SMILAX, Ky. 鈥 In the end it was the delta variant that drove Rose Mitchell, 89, down the winding mountain road to the Full Gospel Church of Jesus Christ to get the shot. Her pastor, Billy Joe Lewis, had told his congregation that, No, ma鈥檃m, a covid vaccine would not leave the 鈥渕ark of the beast鈥 nor rewrite their genetic codes.
Mitchell, who has known the deaths of eight of her 13 children over the years, was done taking chances with the virus stealing up the hollers along Cutshin Creek.
鈥淭hat stuff鈥檚 getting so bad, I was afraid to not take it,鈥 she said, sitting in her daughter鈥檚 car in the church parking lot. 鈥淚 said, 鈥榃ell, if all the rest of them are going to take it, I鈥檒l take it too.鈥欌
Kentucky is in the midst of a covid-19 wildfire sparing no part of the state; new case counts topped 4,000 a day for much of September, before easing somewhat this month. Hospital intensive care units are still at capacity in some regions, with covid patients occupying . Gov. Andy Beshear has called the situation 鈥渄ire.鈥
Across the nation, older people have been steadfast takers of the covid vaccines: About 95% of people 65 and older have received at least one shot. But geographic variations cloud that math. far from Louisville and Lexington are trailing in vaccination, with rates as low as 55% in Wayne County, on the Tennessee state line.
While seniors are still more likely to be vaccinated than younger adults in Kentucky, the simple truth of the pandemic is that older people who forgo the shots face a far greater chance of severe sickness and death. People 60 and older account for of the 9,184 covid-related deaths in Kentucky. Residents 80 and older account for 41% of deaths.
In Leslie County, in the foothills of the rugged Pine Mountain ridge that anchors the state鈥檚 eastern coalfields, gravel roads wind through thick forests blanketed with kudzu vines. House by house, church by church, public health workers are trying to outsmart the fantastical tales about the covid vaccines spread on Facebook and overcome the everyday hurdles of financial hardship and isolation.
鈥淪ome of our older people don鈥檛 have access to vehicles because their family works,鈥 said Maxine Shepherd, a regional health coordinator for Leslie County and four-decade-long member of Full Gospel Church. Even for those with a car, gas is expensive, she said, and trips from secluded hollers to town are rationed out carefully.
While Kentuckians watched the devastating early months of the pandemic from afar, covid has long since made its arrival 鈥 and it hasn鈥檛 spared the church on Cutshin Creek. In recent weeks, Pastor Lewis held a funeral service for a 53-year-old unvaccinated former coal miner, suspended Sunday services after more members fell ill, and with heavy heart canceled Homecoming, a cherished yearly gathering of area churches that marks the fall foliage with a celebration of the gospel and shared faith.
Local health agencies have been eager to enroll churches in the all-hands-on-deck vaccination effort; older residents are more likely to attend religious services, and in communities like Smilax, ministers are trusted advisers.
Some church leaders have refrained, afraid of offending congregants in a state where distrust of government intrusion runs deep. But not Lewis, who helped build Full Gospel Church on a rare flat parcel of land in 1972 and has led it ever since. With a smooth pelt of silver hair and a luminous smile, Lewis spends long stretches of the day in prayer, and he says God told him to protect his flock.
When 鈥淪ister Maxine鈥 from the regional health department suggested a drop-in vaccine clinic in the church parking lot, Lewis was all in favor. He promoted it from the pulpit and on the church鈥檚 must-read .
鈥淲e鈥檝e still got to use common sense,鈥 he said. 鈥淎nything that can ward off suffering and death, I think, is a wonderful thing.鈥
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Vexed by the slow uptake in vaccinations by some Americans, President Joe Biden has mandated shots for health care workers in facilities such as hospitals and nursing homes, as well as for federal workers and employees of large companies. While the exact timing and details of the private-sector mandates are still being hammered out, the specter of coercion outrages many Kentuckians, particularly in Appalachia, where government directives have been met with derision.
鈥淲e do not like to be shoved,鈥 said David McKenzie, who grew up in Louisa, a once-booming coal town on the West Virginia border, and now owns the local nursing home. 鈥淲e resent it, and we shove back.鈥
Opposition to the vaccines in Lawrence County, where the is 39%, is not overtly political so much as willful. 鈥淭hey鈥檙e fearful of 鈥榯he Man,鈥欌 McKenzie said. 鈥淭he Man could be your employer, it could be the government, it could be a newspaper reporter.鈥 People who boasted about refusing the vaccines cannot change their minds, or 鈥渢hey鈥檒l look like they鈥檙e weak, or they caved to the Man.鈥
In nearby Salyersville, the virulence of the delta variant has shaken some holdouts. Santana Salyers, 22, braved torrential rain to get her shot at the county health department, a one-story building on a stretch of freshly paved road. In her third trimester of pregnancy, she feared the hospital would not let her hold her newborn if she wasn鈥檛 vaccinated. Salyers works at the IGA grocery store and says to vax or not to vax comes up there almost every day. 鈥淚鈥檓 a fence-straddler,鈥 she said. But around town, 鈥測ou鈥檙e either against it or for it.鈥
Turnout for the Salyersville health fair was muted by the remnants of a tropical storm, but a few dozen people still showed up to get their shots. In the waiting room, vaccine takers received $25 Walmart cards and a chance to win a Fitbit or Instant Pot. The prizes were a big draw.
James Shepherd, who is both the town鈥檚 mayor and director of the Magoffin County Health Department, bemoans the county鈥檚 44% vaccination rate: 鈥淚n a small community like this, they make up their mind 鈥榶es鈥 or 鈥榥o,鈥 and that鈥檚 it.鈥 What will it take to boost vaccinations? 鈥淎 miracle,鈥 he said with an exasperated laugh.
Shepherd鈥檚 close friend Carter Conley, the beloved captain of the county rescue squad, died last month of covid, despite being vaccinated. Conley鈥檚 death has been deeply felt around town, but also has given fuel to those who see vaccination as pointless.
Doubts about the vaccines鈥 effectiveness extend to nursing homes in Kentucky despite the persistent correlations between nursing home outbreaks and low vaccination rates among staff.
On a mid-September weekday in Danville, a small city southwest of Lexington, residents at the Landmark of Danville Rehabilitation and Nursing Center sat on a quaint covered porch playing a game of 20 questions with the activities staff. Although 80% of the residents in the facility were fully vaccinated as of September, according to the Centers for Medicare & Medicaid, that was true for just 28% of health care personnel, who dash out and back at lunchtime ferrying takeout fast food.
A short drive away, the city鈥檚 other nursing home, the Danville Centre for Health and Rehabilitation, also had a staff vaccination rate of 28% in September, according to federal records. (A month later, staff vaccination rates at both facilities are still below 60%.)
The unprotected workforce does not faze one man who is moving his elderly father into Landmark. The man, who works as a registered nurse at the local hospital, and a family friend accompanying him did not want to give their names, but they doubt the vaccines鈥 efficacy.
The man鈥檚 parents were vaccinated in March but fell ill with covid in August, he said. His mother was put on a ventilator and died; his father was still in the hospital recovering and would soon be moved to the nursing home.
The facility鈥檚 low staff vaccination rate is 鈥渘ot necessarily pertinent,鈥 he said, since his father would be receiving 鈥渆nd-of-life care.鈥 His companion said she personally knew four people who died of covid and that two had been vaccinated and two had not. These cases, she said, 鈥渄on鈥檛 get reported because they don鈥檛 fit the narrative.鈥
Standing on the porch amid festive fall decorations, Landmark鈥檚 administrator, Cindy Hollins, declined to discuss what might account for her staff鈥檚 low uptake and politely asked a reporter to leave.
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In Louisa, three hours east of Danville, David McKenzie believes the high rates of vaccination among residents and staff at his Jordan Center will be a selling point. 鈥淚 advertise I鈥檓 the safest nursing home in the state of Kentucky to live and work in,鈥 he said.
McKenzie and his sister lived in the nursing home as kids; their parents opened the home and couldn鈥檛 find another house to rent when the town was overflowing with coal miners. He learned to play piano from a resident, down a few fingers from diabetes, who had once played in Duke Ellington鈥檚 band.
Last winter, covid ravaged the nursing home for months, infecting nearly every resident. An employee鈥檚 33-year-old daughter, who didn鈥檛 want the vaccine, was buried in early September; then a former employee, who had quit to work at a hospital that didn鈥檛 require vaccination, died.
As soon as vaccines became available, McKenzie and his staff went room to room, explaining the science to residents. Only one family refused. Then he gathered the staff, many shaken by the loss of residents who were family members and friends.
Now, nearly every resident of the Jordan Center is vaccinated with three shots, and the staff vaccination rate hovers at 85%. But the holdouts keep McKenzie on edge.
鈥淚 sat over here on this front porch until 2 o鈥檆lock in the morning talking to two of the nurses that don鈥檛 want to vaccinate,鈥 McKenzie said. 鈥淥ne has been here for 37 years and the other for 15 years. They鈥檙e dug in. They鈥檙e adamant.鈥
Testing staff members who refuse to get vaccinated falls to Misty Robertson, a registered nurse who has worked at the facility for decades. She views every interaction as a chance to educate her co-workers about why they should get the shot. 鈥淚鈥檓 not mean about it,鈥 she said. 鈥淚 say, 鈥業 really don鈥檛 want you to be on a vent and die.鈥欌
Robertson鈥檚 father, who lived at the Jordan Center, died of covid in January. Her entire family is vaccinated, including her three children and her husband, who works at Walmart. Everyone except her twin sister, a receptionist for a local pediatrician. She tells Robertson covid is fake and 鈥渋t鈥檚 all because of Biden.鈥
鈥淚 get mad,鈥 said Robertson. She vehemently disputes the conspiracy theories circulating through the town鈥檚 social networks, but, she said with a sour laugh, that she sometimes goes too far. 鈥淚 was put in Facebook jail.鈥
McKenzie鈥檚 public stance has made him a pariah in some quarters, too. A customer attacked him at Walmart and threatened to wait for him in the parking lot. The darkened mood has carved the town into opposing camps, and he thinks Biden鈥檚 vaccine mandates will just stiffen that divide.
Certainly, they are proving too much for some of his nursing home staffers. Many of the unvaccinated workers at the Jordan Center are on the same shift, and McKenzie fears he may lose his entire night crew.
鈥淭hey told me Sunday night they were going to leave health care and work at Tractor Supply,鈥 he said, 鈥渨here they can make more money per hour.鈥