Emily Smith (right) of Hillsville receives a COVID-19 booster shot from nurse Marcial Baki at Hillsville Pentecostal Holiness Church. Smith said many of her young friends have refused to get their shots "as an act of rebellion." Photo by Ralph Berrier.

HILLSVILLE — Mary Anne Hall wheeled her 2009 Ford Edge sports utility vehicle down Hillsville’s Main Street, where frozen piles of plowed, packed snow lined the roadsides on a cold, gray late-January day.

She’s put more than 253,000 miles on her vehicle, most of them from driving over the mountain every day from her home to her job at the Carroll County Health Department, where she works as a senior public health nurse. She’s driven thousands more across the six-county Mount Rogers Health District, working with new mothers and their babies, visiting elderly shut-in people, conducting health clinics and, for the past year, driving to COVID-19 vaccine clinics.

“My family drives ‘em till they wear out,” said Vernon, joking about the miles on the SUV’s odometer.

She pulled into the spacious parking lot of the Hillsville Pentecostal Holiness Church on the south side of town, where a mobile vaccine clinic was taking place for county residents. A couple of clinic workers played one-on-one inside the church’s cavernous, new basketball gymnasium, while they waited for people to show up for shots.

Two hours into the clinic, more clinic employees had taken shots at the hoop than residents had received shots in the arm.

“Only about a half-dozen people so far,” one of the clinic staffers said.

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Hall remained positive. She has faith that people will show up. The weather has been cold, folks are itching to get out and they’ll show up to get their shots – she hopes.

Carroll County has the lowest vaccination rate in Virginia. About 46 percent of adult county residents are considered fully vaccinated against COVID-19, according to data gathered by the Virginia Department of Health. Neighboring Patrick County has the next lowest rate, with about 48 percent of adults fully vaccinated against coronavirus. Statewide, 80.3 percent of adults 18 and older are considered fully vaccinated, according to the department of health.

Although Carroll County’s vaccination rate remains the state’s lowest, some people have started receiving their first doses during the winter surge of the virus’ Omicron variant, which caused COVID-19 cases to explode ten-fold in the county between Christmas and mid-January. Even as omicron dissipates across the state, cases in Carroll County are not decreasing as quickly as the rest of the commonwealth. Test positivity rates remain high, and the number of county residents dying has been on the rise.

As more people have seen COVID-19 affect their closest relatives and neighbors, some are finally turning to the vaccines for protection.

Simply put, in a rural area where residents like to say everybody knows everyone, everybody these days seems to know somebody who has died of COVID-19.

“It’s everywhere here,” Hall said during a late-January interview.

* * *

Mary Anne Vernon Hall and other staffers at the Carroll County Health Department have worked tirelessly to encourage county citizens to receive COVID-19 vaccines. Carroll County has the lowest vaccination rate in the state. Photo by Ralph Berrier.

The days before vaccine hesitancy

Hall and many other public healthcare workers across Southwest Virginia have spent nearly two years battling a pandemic, first by helping protect people from the virus by encouraging social distancing and masking, ensuring sick citizens (especially low-income people) received care and, ultimately, making sure Carroll County residents had access to vaccines.

Back in her office at the health department, housed inside the sprawling government center that is home to all county offices and courts, Hall talked about the dedication that the department’s 15 staffers have shown during the pandemic.

“There were only one or two of us who worked in epidemiology, then when COVID hit, we all became epidemiology nurses,” she said.

Hall has lived all her 56 years in Carroll County, and she and her husband still live “up in the hollow” behind the house where she grew up in Lambsburg, a small community where the flat Piedmont of North Carolina washes into the foothills of Virginia. This area of southern Carroll is commonly called “below the mountain,” because of its location at the foot of Sugarloaf Mountain. (As a side note, locals call Fancy Gap “on the mountain” and Hillsville, the county seat where most governmental services exist, is “over the mountain.”) The adjoining southern Carroll communities of Cana and Wards Gap are likewise cut off from the rest of the county by the ridge folks call Fancy Gap Mountain, which is crossed by the winding, often foggy U.S. 52.

Hall’s eyes become watery when she talks about the people and place she loves.

“I feel drawn to the whole county,” she said. “I think we have a good team here. We don’t want our county to die. We have seen too much death in our county.”

A deeply religious person, Hall believed the vaccines to be a godsend for her community. As a healthcare worker, she was at the front of the line when vaccines became available, and she remembers the date she received her first shot: Dec. 23, 2020.

“And I was thankful to get it,” she said.

Many Carroll County residents were thankful, too, or so it seemed in the early days of the vaccine program. The department sent mobile clinics across the county to schools, community centers, churches and even apartment complexes to make access easy for all citizens. More than 400 people showed up during an early vaccine clinic, and dozens of others put their names on waiting lists for shots.

“There was a lot of demand,” said Breanne Forbes Hubbard, population health manager for the Mount Rogers Health District. “When we had doses left over, we had a list 50-people long of people to call. So many people wanted the vaccines early. From April to early summer, we didn’t know that there would be people who were vaccine-hesitant.”

Then, by midsummer, demand evaporated. To this day, the health department has hundreds of refrigerated vaccine doses. Hall gave a quick tour of the room where vials of potential life-saving vaccines are stored.

Even though she seems naturally predisposed to positivity, Hall admits that some county residents will never get shots regardless of the decimation coronavirus wreaks across the county.

“A lot of people have made up their mind,” she said. “A human disaster of any shape wouldn’t change their mind.”

* * *

Politics, mandates and ‘rebellion’

In addition to state-low vaccine rates, Carroll and Patrick counties share other similarities, some of which might be reasons why fewer than half of the adult residents have gotten their shots. 

Both counties sit along the border with North Carolina and each is bisected by the Blue Ridge Mountains, which, as noted earlier, cut off many residents in the southern areas from many county services. People wedged between the mountains to the north and the state line to the south often travel out of state for essentials – groceries, medications, clothes and healthcare among them.

Neither county has a hospital, although the General Assembly is considering a feasibility study into re-opening Patrick’s hospital in the county seat a Stuart, a facility that closed in 2017. The nearest hospital to Carroll is in Galax, which is a half-hour drive over the mountain for thousands of county residents. The hospital in Mount Airy, North Carolina is considerably closer.

Other reasons abound for the counties’ low vaccination rates, according to citizens and health experts. The speed at which the vaccines were developed worried some people (although the science behind creating the coronavirus vaccines had been well-established for years before the pandemic started). Misinformation passed along the internet, political preferences and distrust of authority are other commonly cited reasons for vaccine resistance. One Carroll County minister said that potential vaccine mandates emboldened many people to oppose receiving shots out of “stubbornness.”

And it’s remotely possible – although not likely – that some county citizens who received shots out of state due to shorter drives to North Carolina facilities have not been completely accounted for in Virginia’s statistics, which would mean the border counties such as Carroll and Patrick might have higher vaccination rates than the numbers show. An undercount could also affect Lee County, lodged in the western toe of Virginia bordered by two states, Tennessee and Kentucky, where the adult vaccination rate is just above 50 percent.

Last fall, Mount Rogers Health District officials assumed that perhaps as much as 10 percent of Carroll residents who received shots were not being counted in statewide vaccination data because they received the shots out of state. But when the North Carolina Department of Health shared its data with Virginia, Carroll County saw a disappointing increase in the vaccine rate of less than 2 percent.

“We thought they’d give us a big bump in the numbers,” said Forbes Hubbard, the health district’s population health manager. “It wasn’t the monumental increase we’d been expecting.”

Hall still thinks that the state might still be undercounting Carroll County’s vaccine totals based on anecdotal evidence she sees and hears in the community. (“I think they still might be missing some,” she said.) However, other grim statistics seem to validate the low vaccine rates.

According to the Virginia Department of Health, Carroll County has experienced about 120 deaths due to COVID-19. That ratio for a county of just over 28,000 people works out to nearly 400 deaths per 100,000 people. That ratio is more about 33 percent higher than Roanoke, population right around 100,000, which has experienced about 300 deaths per 100,000.

Simply put, a person in Carroll County – or just about anywhere in Virginia west of Montgomery County – has a significantly higher chance of dying from COVID-19 than a person in Roanoke, even though Roanoke’s urban population is more densely packed together than the population of rural Carroll County.

Also, the 2020 census revealed that Carroll County’s population dropped by 3 percent in the last 10 years, which, remarkably, was one of the lower decreases in Southwest Virginia, where some counties, Buchanan County, for example, lost as much as 15 percent of its population. Aside from the human tragedy of the pandemic, Southwest Virginia cannot afford to lose more people to COVID-19.

Some research has shown that the country’s vast political divide has played a role in whether people decide to get vaccinated. Polls and studies have shown that regions that voted heavily for former President Donald Trump have considerably lower vaccination rates and higher death rates than regions that voted for President Joe Biden.

A poll by Fox News in August found that “Americans who voted for former President Trump last year are 10 times more likely than those who cast their ballot for President Biden to say they don’t ever plan to get vaccinated against COVID-19,” according to a report in The Hill, which covers Washington politics. The Kaiser Family Foundation made similar findings in a study last summer. A project by National Public Radio released in December reported that people living in Trump-heavy counties were nearly three times as likely to die from COVID-19 as Biden-supporting counties.

In Carroll County, Trump received 81 percent of the vote, which wasn’t even the highest percentage he received in Southwest Virginia, where he dominated Biden by massive margins.

A possible connection between politics and vaccine hesitancy does not surprise Ann Hawks, an 80-year-old former school bus driver, community advocate in Lambsburg and one of the few Democrats around. Hawks has helped spread word about vaccine clinics at the community center housed in the former Lambsburg Elementary School just behind her house, in a picturesque spot where Sugarloaf Mountain rises majestically in the background. The community center’s playground bears the name of her late husband, Frank, a longtime educator.

“In Carroll County, I’d say it’s become political,” Hawks said of the county’s high rate of vaccine hesitancy. “That’s caused people to not get the vaccine. It seems like families are split over it.”

A number of community members have died from COVID-19 in recent months, she said, especially during the recent surge.

Some community leaders think politics only partly plays a role when it comes to people’s decisions regarding coronavirus vaccines. After all, several counties voted more heavily for Trump than Carroll County, yet also have higher vaccination rates.

“I know people who voted for Trump who took the shot, and I know people who did [vote for Trump] who didn’t take it,” said Jeff Pickett, pastor at Hillsville Pentecostal Holiness Church, which has hosted several community vaccine clinics.

Pickett, who received the first two shots in order to minister to church members who live in nursing homes, said that the possibility of COVID-19 vaccines being mandated by either the federal or state governments was a bigger vaccine deterrent for many citizens.

“When you make it mandated, it brings rebellion,” Pickett said. “You can say, ‘we encourage you, this is proven to help save lives,’ and let people decide for themselves. But when you say, ‘you can’t do this’ or ‘you can’t do that’ that gets people saying, ‘you’re not gonna tell me what to do.’ There’s a stubbornness we’ve got.”

Pickett’s own belief is to “leave the decision up to the individuals. Let people make their own choice. If they’d do away with mandates, you’d get more people” to get vaccinated, he said.

In short, pro-vaccine advocates won’t be able to browbeat or shame vaccine resisters into getting their shots.

As Carroll County nurse Rita Childress put it: “Sometimes you get further with a little bit of honey.”

“Rita’s real persuasive,” Hall said with a smile.

“You could save a whole family!” Childress said.

For her part, Hall steers away from politics when discussing COVID-19 vaccines with visitors to the health department. She encourages people to receive shots, she provides accurate information and she answers questions. She doesn’t pressure people.

“I don’t argue,” she said. “The more people I talk to who haven’t taken the vaccine tell me, ‘I’m just not there, yet.’”

She has learned that many people who resist the vaccines are often hesitant because of something they’ve read on the internet. Misinformation is a pandemic unto itself these days, so she tries to steer them toward better sources of information.

“I try to show them what the factual information is,” Hall said. “I always ask, ‘where’s your source?’ People will say, ‘well, I’m not sure who to trust anymore.’”

Many times, people have shown they trust Mary Anne Hall.

“This community has always been very respectful of this health department,” she said.

* * *

Mary Anne Hall shows where refrigerated COVID-19 vaccines are kept at the Carroll County Health Department. Photo by Ralph Berrier.

A call to help others

Mary Anne Hall didn’t always want to be a nurse. Then, an unspeakable tragedy changed her life.

Hall, who was born Mary Anne Vernon, was just 10 years old when her mother died of cancer, a heartbreak that would only presage an even worse loss years later. She was left to grow up as the baby girl in a household of men, raised by her father who ran a sawmill and three older brothers. Even she admits that she might’ve been spoiled by the boys.

She was an excellent student through high school who married her husband, Michael Hall, in 1985, a year after graduation. She had a good job as a secretary at the Renfro manufacturing corporation in Mount Airy, North Carolina. Ready to start a family, she suffered a miscarriage, then became pregnant again in 1989.

Her baby boy was born at just 26 weeks – more than two and a half months prematurely. The baby, named John Michael, lived for three months and three weeks.

Following the death of her son, “my immediate concern was to survive,” she said.

Grieving the loss of her child and despairing that she might not bear another, she was diagnosed with an incompetent cervix, a weakening of cervical tissue that could lead to premature births. In 1991, she became pregnant and underwent a cervical cerglage, a procedure that stitches the cervix to strengthen it, and she went on bedrest. That November, her son, Matthew, was born.

Soon, having seen firsthand the care and compassion from the neonatal intensive care unit nurses and staff at Brenner Children’s Hospital in Winston-Salem, North Carolina, where John Michael had lived his entire brief life, Hall found a new purpose soon.

“That got me into healthcare,” she said.

She took classes at Surry Community College in Dobson, North Carolina, then received a bachelor of science degree in nursing from Western Governors University, an online college that offers career training. After working for several years at the hospital in Mount Airy, she joined the health department in 2001, where she specialized in working with mothers and babies. Some of her most serious cases had involved substance abuse among expectant mothers in the health district that has seen massive increases in addiction.

Then came the pandemic.

The stories are legion of healthcare workers finding themselves on the frontline against a deadly virus, skeptical patients and a polarized public. Across the Mount Rogers Health District, doctors, county nurses and other staffers worked to keep their communities safe, as cases, hospitalizations and deaths mounted.

Even among the scores of public healthcare workers in Southwest Virginia, Hall stood out for her dedication to getting vaccines to people, and getting the people to the vaccines. She arranged for rides for folks without transportation. During a mobile clinic at an apartment complex, she made sure shots got to people who were too infirm to leave their apartment.

“Mary Anne put the team on her back,” Forbes Hubbard said.

She worked diligently to get vaccines to people in the community where she grew up and still lives.

“Mary Anne is a good advocate for anything,” said Hawks, who has also lived in Lambsburg her whole life and helped promote the vaccine clinics in the community. “Everybody loves her. She’s so outgoing. She was going to make sure everybody knew where to get their shots.”

The work, hard as it is, can be fulfilling, even during a pandemic.

“I won’t work at a job where I am not happy,” she said, tearing up again. “I couldn’t be happier. I like helping people. I’m just one of many team members who couldn’t have done it and survived it without everybody.”

* * *

Inoculated with hope

Back in the gymnasium at the Pentecostal Holiness church, Ryan Lintecum received a shot in his right arm, the one with the Chevrolet symbol tattooed on his forearm.

Lintecum, 20 years old and recently married, was dead-set against receiving a COVID-19 shot. Then, he considered his mother, who has health problems. Other family members have had cancer. What if he caught COVID and passed it to one of them?

“At first, I was totally, completely against it,” Lintecum said. But then “I worried about my family. My mother has a weakened immune system. If I get COVID and bring it to them, it’d always be on my mind if something happened to them. I got it more to protect them than me.”

Lily Lintecum, 20 who’s married to Ryan, admitted to being afraid of the vaccine at first because she feared she might contract the disease from the shot. Her mother got COVID-19 last year and suffered bad symptoms.

Echoing what Rev. Pickett said about people refusing to abide by mandates, Lily added that she and her husband also avoided vaccinations “because we’re stubborn. We don’t really like to be told what to do.”

Now, both she and her husband have received their second doses.

Emily Smith, 23, agreed that younger people in Carroll County – and in a lot of other places – are refusing to be vaccinated because of that sort of youthful obstinance.   

“It’s an act of rebellion not to do it,” said Smith, who received her booster at the church.

Her mother, Christina Simone, 47, also got her booster shot during the clinic. When asked if she knew anyone who had died from COVID-19, she replied, “Not until about a month ago.”

Now, she knows of at least four people who had died from COVID-19, including her husband’s uncle, who was just 56. Several people at her church have contracted COVID, including some who are hospitalized on ventilators, she said.

The increase in COVID-19 cases since December prompted more people to get vaccinated, said Simone, who works cleaning houses. Her husband does home maintenance work. Even she put off receiving a shot for most of 2021.

“I waited for a long time,” she said.

“I prayed about it. I figured if the Lord is going to protect me without the shot, he’s going to protect me with it.”

By the end of the clinic, 20 people had received shots, which included three people getting their first doses and several children who got their second doses. That’s not a super-high number over a five-hour period, but Lauralyn Purchase, the registered-nurse manager for Mobile Health, the New York-based company that handles Virginia’s rural vaccination clinics, said she has been at other clinics in Southwest Virginia where only one person showed up.

She thinks more Southwest Virginians are realizing the benefits of vaccines.

“Decisions are made through multiple factors, such as political, family or generational reasons,” Purchase said. “Now, there appears to be more family pressure [to get people vaccinated], bosses’ pressure, schools’ requirements … They’re seeing the results of people who were not vaccinated in this community.”

That’s why Mary Anne Hall and other public health nurses keep pushing. Gently.

As she said: “My ending statement is always, ‘We keep all three brands of vaccines in the health department, and we’ll be happy to help you if you decide to get it.’”

She just wants to help.

* * *

[Full disclosure: I have known Mary Anne Vernon Hall since we were both six years old and enrolled in Savada Bedsaul’s first-grade class at Lambsburg Elementary School. She is perhaps the kindest, nicest and most caring person I have ever known. For example, a few years ago at a reunion of the Carroll County High School graduating class of 1984, Mary Anne attended and brought her personal scrapbook she had saved from her senior year. I flipped through the pages, looking at newspaper clippings and photographs of the football team and cheerleaders, pictures of class officers, stories about the band and the cast of the high school play, pictures of the homecoming court – and I realized that she hadn’t saved clips of just her own name and face appearing in the paper (the way other self-absorbed teenagers – hand raised – would have done), but she clipped out stories about all her friends and classmates who had been written up in the newspaper. Who does that? Especially at 18 years old? Mary Anne did.]

Ralph Berrier Jr.

Ralph Berrier Jr. is a writer who lives in Roanoke.