Mississippi’s Hospital System Is Rapidly Approaching Statewide Failure

Thomas Dobbs, Mississippi’s state health officer, is an epidemiologist and infectious-disease specialist in his early fifties, with boyishly wavy hair and a courteous but direct manner. His wife, Kim, is a pulmonologist. One of their sons, Wyn, is in medical school in Washington, D.C. Until COVID-19 struck, last year, Dobbs’s expertise had involved communicable illnesses like tuberculosis. Mississippi, the unhealthiest, poorest, least-educated state in the nation, has the second-lowest COVID-19 vaccination rate, behind only Alabama: thirty-six per cent of Mississippians have received the shot, compared with fifty per cent nationwide.

Dobbs, a registered Republican who strives to remain apolitical, is known for his ability to explain urgent medical information with calm lucidity. For the past year, he has patiently told residents that there is a clear path to ending the pandemic: vaccine, mask, distance. But most Mississippians have been reluctant to follow these guidelines, even amid the escalating spread of the Delta variant, which Dobbs calls “an entirely different animal.” Repeatedly, he explains this to the public: Delta is about three times as contagious as previous strains, and its effects appear to be more severe.

As the variant emerged, in July, Dobbs suspected that Mississippi would eventually see about a thousand new cases daily, but the caseload reached double that amount by August 2nd. Around that time, five thousand new cases appeared in one three-day weekend. More than two hundred people were placed on ventilators. At least twelve of those hospitalized were children. Nearly thirty thousand children between the ages of eleven and seventeen caught the virus. Two teen-agers died. Mississippi was now “in the midst of our fourth and most challenging wave,” Dobbs announced. He said, “It’s really bad, y’all.” Virtually all of the state’s I.C.U. beds are now full.

On Wednesday, Alan Jones, a senior administrator at the University of Mississippi Medical Center, announced that the state’s hospital system is approaching the “nightmare” that officials have “feared the most . . . total failure.” He said, “Within the next five to seven to ten days, I think we’re gonna see failure of the hospital system in Mississippi. I mean, hospitals are full from Memphis to Gulfport, Natchez to Meridian. Everything is full.” Owing to a shortage of both beds and staff, hospitals will be unable to treat not just COVID-19 patients but heart-attack and car-accident victims. The center’s pediatric hospital was already full. Jones said, “If there were a bus wreck of kids, we would not be able to take care of all those kids at this hospital.”

Nearly all of these new COVID-19 patients were unvaccinated. Dobbs has called the surge unnecessary—vaccination and wearing a mask are basic acts of both selflessness and self-defense. In Oxford, in northern Mississippi, parents have been warring, on Facebook, about a school mask mandate, despite the fact that children under the age of twelve are too young to be vaccinated. Dobbs has said, incredulously, “We’ve lost more people from COVID than we have from World War Two, and we’re not even willing to wear a mask or get a shot or stay away from a bar.”

Mississippi overwhelmingly votes Republican, the Party whose members have continually downplayed the pandemic as liberal hysteria and decried public-health measures as evidence of a “communist” plot. In the past two Presidential elections, Mississippi supported Donald Trump, who, as President, repeatedly denied the danger of COVID, called the pandemic a Democratic “hoax,” and refused to wear a mask. In Mississippi, eleven of the twelve counties with the lowest full-vaccination rates voted for Trump in 2020, the Clarion-Ledger recently reported. Nationally, nearly sixty per cent of the people who say that they will “definitely not get the vaccine” are Republican, according to a recent Kaiser Family Foundation poll.

Local and national pundits at such right-wing outlets as the Mississippi-based American Family Association, Newsmax, and Fox News have created an impression that it is ridiculous, dangerous, or sacrilegious to get vaccinated. Dobbs has publicly decried the “mind poison” of “some of the cable news stuff” and the “noxious social-media environment” surrounding COVID-19. Citing policy debates “based on mistruths,” he said, “We have allowed lies and disinformation to fool us.” Mississippians had been misled into believing that the vaccine would sicken them worse than the disease. People who had already contracted and recovered from the virus wrongly assumed themselves safe. (Natural immunity alone may be insufficient.) Researchers are increasingly documenting the scope of long-term complications from the disease, which, so far, include damage to the heart, brain, and reproductive system. “COVID is bad for you,” Dobbs said, in a public, live-streamed event with the Mississippi Free Press. “It’s not like getting a cold and getting over it.”

The governor, Tate Reeves, a Republican, has been of little help. On July 29th, he stood onstage at the Neshoba County Fair—an enormous, eight-day political event where families share cabins—and called the latest mask guidelines from the Centers for Disease Control and Prevention “foolish and harmful.” He added, “It has nothing to do with rational science.” Reeves advised parents to “erupt” if school districts mandated masks. Other red-state governors, meanwhile, have begun imploring their citizens to get vaccinated—even Alabama’s governor, Kay Ivey, recently came around, saying, “It’s time to start blaming the unvaccinated folks.” On Facebook, one Mississippian compared Reeves’s behavior to “watching a toddler try to figure a quadratic equation. except, you know, people die due to your ineptitude.” (Nearly eight thousand Mississippians have died because of COVID.)

The more Mississippi’s elected officials fail to lead, the more unnecessary work it creates for Dobbs and his staff. At the Free Press event, Dobbs answered question after question about the risk level of various scenarios, many related to the return to school. A full lunchroom? Bad idea, Dobbs replied. Assemblies and pep rallies? “Very bad idea,” Dobbs said. He cautioned parents and educators about buses and strongly urged universal masking, explaining—yet again—that we get infected by “breathing other people’s air.”

Dobbs has found it necessary to remind people that “COVID is science. There’s nothing political about breast cancer, heart attacks.” The pandemic will continue—and the virus may mutate and worsen—as long as people refuse to get vaccinated. The other day, Dobbs’s ability to balance urgency with clarity was tested. A radio host who was interviewing him compared the coronavirus to “a living, breathing enemy that’s intelligent enough that it knows what it’s doing.” Dobbs resisted a hyperbolic answer, replying, “The less it can spread, the more likely it’s gonna fade or fade out.” He later tweeted that the state of three million still needed about a million more “immune Mississippians.”

Asya Branch is from the small town of Booneville, in the northeastern corner of the state. While a student at the University of Mississippi, she became the first Black Miss Mississippi U.S.A. Last November, she was crowned Miss U.S.A., in a televised ceremony at Graceland. (Trump owned the organization until 2015; it’s now owned by the Endeavor company.) Branch immediately—and mid-pandemic—moved from Booneville to midtown Manhattan, where, by tradition, the reigning Miss U.S.A. lives. “It was a unique transition,” she told me.

Branch’s primary social cause is the children of incarcerated parents—her father, Anthony, served more than a decade in prison for two felonies. When Paula Shugart, the president of the Miss Universe Organization, which manages the Miss U.S.A. pageant, suggested “taking on COVID,” Branch did not hesitate. She told me, “I’m fully vaccinated. I get tested regularly.” She travels with antibacterial wipes, hand sanitizer, and disposable pink masks, which she buys, in bulk, from Amazon. The stash means that she always has extras, for people who need them.

Last week, a day after Dobbs tweeted that Mississippi needed at least a million more vaccinated residents, Branch flew from Newark to Atlanta to Jackson, with Miss U.S.A.’s communications director and a videographer. They took an Uber from Jackson-Medgar Wiley Evers International Airport to the Westin hotel, downtown. Branch changed into an ivory shorts suit, four-inch Lucite block heels, and a satin “MISS USA” sash trimmed in pink rhinestones. She wore her sleek hair down, her nails and eyelashes long.

In some parts of the country, a vaccination drive can be as easy as pointing participants to a specific address at an appointed time. Vaccine-hesitant areas have often required enticements, including lottery payouts. On the Mississippi Gulf Coast, one health-care center distributed fifty-dollar gift cards. Health officials had learned that the vaccination process also had to be easy—no pre-registration—and convenient. Vaccinations had to be offered during lunch hours and during shift changes, and before dark. In Jackson, Branch offered to take selfies with anyone who got vaccinated.

Branch’s vaccination drive was largely organized by Jaelrbreiret Williams (she pronounces it Jella-brett), who works at the state’s Health Equity department and holds a doctorate in public health from Jackson State University. She also serves in the Mississippi Air National Guard. In graduate school, she wrote her dissertation on fruit-and-vegetable intake among Black men. Interviewing patrons at Black-owned barbershops, she initially found that even she, a member of the community, wasn’t trusted. The men questioned her motives until their barbers “cleared” her as someone who wouldn’t “take advantage” of them. Williams knew that the same kind of trust-building would be needed for vaccinations. She told me that in communities of color—the demographic hit hardest by the pandemic—patients “don’t see very many providers that look like them.”

At two in the afternoon on August 4th, Branch showed up at New Horizon Church International, a nondenominational, multiethnic congregation with thousands of members. Williams had thought of the location because it is in her neighborhood, in south Jackson, where many of the city’s Black residents live. Housed in a former Sack’n Save supermarket, the church is known for hosting community events, including a Christmas bazaar where former prison inmates could pick up gifts for their children. Two sets of folding chairs had been set up—one for registration, one for monitoring. A nurse unpacked alcohol wipes, hypodermic needles, syringes, adhesive bandages, and dozens of vials of the Moderna and Pfizer vaccines. Volunteers wore matching yellow shirts that said “Vaccine Equity Access Program.” Tables had been set up around the perimeter of the room, draped with white cloths that Williams had picked up at Dollar Tree: these were bonus stations, focussed on high blood pressure, diabetes, oral hygiene. A banner referred to COVID-19 and its variants as “BULLIES.”

As people arrived, Branch, wearing her Miss U.S.A. sash, warmly greeted each one, asking, “Are you ready?” and “Are you excited?” After a selfie with Rayven Carter, a nineteen-year-old nursing student, Branch said, behind her pink mask, “It makes my heart so happy!” Desiare’ Ingram, a thirteen-year-old athlete at the Mississippi School for the Deaf, came in with her mother, Krystal. “I know a little sign language!” Branch said. Facing Desiare’, Branch wanted to say that one of her relatives attended her school, but she got frustrated, trying to remember how to sign. Krystal said, “Pull your mask down a little and let her read your lips right quick.”

For the next five hours, Branch interacted with every person who came in: “How y’all feeling?” “Had you thought about getting the vaccine before?” “What grade are you in? Seventh? Aw, that’s so fun! I remember seventh like it was yesterday.” “Do you play any sports? No? Band? I was just a cheerleader. Can you tell? I have too much energy! I’m just, like, perky and happy all the time!”

Jaterius Myers, who is twelve, came in with his grandmother looking like he might cry. He waited in the nurse’s chair in silent terror. Branch, who is twenty-three, knelt next to him and said that she had been scared, too, but that “it doesn’t hurt!” She said, “You wanna hold my hand?” The boy took her hand. Branch told him, “Don’t look at it—look at me.” Then it was done. Branch said, “Let’s go get some chocolate!”

By three-thirty, some forty shots had been administered. Recipients gave varying explanations for coming. Twin sixteen-year-olds who Instagrammed their visit told me that they hadn’t been vaccinated earlier because they’d heard about “bad side effects” on social media. One told me, “They were calling people sheeps for getting it.” Zachery Hudson, a college basketball player, came in because his grandmother had been “nagging” him, and because he needed the vaccination in order to play pro ball in Europe. (“It took Miss U.S.A. to pull up for you, bro!” his cousin, Dallas Brown, one of the church volunteers, said.)

Just before 6 P.M., the mayor, Chokwe Antar Lumumba, arrived. Trim, bearded, and vaccinated, he wore a crisp suit and a plaid mask. A lawyer in his late thirties, Lumumba, the son of a former mayor, has vowed to make Jackson “the most radical city on the planet.” Politico recently described Lumumba’s vision as “a whole menu of new progressive ideas like universal basic income, cooperative businesses and alternatives to policing.”

The mayor’s scheduled presence at the vaccination drive was intended to bolster participation, but most everyone had already come and gone. Lumumba told me, “We move at the pace of trust.” In communities of color, many people don’t regularly see a doctor, he went on. “So, if you think about it, what we’re asking them to do is deviate from their normal activity. If you’re asking me to go to a doctor when I haven’t been in ten or twenty years, that’s a significant deviation.”

Buster Caldwell, a warehouse manager in his sixties, sat in the recovery area. He had arrived wearing a plastic face shield but no mask. As the nurse prepared the injection, Caldwell said, “I might holler. Me and needles don’t get along,” then added, “I’m gonna be a big boy, I’m gonna take mine real tough.” Branch came over. Caldwell told her that he had been “struggling with the good and the bad” of whether to get the vaccination. He had prayed about it and received “spiritual confirmation” that the vaccine was the right thing to do. “The spirit sent me down this path, so I’m going boldly,” he said.

“This your first dose?” Branch asked.

“This is my first dose. I hid out for a long time, but the spirit found me.”

The nurse had already finished. Caldwell, surprised, said, “You done did all that?” He memorized the date of his follow-up dose. Later, walking out, he hollered, “See y’all on the twenty-fifth!”

Lee Vance, a mustachioed and soft-spoken sixty-three-year-old, was elected Hinds County sheriff in 2019, after spending more than three decades at the Jackson Police Department, first as a patrol officer and ultimately as chief. On July 20th, Vance announced the worst coronavirus outbreak of the pandemic at the county detention center that he oversaw. Sixty of the jail’s five hundred and sixty detainees had tested positive, along with fourteen employees. In a press interview, Vance appeared at his desk, without a mask. After coughing once, gently, he soon said, “It appears that this particular variant is expanding at a really quick rate.”

Two days later, Vance tested positive. He was fully vaccinated: he had reportedly received a Johnson & Johnson dose. Quarantining at home, the sheriff told a colleague, by phone, that he had nothing more than a runny nose and a cough, like a “bad cold.” On August 3rd, he said that he was eager to return to work. By the next morning, he had died.

Vance’s death was announced hours before Branch arrived at the vaccination drive. Organizers worried that the news of the sheriff’s death would depress turnout. Some had hoped for at least a hundred vaccinations. The final tally was fifty-eight. I heard one man say, “That’s fifty-eight more than were vaccinated this morning.”

A few days later, the Hinds County Sheriff’s Office parked Vance’s service vehicle, a black Chevy Tahoe, on a downtown sidewalk, and invited mourners to leave condolences. The S.U.V. was outfitted with a royal-blue banner bearing Vance’s name, title, and “END OF WATCH.” When I stopped by, no one was there, but visitors had festooned the windshield and hood with a dozen white roses, a Teddy bear, a “Lanier Bulldogs” baseball cap, and a colorful bouquet of fresh-cut flowers in a glass vase, set atop a neatly folded kitchen towel. Downtown Jackson was all but deserted, but near the capitol a throng of well-dressed people emerged—maskless—from a Baptist church. A day earlier, a high-school football team ran wind sprints—en masse and maskless—on a practice field. At Ole Miss this week, thousands of students will move into their dorms.

When this pandemic started, I happened to be in Mississippi, the state where I was born and raised, for a wedding. When the Delta variant started, I happened to be back in Mississippi for the first time since the crisis began. I had thought, like so many others, that the worst of this avoidable disaster was behind us. The trips now felt like cursed bookends. When I left my hotel room one morning last week, I found a handwritten note on the carpet in front of the adjacent door: “STOP!” It was a COVID warning, for housekeeping: the inhabitant of Room 200 was infected.

Dobbs and Branch and Williams showed fortitude and courage, as did all those newly vaccinated people and the church leaders who welcomed them. But there are outbreaks in at least a hundred and seventy-two long-term-care facilities, many of which do not require health workers to be vaccinated. It’s unclear what impact, if any, the warnings of the collapse of the state’s hospital system will have on behavior and vaccination rates. Burned-out nurses continue to abandon their jobs in droves, leaving hospitals too understaffed to handle the fresh coronavirus wave on top of whatever was already wrong with everybody. Dobbs recently warned the public, “Don’t get in a car wreck. Don’t fall off a ladder.” Mississippi’s numbers are ratcheting ever upward.