on oil rigs. Campbell, 56, reasons that he hasn’t caught COVID-19 yet, and when his father did, he only had the symptoms of a mild cold, despite only having one lung.
He is annoyed that the government is pressuring people like him to get vaccinated. “I just don’t like anybody forcing me to do something,” Campbell said.
But there he was, climbing out of his truck on a sweltering Friday into the parking lot of the Grant Parish health unit in Colfax. He donned a blue surgical mask and ambled into the nondescript building where a nurse and some National Guard troops were giving out free shots.
Campbell’s company had given him a choice: get vaccinated or quarantine for five days before leaving for a job. Miller relented. Getting the shot beat jumping through those hoops.
By now, eight months after vaccines became available, health leaders hoped the U.S. would have achieved something close to herd immunity. But the effort has been anything but a success in Louisiana. Getting shots in arms is still maddeningly difficult for health leaders. And in some rural areas, the vaccination rates are stunningly low.
In Grant Parish, for instance, only 24% of the roughly 22,000 residents are fully vaccinated, the third-lowest rate in the state. And that’s after the region saw a notable recent uptick in vaccinations, prompted by the delta variant’s rapid spread, which took the pandemic to never-before-seen levels of hospitalizations in Louisiana.
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Louisiana’s vaccination rate is now just under 40%, well below the U.S. as a whole, where nearly 52% of people are fully vaccinated.
Residents and experts cite a variety of reasons for the low vaccination rate. Many rural areas include some of the most conservative White voters in Louisiana, the demographic group that tends to be most resistant to the shots. Low education levels can help online misinformation take deep root, and a lack of internet access can make finding an appointment difficult. Some say they don’t feel like the virus is a threat because they hardly ever gather in large groups, aside from church services or high school football games.
“Some people probably don’t want to be told; they want to have a choice,” said Don Arnold, the president of the Grant Parish Police Jury, who is vaccinated. “There could be a price to pay for that.”
A vaccination gap
Rural Louisianans do have a choice, of course, and most have chosen not to get the shots.
Vaccination rates in Louisiana’s urban and suburban areas — where about five-sixths of the state’s residents live — are an average of 25% higher than in the state’s rural areas.
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The gap in vaccination rates appears to have had tragic consequences for rural areas since the shots first began rolling out at the beginning of the year, though it remains too early to know exactly how that trend will play out in the devastating fourth wave now gripping the state.
Since January, the death rate in rural parishes has been more than a third higher than in the more densely populated areas of the state.
So far, the divide during the fourth wave — which started at the beginning of July — is not as clear cut, and rural parishes are actually faring slightly better with 559 deaths per 100,000 residents. Urban areas, which saw their cases spike earlier in this wave and thus have seen more deaths so far, have recorded about 637 fatalities per 100,000. It remains to be seen whether, in the final tally, rural areas will again see more severe outcomes from the current surge.
Like many rural places in central and north Louisiana, Colfax is economically troubled. Nearly half the population is in poverty, more than double the statewide rate. Median household income is $22,000, about half the amount in the rest of the state. Only 11% of residents have a bachelor’s degree.
Those economic ills have major implications for health care.
Dr. David Holcombe, the state’s medical director for the region that includes Grant Parish, said the region has historically had poor health outcomes, owing to low incomes, low educational levels and high rates of poverty.
That has made it hard for state health leaders to convince people of the vaccines’ efficacy and safety by promoting the overwhelming consensus of the medical community, and data.
“It makes them very resistant to intellectual argumentation,” Holcombe said. “Because most of the fears and anxieties are emotional.”
The more rural places, in particular, reached a point of diminishing returns pretty early in the vaccination effort. Delta has changed that somewhat, resetting the “anxiety level” as people saw more friends, neighbors and kids come down with COVID, he said.
Still, the uptick hasn’t moved the needle nearly enough. Holcombe said while people who live in more isolated, rural areas like Grant Parish tend to have fewer interactions, it doesn’t take many big gatherings — whether a sporting event or a religious service — to spread the Delta variant, which is far more transmissible than previous iterations of COVID. He worries the only way some rural places will ever get close to herd immunity is if the virus runs wild and infects most of the unvaccinated population.
“The tragedy is you don’t have to do that,” Holcombe said. “You don’t have to let people get sick to achieve herd immunity.”
Fear, hesitancy and misinformation
Oakdale federal prison, in rural Allen Parish, made national headlines in March 2020 when after a major COVID-19 outbreak ran through its population of about 1,900 inmates. The virus infected 689 inmates and guards, and nine inmates died.
Almost a year and a half later, about 70% of its inmates have been vaccinated against the coronavirus, according to a recent Reuters report. That number stands in stark contrast to the 34% of Bureau of Prisons staffers there who have been vaccinated, Oakdale's union leader Ronald Morris, president of the American Federation of Government Employees Local 1007 told Reuters.
The relatively low vaccination rate among prison staff is reflective of the broader community.
Allen Parish, with a population just over 25,000, according to the most recent Census data, is the least vaccinated parish in the state, with just 21% of the population vaccinated.
At Allen Parish Hospital in Kinder, Dr. Jacqueline Rae Costley-Reviel, the hospital’s CEO, knew the fourth wave of the virus was spreading among her community in late July as more and more patients visited the hospital’s emergency room.
"Still, at the moment, our beds are full," she said Thursday. "The ICU unit we created has no space left, and we are keeping patients on ventilators that we usually don't keep. I hope we are at the end of the peak."
The parish is seeing an average of 25 cases per day, a 32% increase from the average two weeks ago. LDH data shows the parish has a positivity rate of 10.4%, up from the 9.9% registered the previous week, while the hospitalizations increased by 74% in the last 14-day period.
But outside of emergency rooms and ICUs, it looks like the public-health emergency is almost over. On Aug. 12, children were back in Allen Parish schools, albeit wearing masks. Kent Reed, the Allen Parish School System's superintendent acknowledged in a recent Facebook post that keeping kids safe and healthy would be a challenge.
“We are going to try our best to keep our schools as clean as possible, and sanitized, and safe for everyone involved," Reed said. "We have, and we will continue to have cases of Covid-19 to deal with."
But most businesses across the parish have resumed normal routines. The mask mandate reinstated at the beginning of August by Edwards is rarely enforced.
And in local pharmacies and drugstores, there has been a marked increase in customers.
"The situation changed for us about two weeks ago," said Liam James, manager of Oakdale Drug Company in Oakdale, the most populated town in the parish. "A lot of people are getting medicines. It got wild," he said.
But they’re not getting vaccines.
Just saying the word vaccination in Allen parish prompts responses of fear, hesitancy, and misinformation. Some residents don’t get vaccinated because their families told them vaccines are not safe. Others distrust the federal government. Still others, usually the youngest, believe there’s no need for a vaccination because, in their minds, COVID overwhelmingly affects the elderly.
"It is probably lack of knowledge, lack of understanding, and fear, the three biggest things that we battle," Costley-Reviel said. "And when people just believe what they believe, nothing can change that."
When Costley-Reviel broached the subject of mandatory vaccinations for hospital employees, at least a third of the staff opposed it, some threatening to leave.
"I was already short-staffed. I could not have a third of my force quit," she said.
"You can ask 20 different people why they did not get vaccinated, and you can probably receive twenty different answers," Dr. Lacey Cavanaugh, the Louisiana Southwest Regional Medical Director of Public Health, said. "I think there is distrust in general to the government. And each community is different and has different managers who can build trust because they lived there so long, so we count on them.”
Her office made almost 100 phone calls to community leaders, groups, and partners within the parish to promote vaccines and pop-up events.
"We may not be the first trusted voices in communities,” she said, “and for this reason, we need the help of local institutions."
To convince people to get vaccinated, the regional health officials urged the help of local community leaders, hoping residents’ distrust might be limited to government at state and federal levels.
Local officials, however, don’t always want to be involved in promotion of the vaccine.
"I am not a medical person. If you asked me, I would recommend taking the vaccine, but I won't go out and solicit and convince people to get it," said Gene Paul, the mayor of Oakdale since 2013. He said he is fully vaccinated and ready to get the third dose, which is expected to be made available to all American adults in September.
"I am willing to do it, but I think it is an individual's right,” Paul said. “I think it should be left to the single person."
Meanwhile, local health care providers such as Alex Courville, a physician in Kinder, are frustrated by the increase in patients and hospitalizations.
“We had the tools to avoid this wave, but we did not use them, and this is unacceptable,” Courville said. “This is the community where I grew up in. The people I see suffering are my people. It hurts.”
His message is the same he has been repeating for months: “Please, wear a mask and get vaccinated.”
James believes more people will be inclined to get the vaccine after the FDA fully approves it. Mayor Paul agrees.
"I think that the people dying due to the Delta is changing some people's minds," Paul said. "But you have to wait for 100% approval for a significant increase, from what I understand."
'A lot of fertile ground'
Stephanie Bruce, who lives in Dry Prong, outside of Colfax, drove her Sheriff’s Office vehicle to the health unit Friday to finally get her first shot. A deputy for the last eight years, Bruce said she was scared of the vaccine because she thought it was too new, even though she isn’t generally opposed to vaccines. Delta’s surge finally tipped the scales.
“It’s definitely spreading like wildfire now,” she said.
Bre Felton, a day care worker who lives in Colfax, said she was exposed to the virus at a recent kids’ birthday party where the child’s dad and sister tested positive. Felton still doesn’t plan to get vaccinated, though many of her family members have relented.
“I’m concerned, but I don’t have any underlying health issues, so if I get it, I think I’d be OK,” Felton said. “I have trust in God.”
Bobby Morrow, 67, retired to Colfax — a “nice, quiet, peaceful place” — a few years ago with his wife, Karen. Morrow said he “didn’t have any real legitimate excuse” not to get vaccinated, other than the fact he doesn’t go out much. But the Veterans Administration convinced him to get the shot, and his wife’s son, a nurse, convinced her to get it.
They don’t ask their friends if they’ve been vaccinated, and Karen said she still social-distances at church. An unvaccinated friend of theirs is now “fighting for his life” in the hospital with COVID-19, she said.
The hospitals in the region are crowded with patients and are running into the same dire problems as facilities in Baton Rouge and New Orleans.
At Christus St. Frances Cabrini Hospital in Alexandria, a half-hour southeast of Colfax, Chief Medical Officer Dr. Jose Zapatero said he’s had to refuse transfers from smaller rural hospitals because he doesn’t have the bed space.
The positivity rate of tests at the hospital has soared from 3% in early July to 36% last week, Zapatero said. Nearly 90% of COVID patients in the hospital are unvaccinated, he said.
“There’s a lot of fertile ground for this virus to take off,” he said.
A raft of challenges
Lana Francis, the CEO of LaSalle General Hospital, next door to Grant Parish, said she has struggled to keep enough staff on hand because so many employees are infected. The hospital has started sending sicker patients to Texas, Arkansas and Mississippi.
The latest surge of the pandemic has created huge challenges for some rural schools. A little more than a week after school started, around 240 of Winn Parish’s 2,000 students were in quarantine, said Al Simmons, the superintendent. An entire sixth grade class was in quarantine.
Simmons hopes schools can stay open for in-person learning because the students need it. But he also noted: “We are doing distance learning when you consider how many students are in quarantine right now.”
Sharing the same building as the state health unit for Grant Parish is a federal health center that offers similar services, including vaccinations and testing. The center didn’t have any vaccines scheduled Friday, but was offering drive-through testing.
Ken Humbels, a delivery driver for the state’s vaccine distributor, Morris & Dickson, pulled up and carried a large white styrofoam box labeled “vaccines” inside. He opened it to reveal a single vial of vaccines: 14 doses. Rachel Wise, the site manager, said they’d use them next week, mainly on adolescents.
Deano Thornton, who runs federal health centers in other rural parishes, said he’s seeing a slight increase in vaccine requests, after “hardly anyone” sought them in June and July.
His board recently met to establish new protocols, requiring employees to get tested once a week if they’re not vaccinated, and to test daily if they’ve been exposed. But he said he’s already short of employees, and worried that if the centers mandate the vaccine, many workers will quit.
Thornton said health workers are “tired” after 18 months of the pandemic. Transmission in rural areas is primarily driven by schools and churches, Thornton said, and schools were largely online last year. With in-person learning, he worries the virus will run rampant.
“Our fate’s in our own hands, it looks like to me,” Thornton said. “We can lead them to water, but we can’t make them drink.”
Staff writer Jeff Adelson contributed to this story.