Connect to End COVID-19:

Virginia Special Populations

The pandemic began in March 2020 during the term of Virginia Gov. Ralph Northam, a physician, so the state was a leader in terms of mandating mask-wearing, enforcing social distancing, closing schools and certain types of businesses such as bars and restaurants early, and stopping large-crowd events such as festivals and concerts.

In addition, the state deployed a strong, evidence-based education outreach strategy; an innovative dashboard tracking positive cases, hospitalizations, and deaths; daily media updates by the governor himself; close partnerships with the higher education, healthcare/hospital, faith-based, and business communities; and rapid deployment of vaccines when available.

However, it wasn’t long before emerging research around COVID-19 prevention and treatment revealed that many vulnerable and underserved populations in Virginia—like the nation—were experiencing the virus with greater patterns of negative impacts (serious illness, hospitalization, death), as the state reported. These included Blacks and other minorities, older adults (especially those over age 80 but also even those over 65), patients with chronic health conditions such as diabetes and hypertension, and low-resource populations.

 

As of August 18, 2022, Virginia ranked 21st in the list of states for vaccination rates, according to the World Population Review. About 1.6 million Virginians are not vaccinated at all, with Black residents being the least likely to be partially or fully vaccinated.

 

On June 2022, however, Black people were being vaccinated at the same rate as whites, and Latina/Latinx/non-white Hispanic populations are being vaccinated at 1.4 times the rate of whites. Observers credit targeted community outreach with this progress (see government and nonprofit efforts cited below).

 

Virginia has 81.7% of its approximately 8.5 million residents vaccinated with at least one dose, and that percentage jumps to 92.8% for citizens over age 18 (May 20 figures from Virginia Department of Health). The state and Centers for Disease Control list 73.1% Virginians as being fully vaccinated (completed two doses), but that percentage rises to 83.3% of people age 18+. About 3,032,809 residents have also received a third dose (booster).

Source: Virginia Department of Health. Accessed August 18, 2022.

In July 2022, President Biden and the U.S. Department of Health and Human Services extended the Public Health Emergency on COVID-19 and its variants, which was set to expire July 15. As noted by the White House and government agencies, the move enabled continuity of telehealth services, ensured easier access to virus-defending tools such as COVID tests and personal protection equipment, encouraged states to continue to allow licensed health care providers such as social workers work across certain state lines to address workforce shortages, and provided “special access to Medicaid” to low-resource people.

The CDC and Food and Drug Administration only recently authorized and recommended the Pfizer-BioNTech COVID-19 vaccine for children six months through four years of age and the Moderna COVID-19 vaccines for children six months through five years of age. This decision generated a new special population for Virginia health care providers to help protect from the virus.

 

 

 

 

 

 

 

Source: Virginia Department of Health. Accessed Aug. 18, 2022.

Overall, as of late May, Virginia Department of Health reported that the state has had 1,726,749 cases of COVID with 20,301 deaths and a current infection rate of 44,041 cases. These numbers, especially among minority and vulnerable populations—are low because many people test at home and never report positive cases to the state for tracking.

 

 

State data from the Department of Health show that hotspots—mostly in high-population counties—are Arlington County with 66 cases per 100,000 people (as of May 30); Henrico (46 cases per 100,000), Highland (46 cases per 100,000), and James City (44 cases per 100,000) counties.

Rural areas also less likely to be vaccinated. Between rural and urban residents, 88% of Virginians consider themselves living in rural communities, but only 26% actually reside in rural [KS1] districts as defined by state and federal agencies, according to U.S. Census data.

From a race standpoint, hardest hit by the virus—according to data of the Virginia Department of Health--were whites (799,180 cases—not surprising since whites comprise the largest racial segment in Virginia), Blacks (319,493), and Latinos/Hispanics (170,344). [see chart]

Source: Virginia Department of Health. Accessed August 18, 2022.

U.S. 2020 census numbers show that Virginia is 12.4% Black, with heavily Black communities often centralized in urban areas such as Petersburg (76.3%, 30,791 Black), Emporia (59.5%), South Boston (59%) and Franklin (52.6%, Virginia Department of Health data). Richmond, the state capital, ranks 8th in state Black population with 229,233 Black residents (45.8%).

Black individuals make up the fastest growing racial segment in the state, and their relative hospitalization and death rates—as well as that of Latinas/Hispanics (18.7% of Virginia’s population)--have both fallen to around .8% in the past year. Asian (6% of the state’s population) and Pacific Islander people (.02% of the population) had much higher vaccination rates, 1.5 times higher than White people (61.6% of the population).

[Note: 2020 Census numbers. Also, 10.2% of Virginians identified as two or more races, 8.4% reported they were of “other races,” and American Indiana/Alaska Natives made up 1.1%, according to 2020 U.S. Census reports.]

Progress on vaccination, as well as numbers of cases and deaths, is tracked by county here.

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NOTE: Data on Native American vaccination is higher than 100% because “there are small numbers of vaccinations and small population estimates for Native Americans at the city/county level in Virginia. VDH gets population estimates from the National Center for Health Statistics (NCHS). For example, there were 3 Native American vaccinations in a county. Population estimates say there were only 2 people who identify as Native American in that same county. This means that the data would say there were 3 vaccinations over 2 people in the population. This would equal 150%, or a percentage over 100%.

 

Also, some people may identify that they are Native American and multi-race when they are getting their vaccine. They will be categorized as Native American only in the data system. This is because population estimates from NCHS do not include multirace as an option. If there was a multirace option, a person who identified as Native American and multirace would be in the multirace population estimates.

[See figure below for six-month mortality trends, March-July 19, 2022. According to USA Facts, Virginia had 2,783 newly reported COVID-19 cases and 20 newly reported COVID-19 deaths on Aug 17, 2022.]

Source: USA Facts. Accessed Aug.17, 2022.

The political landscape in Virginia for COVID-19 vaccination: What’s government doing, especially for special populations?

Shortly after Glenn Youngkin became governor in January 2022, he announced his “COVID-19 Action Plan,” a framework for “refocusing health care on the whole of an individual and the whole of health care infrastructure…. Communities that have stronger healthcare systems with higher staff retention and more access to available resources are better prepared to support their neighbors. We have seen the negative impacts of COVID-19 on individuals’ other health care needs as they have been struggling to maintain the necessary care to keep those needs addressed or managed. We have seen those with obesity, diabetes, asthma, and other underlying conditions to be more at risk….”

The plan encourages “individuals to get vaccinated to protect themselves and their neighbors through public service announcements, expand vaccination event efforts, disperse rapid-result COVID tests, and provide flexibility and support to our healthcare facilities while also empowering individuals to make health care decisions that work for them and their families.”

Simultaneously, he removed mask mandates statewide and required state workers to return to a physical workplace by July 5 unless granted special telework permission by high-ranking officials.

People of color are most likely to work in jobs—especially those considered “essential” such as home health care aides, nursing facility aides, and restaurant workers--that do not allow telework or are unable to be achieved off-site. This makes them more vulnerable to the virus and in particular need of vaccination.

Youngkin pledged in his COVID-19 Action Plan and in media briefings to devote additional resources to increasing vaccination rates and boosters, especially in vulnerable or underserved areas. Among the tactics planned or implemented already in the plan are the following:

  • Working with local community experts and “trusted voices,” especially in disproportionately unvaccinated communities to ensure that “messages are appropriate and fact-based.”

  • Personal PSAs and a video by the Governor encouraging vaccination

  • Hosted roundtables with Youngkin and Little with community leaders in Southwest and Central Virginia, where vaccination is among the lowest in the state;

  • Leveraged research by the Virginia Department of Health on marketing messages that resonate with Virginians who have not yet received the vaccine. In March, the state produced a video series highlighting the stories of rural Virginians and other target demographics who advocate for the vaccine in their communities.

  • Launched a Vaccine Communications on Hesitancy Education Workgroup (VCHEW) to identify barriers and solutions in populations with lower vaccination rates.

  • Partnered with Historically Black Colleges and Universities to promote testing, vaccination, and address vaccine hesitancy in Black young adults and their surrounding communities.

  • Partnered with faith-based organizations throughout the Commonwealth to promote vaccination and address vaccine hesitancy in surrounding communities.

  • Helped develop a format for tele-town halls focused on providing schools and parents vaccine information via panels of local health district representatives and pediatrician partners as subject matter experts. These addressed hesitations from parents of young children about vaccination; to date, 17 health districts have been hosting tele-town halls for their school communities.

  • Conducted school-based vaccination clinics in target areas to support access to the COVID-19 vaccine for children who do not have regular health care providers.

  • Expanded Spanish vaccinate marketing campaigns to especially focus on pediatric vaccination and public health guidance, paralleling with English campaigns.

  • Collaborated with the Department of Medical Assistance Services and Medicaid managed-care organizations, working on incentive and other programs to identify unvaccinated populations and plan vaccination events and targeted communications to encourage vaccination and address vaccine hesitancy.

  • Held nearly 2,000 vaccination site events between January 20 and April 30, 2022.

  • Deployed more Mobile Vaccine Units to rural communities. Since January 1, Virginia Department of Health has conducted more than 15 Pharmacy Clinics in areas with low vaccination rates. Two-hundred-plus mobile events for first, second, and booster doses were held through March at schools, faith facilities, and partner sites.

  • Signed executive orders creating exemptions to scope of practice requirements such as allowing out-of-state licensed nurses and social workers to practice in Virginia to help relieve worker shortages that could impact vaccination delivery and COVID care.

  • Supported continuation of telehealth usage and reimbursement to deliver mental health care and that could include supportive conversations from trusted medical advisors such as social workers regarding vaccination.

Nonprofits in Action:

NASW Virginia continues to urge social workers and their clients to get vaccinated, and—through the “Connect to End COVID-19” campaign—provide professionals with the training, resources, and background needed to comprehensively guide clients—especially those in special populations--through the journey to an informed vaccination decision.

Centers for Disease Control and Prevention: Identified Special Populations and Place-Based Focus with Lower Vaccination Rates

  • Racial and ethnic minority populations

  • People living in rural or frontier areas

  • People experiencing homelessness

  • Essential and frontline workers

  • People with disabilities

  • People with substance use disorders

  • People who are justice-involved (incarcerated persons)

  • Non-U.S.-born persons

Source: CDC Special Populations Data in the U.S.

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