Just as the COVID-19 virus continues to mutate into new variants, health officials continue to encourage safety measures and vaccinations. Not everyone, however, is enthusiastic about getting their shot. 

According to recent Virginia Department of Health data, 98% of COVID cases are from unvaccinated or not fully vaccinated people, and of current hospitalized cases, 97% are from unvaccinated or not fully vaccinated people. Breakthrough cases — meaning fully vaccinated people who contract COVID — make up less than 1% of cases and hospitalizations.

Data at the time of this publication shows 57% of people in the Blue Ridge Health District are vaccinated. BRHD, under the umbrella of the Virginia Department of Health, serves the city of Charlottesville and Albemarle, Fluvanna, Green and Nelson counties. 

Ryan McKay, BRHD COVID incident commander, explained a recent uptick in cases during a press conference on Monday.

“We’ve really been seeing this increase in cases across the district,” McKay said. “It’s not necessarily attributable to any particular one locality, but the spread has occurred across all of our districts. 

McKay noted low to moderate spread through mid-July in each locality that BRHD serves and how now high or substantial spread is visible. 

“We are definitely in the midst of a surge,” McKay said.  “Cases will continue to increase as we continue to see more individuals — particularly those who are unvaccinated — come into close contact with each other over the next several weeks.”

 

A healthy discussion

While BRHD urges people to get vaccinated and continue taking safety precautions to mitigate the spread of the virus and lessen chances of more variants, officials and medical professionals note the new social norm of discussing vaccination status between vaccinated and unvaccinated people. 

“It can be polarizing. A lot of people are convinced they don’t need it or want it, just as there are people who are convinced they do need and want it,” said Jason Elliott, a communications specialist with the health district. “BRHD obviously wants people to get vaccinated. But we understand there are people who will not get vaccinated.”

He adds that it can feel “like an overwhelming thing to say, ‘I don’t want to be around you because I don’t feel safe around you,’” but that it’s important to consider personal safety precautions and comfort levels. 

Elliott suggests vaccinated people be transparent with friends or family about personal boundaries regarding who they will or won’t spend time with related to vaccination status and whether an outdoor meetup might be an option.

“That might sound something like ‘hey I’m limiting the people I’m interacting with indoors right now, can we plan something outdoors instead?’ or ‘I’m really worried about Delta right now, so I’m only hanging out with vaccinated people who aren’t feeling sick for the time being.’” Elliott said. 

Dr. Taison Bell, whose expertise is in pulmonary and critical care at University of Virginia Health System, reiterates the new social norms the virus and vaccines have created. 

“It adds to just how awkward social interaction can be in general,” Bell said. “Do we hug, do we shake hands? I’ve learned to just ask ahead of time, ‘What are the rules of engagement?’ so to speak.” 

For Bell, he said his friends and family know his rules entail the need to be vaccinated if they want to spend time with him. 

“I’m well on the record that I’m pro-vaccine,” Bell explained. 

Meanwhile, he suggests “getting to the root cause of why” someone is unvaccinated may help the conversation.

“I’m not approaching it as ‘well you should get vaccinated,’ but ‘tell me why you’re not,’” Bell explained.  “Lead with what their thoughts are and then try to address it in a way that doesn’t make them feel like they’re not well-read or not understanding science.”

As such, unvaccinated people hold a variety of reasons why they either have not become vaccinated yet or do not plan to — with distrust often at the core.

“Novel coronavirus” was a common phrase in news articles around the world as the new — or “novel” — virus spread. 

With both the disease and vaccine having entered people’s everyday lives for over the past year, some people distrust new or changing information. Distrust also stems from concerns about long-term effects or efficacy of the vaccines, or from misinformation and conspiracy theories, from politics, from belief in alternative medicine and from racial history. 

Some vaccine messaging has targeted communities of color who may hold reservations due to racial public health history like the Tuskegee Experiment or how the University of Virginia conducted eugenics research. 

Recently, the Centers for Disease Control and Prevention issued a statement that vaccinated people are advised to continue wearing masks. Dr. Denise Bonds, director of BRHD, said that while a fully vaccinated person may not contract COVID or contract a less severe case, they can still contribute to the spread of the disease. 

“Delta is a little bit different from the previous variants that we saw,” Bonds said. “Individuals who are vaccinated are infectious if they become infected with the [variant] — they are going to spread virus particles, but the very good news is that the individual who has that vaccine is protected.”

Bonds referenced a recent outbreak in Provincetown, Massachusetts, last month where despite breakthrough cases in vaccinated people among the outbreak, few of them needed hospitalization. 

Bell said that understanding why someone is hesitant can be helpful while a vaccinated person may want to encourage an unvaccinated person to get their shot.

“It’s kind of like when you get in a car, do you put your seatbelt on — yes,” Bell said. “So I mean you could talk about all the latest safety features of the car, but you put your seatbelt on to obey traffic rules and that’s how you fundamentally keep yourself safe.”

Bell adds that most of the intensive care patients he is seeing are unvaccinated people. 

Elliott said that continued monitoring of local, state and federal data regarding the virus is helpful to understand risks.

“In the early days of the pandemic, we didn’t have the data. We didn’t know what to collect,” Elliott explained. “As we’ve moved along, we now have more data points, it gives us a better understanding of what this virus is doing.” 

While Elliott and other officials still encourage vaccination as one of the best protections individually, they say that mask use and social distancing can help protect communities, as well.

“We also understand that there are some people who they will not get vaccinated — absolutely will not — then it gets to risk reduction. It’s important that all of us continue to adopt mitigation strategies and understand if someone is not yet vaccinated, we can still take a stance as a community and still help our community be healthier.”