Some of us in the biomedical scientific community predicted that low vaccination coverage in Southern states, together with the emergence of the highly transmissible delta variant of the SARS-2 coronavirus, would precipitate COVID-19 outbreaks or even a resurgence this summer.
Right on cue, the start of summer is coinciding with COVID-19 resurfacing in force in the Ozark states of Arkansas, Missouri, and Oklahoma.
These three states are now seeing some of the fastest-growing new seven-day case increases in the nation. Not surprisingly, Freeman Health System located in Joplin—one of the worst-affected areas so far this summer—just reopened its COVID ward after shutting down in March, and Southwest Missouri ICUs are reportedly filling up.
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The highly-transmissible delta variant has been reported to account for a significant percentage of the cases in Missouri. According to the CDC, as far back as June 5, 29 percent of COVID cases in Missouri were caused by the delta variant, the highest share nationally.
It’s safe to assume that figure is even higher now.
But a second crucial element contributing to COVID-19 rise in the Ozarks is low vaccination coverage, with many southern Missouri counties less than 25 percent fully vaccinated. All three Ozark states rank in the bottom half of vaccination rates and are below the national average. Arkansas is the sixth-worst state in the continental U.S. in terms of vaccination coverage, and the Arkansas Department of Health is now reporting significant rises in cases, especially in areas near the Missouri border.
Next to the Ozark states, nearby East Texas is also suffering sharp increases in COVID-19 and similarly has low vaccination coverage, among the worst rates in the state of Texas.
That’s where we are, or where we’ve been. And many Americans who have been fully vaccinated or are in far-off states like New York might think the story ends there.
It’s not that simple.
First, it is unlikely that vaccination rates will rise in places like Arkansas anytime soon. The Ozark states and East Texas represent GOP strongholds, and multiple surveys have shown how the political right is strongly resistant to COVID-19 vaccinations. As delta accelerates in this region, we can expect the number of COVID cases and hospitalizations to continue to rise. Potentially contributing to a surge are mass-gathering events over the summer in Missouri theme-parks located in Branson or Lake of the Ozarks.
One possible silver lining: Vaccination rates overall are higher among older populations, so the number of deaths should not be expected to rise as high as in past waves of COVID-19 in the U.S. Still, we should expect that many unvaccinated individuals—including young people—coming out the other side of these summer outbreaks will suffer disabilities from long-haul COVID illness.
This new rise of COVID in the Ozarks is yet another reminder that the epidemic is far from over, but also may represent the beginning of a new phase for the whole country. If they haven’t already, delta variant and associated spikes in cases should spread soon into the Deep Southern states, including Louisiana, Mississippi, and Alabama, where vaccination rates likewise rank at the bottom nationally.
Eventually “two COVID nations” might emerge, in which the epidemic slows or largely halts in the North or Pacific West, only to resume in the South. But there’s no guarantee it stops there. If delta spreads in the South, it might continue to be transmitted nationwide and infect unvaccinated individuals. These include children under the age of 12 who are currently ineligible to receive a vaccine. For that reason, the rise of delta in Ozark and Southern states this summer could make life more complicated for the entire country in regards to school openings in August and other efforts to return to a pre-pandemic normal.
Also, while the vaccines used in the United States have so far proven to be effective against the delta variant, there remains the possibility that the delta or other variants now circulating among unvaccinated individuals could continue to mutate. Any resulting mutations could become partially resistant to our current vaccines.
A serious Southern surge is still not inevitable. But we must embark on yet another aggressive vaccination campaign, especially among young people.
With that understanding, the administration—including President Joe Biden, the first lady, the vice president, the second gentleman, and others—are fanning out across the country. Their very important message is that COVID-19 deaths now occur almost exclusively among unvaccinated individuals, and that now is the time to save your life or the lives of your loved ones by getting fully immunized.
Still another message: to become fully immunized takes time. Two doses of mRNA immunizations, spaced three to four weeks apart, followed by another one to two weeks to generate high levels of virus-neutralizing antibodies, means that an unvaccinated individual is at least five to six weeks away from full protection. And that’s if they get their first dose tomorrow.
While it is important that the White House exhaust all avenues to reach an estimated 55 million unvaccinated adults, many scientists and even some administration officials I talk to are pessimistic. The areas of the country in greatest need are conservative strongholds, some with leaders who are all-in on the anti-vaccine, anti-science positions of the political right. It is doubtful whether Team Biden can compete successfully with the nightly anti-vaccine rants on conservative news outlets, or the views espoused by prominent leaders of the GOP.
Wisconsin U.S. Sen. Ron Johnson’s Monday roundtable on vaccine-adverse events will only worsen this situation.
There is still time to save lives and prevent long-term debilitating effects from COVID for thousands of Americans. But the already visible, delta-fueled surges in Missouri—and similar hotspots as far west as Colorado and California—show that time is running out. COVID-19 could become widespread once again in the Southern U.S. and elsewhere by the end of July and into August.
Once the delta variant gains a stronger foothold, the entire nation is at risk. State and local leaders and high-profile and charismatic personalities from conservative communities must redouble their efforts to vaccinate even the most skeptical audiences they can come across. We’re all depending on them.
