Nurse Matt Robinson braced himself before pushing the heavy doors to the recently reopened Covid-19 ward at Methodist University hospital in downtown Memphis, Tennessee.
This hadn’t been in the script. After over a year of continuous work with Covid-19 patients throughout the pandemic, the burnout brought on by constant exposure to death and trauma, Robinson had hoped his job might return to normal.
Just a few months ago the hospital had no Covid-19 patients, with hopes that the widespread availability and effectiveness of vaccination in the US would keep things that way. But with the Delta variant now tearing its way through unvaccinated Americans and inoculation rates plateauing in Tennessee amid a dangerous conservative political backlash against vaccines, hospitals are experiencing a new wave of cases.
Covid-19 hospitalizations in Tennessee have more than doubled in the past three weeks, from 195 to 579. It’s currently far less than the peaks of last winter, when hospitals cared for upwards of 3,300 Covid patients statewide, but data shared with the Guardian shows that officials in Memphis believe almost 80% of new cases are now tied to the highly transmissible Delta variant with the transmission rate, or R number, at 1.53 and climbing, close to the highest it has ever been in the city.
It’s a sobering moment as the doors swing open to reveal a brightly lit, rectangular ward, filled with the humming of negative air machines and rhythmic beeping from monitors. Behind each of the 25 doors is a single patient held in isolation, some visible between white slatted blinds. Many lay prone, hooked up to oxygen tanks. About 95% of Covid-19 patients here are unvaccinated, in line with state and national trends. Physicians are already planning to move to an expanded ward, twice the size, as they prepare for more patients in the coming days. Some are now referring to this as the fourth surge.
“Seeing patient after patient go through this, especially at the point where we actually have something that has proven efficacy …” said Robinson, a fresh-faced 29-year-old. “It’s just sad to see it, that we’re back at this point.”
The average age of patients in this healthcare network, the largest in Memphis, has now dropped by a decade, from 61 in December 2020 to 51 now. Months ago, the majority of people Robinson treated reminded him of grandparents and parents. Now, they remind him of himself.
He recalls the recent case of a young patient in their mid-20s being placed on a ventilator. “That could have been me,” he said at the time, before reminding himself he was fully vaccinated.
“It just hits closer to home when it’s someone your age sitting in that bed, or on a ventilator. It’s heart-wrenching seeing that because we have a solution.”
Still, many of Robinson’s own colleagues remain unvaccinated as the hospital weighs up whether to make inoculation mandatory for staff. Earlier in the day, he spoke to one of his friends who had worked the Covid-19 wards during the height of the pandemic.
“I don’t want to have to take care of you,” he told her. “I don’t want to have to see you here because I care for you and value you so much.”
Just 38% of Tennessee’s population is fully vaccinated, one of the lowest rates in the country, but slightly above the deep south states of Louisiana, Alabama and Mississippi that lag even further behind.
Unpicking the forces behind vaccine hesitancy is complex and multifaceted; from pervasive disinformation online, to skepticism tied to systemic medical failures and historic abuse on American communities of color.
But the political situation in Tennessee has undoubtedly exacerbated the issue and left many beleaguered healthcare workers frustrated and perplexed. Tennessee’s Republican governor, Bill Lee, received his vaccine earlier in the year, but did not do so in public, mirroring a vaccine dog whistle initiated by Donald Trump.
Last week, under relentless pressure from conservative state lawmakers, Tennessee fired the head of its immunization program, Dr Michelle Fiscus, a respected pediatrician, after a rightwing backlash made her a major target. She was placed in the spotlight as the state expanded its vaccine outreach to eligible school students. Unlike most states, a legal precedent in Tennessee allows certain adolescents to be vaccinated without direct parental consent. On Friday the state reversed a decision to cancel vaccination outreach to all adolescents it had announced last week.
After authoring an innocuous memo to inform the state’s medical providers of the precedent, Fiscus was targeted in a wave of online abuse. At a June hearing in the state legislature, conservative lawmakers threatened to dissolve Tennessee’s entire health department for producing targeted vaccine advertising for adolescents.
“We know how impressionable our young people are. For a department of ours to make it seem like you need a vaccine … to fit in is peer pressure applied by the state of Tennessee,” said Republican state representative Scott Cepicky. “Personally, I think it’s reprehensible that you would do that, that you would do that to our youth.”
Just a few weeks earlier, outside the city of Knoxville, a woman attempted to drive her car through a state vaccine site, reportedly coming within inches of mowing down a dozen healthcare workers as she shouted “no vaccine”. She was later charged with reckless endangerment.
Speaking to the Guardian, Fiscus admitted the conservative backlash against the vaccine was something she had not expected. “I think I really underestimated the political divide,” she said, noting that like many states Tennessee’s initial vaccine outreach had been focused on Black and minority communities with historic distrust of medical systems.
“We were all really surprised that [conservative rural white men] ended up being our most vaccine-hesitant population, and it’s not necessarily because of mistrust of government, it’s because of an ideology – that if I get this vaccine I am somehow placating the left wing of the political spectrum,” she said.
“To see people sacrificing their own health and wellbeing and that of their families and community to spite this perceived political benefit to the left is just really dumbfounding.”
Some doctors on the Covid-19 ward in Memphis said they now turned off the news any time the political handling of the pandemic came on.
“I just find it incomprehensible,” said Dr John Eick. “I have no understanding of the reasoning, why those ideas and decisions are being made. All I can say is that it certainly makes my work much harder.”
In the rural town of Munford, 40 minutes north of Memphis and in a county that voted 73% Trump last year, it was not hard to find a sense of overwhelming vaccine distrust, often rooted in conservative conspiracy theories. Only 25% of residents are fully vaccinated here.
“I don’t trust anything the government is doing right now,” said one unvaccinated man, Mike, who refused to give his surname and reiterated the baseless claim that Trump had won in 2020. “People taking it are just falling right in line. They’re sheep. Liberal sheep.”
He later admitted that his own daughter, a “liberal college student”, had been vaccinated, against his wishes.
Jennifer Wade, a local hairdresser, sat in the shade and nodded in agreement. “I don’t understand how they could have made this thing [the vaccine] within a year. I won’t put it in my body. It’s my constitutional right.”
In Shelby county, home to the city of Memphis, and one of only three Democratic counties in the entire state, the vaccination rate sits at 35%, still below the statewide average and the lowest of any major city in Tennessee.
The county is 52% Black, but African Americans currently make up 67% of the 78 people currently hospitalized with Covid-19 in the city’s largest healthcare network, Methodist Le Bonheur.
The disparity underlines the frustrations and sadness among leaders in the Black community here, who have worked tirelessly on vaccine outreach with mixed results.
The Rev Dr J Lawrence Turner of the Mississippi Boulevard Christian church, one of the oldest Black churches in the city, accepts there is much more to do as the Delta variant begins to take hold.
“As time has gone on, I think those who were ready to receive the vaccine have taken it. However, we’re at a point where educational efforts have slowed but the misinformation persists,” Turner said. “We’re at a moment in the pandemic where it takes vigilance and determination. And I don’t think many of the people who have possibly become infected are being wary of the simple things.”
Turner argued that the lack of political leadership in the state had ramifications for vulnerable communities throughout Tennessee, not just those in white conservative areas.
“To be frank, it’s illogical to me, knowing the healthcare disparities in our state. This will only put more vulnerable people at risk,” he said. “Whether you’re Black, white or Hispanic, the abdication of leadership by many elected officials has placed many residents in peril.”