Robeson County Has The Lowest Vaccination Rate In North Carolina. The Reasons Why Are Complex.
Earlier this summer, Dr. Obiefuna Okoye thought some relief from the pandemic was on the horizon.
“We thought we had come off this pandemic,” he said over Zoom from his office, between a busy day of meetings and visits with patients.
Then toward mid-July, Okoye said the next surge started going “haywire.”
“Healthcare workers, including doctors, nurses, techs, pharmacists swarmed with patients,” he said. “They just keep coming at you like bullets.”
Okoye is an infectious disease specialist at UNC Health Southeastern in Lumberton, North Carolina. The facility is the only hospital in Robeson County, which sits along the South Carolina border in the southeastern part of the state.
"All the bones in my body feel like they are broken. But I'm still up and I'm walking. I don't know how I'm doing it."
As of Sept. 14, the county had the lowest vaccination rate in North Carolina with less than one-third of the population fully vaccinated. To compare, more than half of North Carolina’s total population is now fully vaccinated.
As a result of that low rate, COVID-19 has torn through the largely rural and racially-diverse community. In the past two weeks, 37 people have died from the disease, representing more than 10% of those who have died from COVID-19 in the county since March of 2020. During that same period, more than 1,800 people have tested positive, including more than 800 Native Americans.
The Robeson County Health Department reports nearly a third of residents who recently tested positive are children. Over one-third of those children were eligible for vaccination.
Today, UNC Health Southeastern is full, from the ICU to the emergency room, with patients who have contracted COVID-19. Healthcare workers, like Dr. Okoye and his staff, bear the physical and emotional toll of caring for largely unvaccinated patients.
“All the bones in my body feel like they are broken,” said Okoye, referring to the physical exhaustion of it all. “But I'm still up and I'm walking. I don't know how I'm doing it.”
Dr. Shelly Lowery, a family physician and chief medical officer for nearby Scotland Physicians Network, sees patients out of her office in Pembroke, N.C. She said many of these patients have simply just put off care.
“They have not wanted to come in for a year or so,” Lowery said. “Instead of being able to prevent a hospitalization, they're coming to the practice and we may be directing them to the emergency department.”
Lowery said that most hospitals in the area “have been on diversion almost every day,” meaning ambulances are often diverted away because of a bottleneck of patients. Those who make it to a local emergency department on their own or get a lift may face long wait times before being formally admitted. Lowery said at Scotland Memorial Hospital, just over the Robeson County line, patients who present to the emergency department may wait up to three days before being admitted to an inpatient bed.
The outcomes for high-risk COVID patients are stark. According to research published in the peer-reviewed American Journal of Respiratory and Critical Care Medicine in January, about half of patients who are put on a ventilator don’t survive.
That’s why Okoye starts his rounds every morning with a sign of hope.
“I had a lady who was on the ventilator for three weeks. And we eventually extubated her. So each morning, that's where I start my rounds. I go to her room, and I see her smile,” said Okoye. “It gives you hope that you are doing something. You brought somebody back to life.”
Health Officials Worry As Vaccine Uptake Stalls
Bill Smith, the health director for Robeson County, leans back at his desk with a weary countenance as he reflects on his department's outreach the last couple of months.
Over the summer, the county distributed $100 prepaid cards as an incentive for residents to get vaccinated — part of a state-wide initiative. That program wrapped on August 31, and now Smith is concerned vaccinations have stalled.
"The number of calls to the poison center have just gone off the chart. Because, you're not a horse. You don't weigh 2,000 pounds. And that's the kind of medicine you're taking."
“The question is: are they going to come back for the second shot?” said Smith.
As it stands, the county has a 7% gap between residents who are fully vaccinated and those who received only their first of multiple shots. Smith said that despite Robeson County being a largely rural community, the vaccine is available at decentralized locations like Federally Qualified Health Centers and pharmacies.
Additionally, the Lumbee Tribe — in partnership with the hospital, county health department, community groups, and the University of North Carolina Pembroke — has launched a new vaccination clinic that will run every Tuesday afternoon at the Lumbee Tribal Housing Complex in Pembroke.
As Smith discusses the vaccine efforts that have seen some positive outcomes, he also considers the barriers that his team faces. Among them is misinformation.
A physician on the Scotland County Board of Health recently published an op-ed in The Laurinburg Exchange that praised the horse de-wormer ivermectin as “an effective treatment for COVID.”
The FDA meanwhile, has “not authorized or approved” the drug for preventing or treating COVID-19. The agency says individuals have needed “medical attention, including hospitalization, after self-medicating” with the drug.
“The number of calls to the poison center have just gone off the chart,” said Smith on the impact of ivermectin’s promotion. “Because, you're not a horse. You don't weigh 2,000 pounds. And that's the kind of medicine you're taking.”
Fear, Values & Infrastructure: The Complex ‘Why’ Of Low Vaccinations
On a recent Tuesday afternoon, as the late summer heat permeated the air, cars circled the block with residents waiting for their turn at a COVID drive-thru test site at UNC Health Southeastern in Lumberton, North Carolina.
The community continues to get tested, despite the slow, hesitant climb of vaccinations. Amanda Crabtree, marketing and public relations coordinator for UNC Health Southeastern, said the hospital was averaging 420 tests per day during the last week of August.
Meanwhile, many of the hospital’s own staff were hesitant to get the shot. Last month, the CEO of UNC Health Southeastern Joann Anderson announced a vaccine mandate for employees. Staff members will now need to have both doses of vaccine by Sept. 21 to continue working in the facility.
“It came down to, ‘OK, I'm just going to have to mandate it.’ Because if I'm going to protect the staff, if I'm going to protect our providers and our community, we need to be leading the cause of vaccinations,” said Anderson.
Kaitlin Meares is one of the roughly 50% of UNC Health Southeastern who were unvaccinated when Anderson announced the mandate. Meares, an employee benefits representative, has worked at the hospital for five years.
“I was not comfortable getting the vaccine to start with, before the mandate. And I can't say that I was 100% confident in getting it either,” she said.
Meares said she researched the vaccine on her own and she prayed about the decision. Ultimately, a friend who works in healthcare helped drive home the risks of waiting.
“One of my trusted nurse friends, she said to me, she said, ‘Well Kaitlin, don't you think that getting the vaccine, any kind of side effects that you might have from that, are a lot better and treatable than you being on a ventilator,” Meares recalled, adding that she and her close family plan to receive their second dose this week.
Another Southeastern employee, Cardiovascular Sonographer Malik Corbin, said despite working in the hospital, he wasn’t planning on getting the vaccine when the case count was low back in the early summer.
“I was kind of skeptical with what I try to put in my body,” said Corbin. “I kind of wanted to ask different people about it, and just hear different people's opinions before I got the shot.”
As the COVID patients continued to stream in, Corbin shifted his perspective. A few weeks ago, he got his first vaccine dose.
“Especially with the amount of young people I see coming in, that really started getting to me a lot,” he said.
A Potential Tipping Point?
Linda Maynor Oxendine is invested in understanding the many reasons people like Meares and Corbin initially wavered on getting the vaccine. Oxendine is the North Carolina regional director for CORE (Community Organized Relief Effort), a crisis response organization. In August, the group received a $1 million federal grant to support COVID vaccination efforts and other crisis relief efforts.
Her organization surveyed Robeson residents to try to understand their position on the vaccine. Oxendine found a range of reasons why residents hesitate. Among the standout themes were government mistrust, faith-based reasons, exposure to misinformation, and a lack of understanding behind the science.
“A lot of folks thought that it had SARS-CoV-2. That if you take the vaccination, then you're gonna get COVID,” said Oxendine about the incorrect assumption.
As part of the effort to distribute the vaccine equitably, the North Carolina Department of Health and Human Services is also interested in the broader structural reasons why residents in Robeson are so hesitant.
"Not to sound selfish, but you got to protect yourself, you got to look out for yourself. Nobody in the ICU thought they would be there, you know what I mean, fighting for their lives."
Kody Kinsley, chief deputy secretary for health at the North Carolina Department of Health and Human Services, said routine access to a health care provider is a big factor.
“More than a million people in North Carolina [don't] have access to health insurance,” Kinsley said. “And that coverage enables people to have relationships with primary care providers.”
Kinsley said without this routine access, mistrust of the medical system can build up. With nearly a one-third poverty rate, Robeson County residents must also navigate finding the time and the money to travel to a vaccine site.
“In a place like Robeson County, we see the kind of the compounding factors of all those complexities pile up,” said Kinsley.
As the delta variant sweeps across the county, more people in the community now know someone personally who has died from complications related to COVID-19. It’s a potential tipping point that may help encourage holdout residents to seek the vaccine for their families and themselves.
Corbin, the once vaccine-hesitant cardiovascular sonographer, is among those who have witnessed the pandemic’s steady impact on the community. He now sees the effects first-hand nearly every day.
“Not to sound selfish, but you got to protect yourself, you got to look out for yourself. Nobody in the ICU thought they would be there, you know what I mean, fighting for their lives,” he said. “I just scanned a patient on Thursday, and he's not here today. He had no clue that he’ll be in that situation.
"That right there makes me think, we have to do this. Because any one of us can wind up in that situation.”
In the next episode of Tested, WUNC explores the significant impact the delta variant COVID-19 wave is having on the Lumbee Tribe.
Editor's Note: A previous version of this story stated that Scotland Memorial Hospital patients may wait up to three days before getting care. In fact, Dr. Shelly Lowery said patients who present to the emergency department at Scotland Memorial may wait three days before being admitted to an inpatient bed. The article has been updated to reflect this.