JOHNSON CITY, Tenn. (WJHL) – Dr. Amit Vashist and his fellow doctors, nurses and other clinicians at Ballad Health began 2021 as hopeful about COVID-19’s future impact as they’d been in months.
Northeast Tennessee had just experienced its highest month yet of COVID deaths with 249. But healthcare workers were already getting vaccinated and the elderly, by far the hardest hit by fatalities during the Alpha variant’s winter surge — were up next.
“December of last year, January, we were very, very hopeful,” Vashist told News Channel 11 Wednesday. “Vaccines were coming along and we were sure there was going to be a robust supply. So, we expected large segments of our population to get vaccinated as soon as their turns came.”
But health care workers ended the year exhausted, grappling with a resurgence of the Delta variant wave that’s sent hospitalization and death rates back up and with the Omicron variant poised to slam the region with another case surge.
“The nurses and the techs, even the physicians are emotionally drained,” Holston Valley Medical Center Nurse Angel Light told News Channel 11 in mid-October as Delta cases were declining before rising again.
“It’s something we prepared for but not to this to this extent ever I mean I’ve been a nurse for almost 20 years. It’s amazing that it’s still going on to this day and we don’t have a cut-off switch, anytime soon, it doesn’t seem like.”
Light was correct. Two weeks after her interview, the Delta variant got a second wind in the region and cases began rising again. Even at their “floor” in late October, the seven-day rate of new cases per 100,000 was about 150 — compared to a rate below 100 in early March coming off the Alpha surge and before a small increase in April.
Even though about half the population was vaccinated as Halloween arrived, Vashist thinks “COVID fatigue” helped sow seeds for a resurgence in cases after the steep drop from Delta’s first peak in mid-September. Case rates began climbing at the beginning of November and ran close to double Tennessee’s overall rate through early December.
“When the numbers of the Delta variant started to plummet we were cautiously optimistic that they would continue to drop,” Vashist said.
“But looking around in the community you go to the malls and other crowded indoor public gatherings that were going on, we were certainly worried that even before another variant comes, Delta was clearly not out of the door.”
A spring of hope
When Easter arrived, vaccines were becoming widely available and Northeast Tennesseans flocked to get jabs in large numbers — for about three weeks.
Vaccination rates began slowing in late April, but so did the virus, and in a big way.
After increasing some to reach 190 weekly new cases per 100,000 in early April, case rates dropped steadily. On July 4, they were at 18 — well within the Centers for Disease Control’s (CDC) “moderate transmission” zone. Deaths averaged fewer than one a day across the region from early June to the beginning of August.
But vaccination uptake slowed to a trickle as well, while it stayed much stronger in Virginia, the U.S. and to some degree in Tennessee.
When the Delta variant arrived in July, spreading from the west, Ballad’s chief infection prevention officer warned it would get bad.
On July 22 Jamie Swift told News Channel 11 that despite case rates more than tripling over three weeks, the region was in the variant’s early stages. At that point, Tennessee’s overall case rate was higher.
Asked what “inning” the region is in, she wasn’t encouraging.
“For delta, I would say first or second,” Swift said.
“In my opinion we’ve got a long way to go. We know delta’s here. We’re starting to see that in symptom presentation, we’re starting to see that in the age of patients that are being affected, but I do not think we are anywhere near the peak of what delta could do to this region.”
Shortly after the interview, the Tennessee Department of Health (TDH) reported that Northeast Tennessee had a total of 40 new cases, bringing the one-week total to 254.
Within a few weeks, the region was logging totals of more than 254 cases almost every day. Between July 22 and Aug. 13 the case rate increased fivefold — then doubled again over the next two weeks.
After recording just 32 COVID deaths in June and July combined, the region saw that number jump to 139 in August before it broke December’s previous one-month high of 249. A total of 253 people died in September and another 147 in October.
That three-month period came with half the population vaccinated and far fewer older people dying. Yet the total of 539 deaths wasn’t that far below the worst three months of last winter, when 643 people died between November and January.
And when October ended with cases on the decline, Delta wasn’t done, just like Vashist said.
Not out the door and attacking the unvaccinated
Since Light’s Oct. 15 interview, 220 more Northeast Tennesseans have died of COVID, along with more than 200 Southwest Virginians.
People in the region are vaccinated at lower rates than their respective states — by a lot in Virginia, not as much in Tennessee — and the region’s population-adjusted COVID death rates reflect that.
Light spoke of a 60-year-old man whose unvaccinated wife was being put on a ventilator and said that outcome has been far too common among unvaccinated patients.
“She’s very short of breath, he’s at the front entrance wanting to come back and see her and (staff says) “you can’t, she’s COVID positive you have to stay outside.’
“And we told him ‘she’s going to be intubated and we’ll take the best care of her that we can,’ and you can see it in his face … you may never see her again. That was the last time they’ll speak, last time they’ll ever be able to see each other, and emotionally that’s difficult for patients, for the staff, for all.”
Since Aug. 1, when everyone but children had had the opportunity to be vaccinated, Northeast Tennessee’s death rate per 100,000 is 138. Southwest Virginia’s is 115, Tennessee’s 103, the U.S.’s 61 and Virginia’s 44.
Vaccination rates are flipped, largely. Virginia is 67.4% fully vaccinated, the U.S. is 61.8% fully vaccinated. Those numbers drop to 51.8% for Tennessee, 48.8% for Northeast Tennessee and 47% for Southwest Virginia.
“I think the evidence is pretty clear and is pretty consistent with what is happening across the country, which is the rates of vaccination are inversely proportional to death and suffering,” Vashist said when presented with the data.
And Northeast Tennessee’s 34% higher death rate than Tennessee’s is a wider gap than it was before August. Most deaths through July 2021 occurred last fall and winter, when no vaccines were available. During that period, Northeast Tennessee’s rate of 229 was only 14% higher than the state rate of 201.
The trend has also held within Northeast Tennessee, particularly if one removes the two smallest counties, Unicoi and Johnson.
Generally, COVID death rates since Aug. 1 are higher in the Northeast Tennessee counties with lower vaccination rates. 
This breakdown shows state and regional COVID death rates since Aug. 1 as well as vaccination rates. 
The gap between Northeast Tennessee’s COVID death rate and that of the state has been wider since Aug. 1 than it was before.
Washington County has by far the highest vaccination rate in the region at 58.6%. Since Aug. 1 its COVID death rate is 100 per 100,000.
That’s 47% lower than Hawkins County’s rate of 190, 43% lower than Greene’s 175 and 41% lower than Carter’s 170. But before vaccination was widely available, Washington County’s death rate was only 8% below Hawkins’s, 15% below Greene’s and 33% below Carter’s.
Those three counties have vaccination rates of 41.4%, 44.2% and 37.1% respectively.
“The more the community gets vaccinated the lesser severity of illness, the lesser hospitalizations and a lesser mortality is what you’re going to see,” Vashist said. “That is expected – the data is staggering, but it’s not surprising.”
Deaths skewing much younger than pre-Delta
Vashist also wasn’t surprised at data showing a huge jump in the share of COVID deaths involving people under 60. And Light mentioned it on the floor at Holston Valley in October.
“This wave, it’s young people,” Light said. “It’s your average, normal, everyday person that goes to work, that has children, has a life outside of here.
“All of a sudden we’re intubating them and they’re passing away. It is emotionally on our staff, it is exhausting. Because … they’re young … they have their whole lives ahead of them and unfortunately they’re cut very short.”
Before August, only 14.1% of Tennessee’s total COVID deaths occurred among people in the 20s through their 50s, while 85% were among people 61 and older.
But the older population is also the most vaccinated, and the long-term care outbreaks that killed thousands in late 2020 are essentially a thing of the past.
In the five months since Aug. 1, 32.7% of deaths have been among people 21 to 60. Where just 55 people in their 20s died in the year-plus through July, 1-4 have died since. Another 306 people in their 30s have died during that short span, more than double the 148 who died in the previous months.
Even the share of deaths represented by people in the 50s has doubled, from 9% of total deaths to 18.6%.
And all together, more than 2,500 people in the 21 to 60 age range have died since Aug. 1 while fewer than 1,800 died in the previous 16 months.
Vashist works directly with patients several days a month and has seen it himself. He was at Johnson City Medical Center recently when they admitted a son in his mid-40s with a traumatic brain injury and his mom, both COVID positive.
Both started off on the med surg unit because they had oxygen needs that weren’t severe enough to require intensive care.
“Overnight the mother’s oxygen level started to spike up eventually where we had to put the mother on the ventilator,” Vashist said.
Meanwhile, the son was recovering.
“Here we were in a life or death battle trying to save the mother … but in the back of our minds and in our hearts we were terribly worried that when the inevitable happens, which unfortunately happened in the case of the mother, who will be the one taking care of the son?”
“I know for a fact a few tears were shed, a few phone calls were made, and I think that kind of emotional trauma again and again with stories like this, they hit home in a way they never hit us before the pandemic.”
Both Light and Vashist pointed to frequent instances of people sick with COVID and trying to process the reality of something they had taken lightly due to what Vashist calls a high degree of misinformation.
“We’ve had multiple patients who don’t think that the vaccine is real, that COVID is real, ‘it’s just the flu, it’s just a cold,'” Light said.
“It is not just the flu or just the cold. I mean this is death. We live in it every single day it is patients dying who, in a perfect world, should not be when it’s preventable. I mean it’s not 100% But your chances are much better with a vaccine.”
Vashist said a patient came into the emergency room recently with typical COVID symptoms. After testing positive, her oxygen requirements began spiking upward quickly and she was admitted.
“I go into the room and the patient, who is now on a very high level of oxygen, almost 50 liters, clearly in a very emotionally and physically vulnerable state, she asks me a question, which was ‘is it too late to get vaccinated, doc?”
“As much as I wanted to tell her otherwise I had to tell her the truth that the train had long left that station, and unfortunately we had to put that patient on a ventilator in a couple of hours. So those types of stories are playing out left and right in our communities.”
Omicron looms and the burnout is real
Delta’s second wind sent death numbers higher again, with 102 December deaths through Wednesday compared to 68 for all of November. Nearly half of Northeast Tennessee’s COVID deaths have occurred since vaccines became widely available.
With uptake rates still well below the national average and a population that is older and sicker generally than state and national norms, Vashist enters 2022 quite concerned about the Omicron variant. Early research shows its disease severity is significantly less than Delta’s, with hospitalization rates per case looking to be around 70% lower.
But Vashist said the low vaccination rates and higher rate of chronic diseases like heart disease, obesity and diabetes “could be the potential game-changer in an adverse way for us.
“That may make the Omicron variant more severe on this community compared to some others across the country.”
He said Ballad’s projections envision “a large number of hospitalizations.
“Now, have I been surprised? I’ve been surprised before. I would hope that we are wrong, but we are driving our data modeling strictly based on scientific facts, nothing else.”
If that wave hits, it will come as health care systems struggle to remain adequately staffed.
“We have a lot of staff turnover,” Light said. “A lot of nurses leave suddenly for other assignments, because a lot of this is not what we signed up to be a nurse. The nursing population cannot keep this up. We are struggling.”
A mother of two daughters and grandmother to three, Light said the toll is intense on multiple levels.
“Physically, mentally, especially mentally it is draining, because every day is the same,” she said. “The wait times are long, the patients are upset, families are upset the patients are sick.
“And there’s nothing that we can do immediately, they want immediate. ‘Fix my mom. Let me take her home.’ It doesn’t work that way. Unfortunately, your mom might not make it home. So mentally, draining.
“It’s been a long two years, we handle it very well. Sometimes I think we all need a good cry in the car on the way home.”
