Tennessee’s COVID-19 deaths now almost all among the unvaccinated

Brett Kelman
Nashville Tennessean

Although the spread of coronavirus has slowed to a trickle in Tennessee, the smoldering pandemic continues to hospitalize and kill a few Tennesseans each day, and almost all of them have something in common – they are not vaccinated.

Of about 530 people who’ve been hospitalized with the virus in the six-week span from May 13 to June 24, only 58 were fully vaccinated, according to a comparison of daily virus data and critical indicator reports from the Tennessee Department of Health.

At least 250 Tennesseans died from the virus during the same time period.

How many of them were fully vaccinated? Six.

These statistics, from a first-ever analysis of breakthrough infection rates in Tennessee, illustrate the power of vaccines to prevent the most severe ramifications of coronavirus. While the protection from vaccines is not absolute, a growing collection of scientific studies and real-world health data show the vaccines dramatically lower the risk of infection, sickness and death. Nationwide, more than 99% of coronavirus deaths in May were unvaccinated, according to an analysis from the Associated Press.

Dilashad Abdullah poses for a photo taken by his daughter Layla Haji,17, before he received his first COVID-19 vaccine during a mass vaccination event at Valor Collegiate Academy Saturday, April 10, 2021 in Nashville, Tenn.

This trend speaks loudly, if only people will listen, said Dr. William Schaffner, a virus expert at Vanderbilt University Medical Center. The vast majority of coronavirus patients at Vanderbilt are now either unvaccinated or partially vaccinated, Schaffner said.

“Just think of the number of people who went through all of the agony of having to be hospitalized, and all the work it took to get them better,” Schaffner said. “Think about all the strain and pain in the intensive care unit. Think about all the care needed from nurses, from doctors, from aides, from everybody. It’s all avoidable if we get vaccinated.”

More evidence of vaccine effectiveness comes from Tennessee nursing homes and long-term care facilities, which were once hotbeds of coronavirus casualties. The rate of infections and deaths in these facilities fell by more than 97% in the four months after they were prioritized for vaccination early this year, according to state data compiled by The Tennessean. The infection decline in these facilities was sharper than in the general population, where vaccinations started later and proceeded slower.

Vaccination is also believed to be the best defense against the delta variant, a more transmissible version of the virus that surfaced in India and has since spread across the planet. The variant sparked new outbreaks in rural regions of Missouri with low vaccination rates, and it has potential to do the same in Tennessee.

First lady Jill Biden, left, tours a pop-up vaccine clinic at Ole Smoky Distillery in Nashville, Tenn., Tuesday, June 22, 2021. Biden visited the clinic as part of the #WeCanDoThis bus tour.

Despite this persistent threat, Tennessee’s vaccination rates are slow and getting slower. As of Sunday, only about 38% of state residents are fully vaccinated, which is the tenth lowest rate among all U.S. states and nearly 10 percentage points below the national average, according to the Centers for Disease Control and Prevention.

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The pace of new vaccinations in Tennessee dropped about 45% in the past month and more than 85% since its peak in early April. Health officials say vaccination venues that once drew hundreds of recipients are now lucky to get dozens, and advocacy efforts battle for inches against misinformation, conspiracy theories and partisanship.

“We haven’t given up yet,” said Dr. Alex Jahangir, who leads the COVID-19 task force in Nashville. “It can’t discourage us when we go out there and only three people get vaccinated, because that’s still three people who weren’t vaccinated before.”

The political divide over vaccines is getting wider

Politics remain the most reliable indicator of vaccination rates in Tennessee, and a partisan gulf that splits this state in two is growing.

Counties with highest levels of support for former President Donald Trump in the 2020 election generally report lowest vaccination rates, according to a USA TODAY Network – Tennessee investigation published in April. The statistical link between Trump votes and vaccine hesitancy is stronger than any correlation between vaccination rates and race, poverty, unemployment, population density or overall health.

And this pattern has only intensified since April. The statewide correlation between Trump votes and low vaccination rates strengthened by 27% in the past two months, according to an updated analysis by The Tennessean. In a vaccination footrace, red counties remain at the back of the pack and are falling further behind.

The Tennessean analysis also shows this partisan divide is now largest in Middle Tennessee. While vaccination rates have slowed in the blue and purple communities of Nashville and its suburbs, rates are falling much faster in deep-red counties in the city’s furthest orbit. Some of Middle Tennessee’s smallest and most conservative counties now report an average of less than two new vaccinations per day.

Jahangir worries the divide over coronavirus will have long-lasting consequences on much of the state, similar to how the opioid crisis left deep scars measured not only in lost lives but broken families and erased prosperity.

To prevent this, Jahangir said, Tennessee needs a grassroots campaign that woos rural communities from within. It is obvious many are not swayed by the recommendations of politicians and health officials, so the state must instead enlist small-town figures who carry weight where traditional figureheads do not.

“It has to come from somebody they trust. Somebody they know isn’t hustling them. Somebody who can say, 'dude, they’re not putting a microchip in you,'” Jahangir said. “I know that sounds absurd … but I that’s what it takes.”

Tennessee's defenses may hinge on 'natural immunity'

While widespread vaccine hesitancy has left the Volunteer State more exposed than most, the virus has not taken advantage of this vulnerability – at least not yet.

Despite low vaccination rates, the pandemic has receded for months in Tennessee, and the state now reports less than 2,000 active infections and fewer than 5 deaths per day. Most new infections now occur in unvaccinated populations that skew younger, and therefore face lower risks of complications, said Health Commissioner Dr. Lisa Piercey.

But if Tennessee's vaccination rates are so low, why isn't the virus surging? Piercey has a theory: Many of the counties with low vaccination rates are the same places that previously eschewed other precautions like mask wearing and social distancing. This exposed these areas to more significant outbreaks last year, leaving more residents with some amount of natural immunity from prior infections, Piercey said.

A resident crosses the street in Erin, a city in Houston County, which at one point last year reported one of the highest levels of coronavirus positivity in Tennessee. Communities like Erin are now believed to have high levels of natural resistance to the virus, although it is unclear how long these defenses will last.

The antibodies created by a prior infection provide some protection from the virus, Piercey said, but it remains to be seen if this natural immunity is as dependable or long-lasting as the protection provided by vaccination.

“We know that duration may be at least nine to 12 months after natural infection,” Piercey said. “But even if they were infected three or four months ago and are still well within that window, their immune system might not have mounted a really big response, and so their immunity might be inconsistent.”

Numerous virus experts told the USA TODAY Network it is not yet clear exactly how the protection provided by coronavirus vaccines stacks up against natural immunity, but because natural immunity is generally less dependable, the safest option is to get vaccinated even if you were previously infected. 

Schaffner, the Vanderbilt expert, said years of study of other illnesses shows that vaccination generally creates more antibodies than natural immunity, and more antibodies generally translates into longer-lasting protection.

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'The delta variant has arrived …'

There is also growing but not-yet-conclusive evidence the COVID-19 vaccines provide a stronger defense against coronavirus variants than natural immunity, Schaffner said. 

This is particularly important in the face of the looming delta variant, which is expected to become the dominate strain of the virus in the United States.

The CDC estimates the delta variant accounted for 2% to 8% of all active COVID-19 infections in the American southeast as of June 5. The Tennessee Department of Health has counted at least 27 cases of the delta variant in the state so far – including at least 10 cases in Shelby County – but these tallies come from only a small number of virus samples that undergo an extra level of genomic sequencing needed to detect variants.

The true total of variant infections in the state is almost certainly higher, and it is all but guaranteed to rise.

“The delta variant has arrived in Tennessee – no big surprise,” Schaffner said. “It’s gaining steam nationally and is anticipated to become the dominant strain in three or four weeks. And it is very contagious.”

Brett Kelman is the health care reporter for The Tennessean. He can be reached at 615-259-8287 or at brett.kelman@tennessean.com. Follow him on Twitter at @brettkelman.