Medical Examiner

“Everybody Knows That It Will Get Worse”

My parents are physicians in unvaccinated America. It’s starting to feel like they’re in a different world.

A nurse and pedestrians wait to cross an intersection outside of the Houston Methodist Hospital on June 09, 2021 in Houston, Texas. Houston Methodist Hospital has suspended 178 employees without pay for 14 days for their refusal to comply with its COVID-19 vaccine requirement.
A nurse and pedestrians wait to cross an intersection outside of the Houston Methodist Hospital on June 09, 2021 in Houston, Texas. Brandon Bell/Getty Images

Over the past few months, America has insidiously split into two countries: vaccinated and unvaccinated. In vaccinated America, a post-pandemic normal seems within reach. Unvaccinated America, meanwhile, is contending with new surges of cases and hospitalizations, driven by a rapidly-spreading delta variant.

For me, and I imagine for many others, the civil divide is personal. I grew up in rural Oklahoma, where my parents were, and still are, practicing physicians. Both see patients in our local hospital and together run their own clinic. As I’ve started my own career in medicine as a resident physician this past year, we’ve frequently commiserated about working in health care during the pandemic. Increasingly, however, our experiences with COVID seem to be diverging. In Rhode Island, where I currently live and work, the adult vaccination rate as I am writing this essay is 71 percent. In Bryan County, Oklahoma, where I grew up, that rate is 34 percent.

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From afar, the situation back home in unvaccinated territory seems precarious. A few hundred miles north of Bryan County is the Ozark region of northern Arkansas and southern Missouri, where the delta variant is spreading unabated. The variant has started to spread into Oklahoma, with the state recording over 1,100 cases per day over the past week alone.                In a recent phone call, my father and cardiologist, Vivek Khetpal, shared that the COVID census in our local hospital is creeping back up, from a nadir of zero earlier this summer. These days, a trickle of COVID patients get admitted to the hospital daily, and COVID now occupies a small but growing beachhead in the ICU. The patients, this time, are different than before—they’re typically middle aged, and unvaccinated with few exceptions. In the hospital, this inspires some fleeting hope that outcomes might be better compared to the earlier surges, only to be quickly replaced by concern that people who were seemingly healthy now find themselves hospitalized by COVID. My mother and internal medicine physician, Sangeeta Khetpal, tells me that more people in town have had respiratory symptoms, and that a 3-month supply of COVID tests, stocked in their clinic, ran out recently in a matter of weeks.  In the hospital, “everybody,” my father tells me, “knows that it’ll get worse.” Meanwhile, local businesses remain fully open and masks are scarce. The only exception, I hear, are the hospitals and clinics run by the Choctaw Nation. Fitting the pattern of the tribes taking earlier, more aggressive preventive measures against the coronavirus throughout the pandemic, they reintroduced their mask mandate last week.

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As all of this takes place, COVID vaccines, once exclusive commodities in Bryan County, now languish on shelves in drugstores and supermarkets, circling the drain toward expiration. After making a point to stock vaccines as early as possible, my parents’ clinic stopped requesting additional vaccines after demand fell off over the past two months. When it comes to persuading people, they’ve hit a wall. The vaccine hesitancy they encounter, my mother tells me, has to do with “how rushed everything was, and the fear that everything is experimental.” Patients tell my father that “the government and businesses seem to be pushing this on us too hard, so something must be wrong with it,” he tells me. My mother adds that “people,” at this point, “are emotional when it comes to talking about vaccines.” Conversations about COVID vaccines shut down these days, with holdouts unmovable to persuasion.

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My experience, in recent days, could not be more different. In my outpost of vaccinated America, the worst of the pandemic feels like it’s passed us. If you were to visit Rhode Island, it would be difficult to imagine that it once had more recorded COVID infections, adjusted to population, than anywhere else on the planet just months ago. The state’s Convention Center, once home to a busy field hospital caring for COVID patients, plans to soon reopen for conferences and expos. The Dunkin’ Donuts Center, where thousands of Rhode Islanders have gotten their COVID vaccinations, has started turning its sights toward the minor hockey league season this fall. People in downtown Providence, the capital city, mill about beer gardens, bookstores, and restaurants unmasked. Though small numbers, according to our state’s COVID tracker, have persisted in our hospitals, I personally haven’t encountered or taken care of a COVID patient since May. When COVID does come up in an exam room, it’s usually to update a patient’s electronic medical record to show that they’ve been vaccinated already.

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Watching the events unfold at home reminds me of the early days of the pandemic, when Italy and China first grappled with COVID outbreaks and were harbingers of what was to come. With the delta variant, there is a palpable fear that the dam here may soon break. But the data emerging thus far suggests that fear is irrational for now; multiple studies have found that a completed vaccination series offers significant individual protection against a severe case of COVID, including from the delta variant. (In a severe case, a person requires supplemental oxygen, while in a critical case, they need a ventilator).  Real-world data offers similar conclusions. In an analysis for the Financial Times last week, John Burn-Murdoch and David Pilling compared the case and hospitalization rates of countries now facing a surge of delta cases. In poorly-vaccinated countries, like Namibia, hospitalizations tracked evenly with a rise in cases over the past few days. In well-vaccinated countries like the United Kingdom, however, hospitalization rates have stayed largely flat as cases have mounted. All of this suggests that the epidemiologic fates of unvaccinated and vaccinated America, at least for now, are no longer as intertwined as before. An outbreak in Bryan County no longer translates to an outbreak, of similar size and magnitude, in Rhode Island.

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As Oklahoma braces for another surge of cases, I’m worried about how long my parents, and others in their position, can keep doing this. America’s partitioning into vaccinated and unvaccinated territory threatens to keep one part in a forever pandemic, sustaining population-level burnout and adding to the cognitive load we’ve all carried for the past 18 months. It also reinforces messy social divisions—divisions that have long existed due to political persuasion or income inequality or privilege–into divides that feel more physical, and permanent. For so much of this pandemic, I felt like my parents and I were in this together. Now, I’m worried that’s no longer true.

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