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This illustration provided by the Centers for Disease Control and Prevention in January shows the 2019 novel coronavirus (COVID-19). This virus was identified as the cause of an outbreak of respiratory illness first detected in Wuhan, China.

CHARLESTON — West Virginia Gov. Jim Justice painted a bleak picture.

“The weather is going to get bad, and absolutely we’re going to be overrun in our hospitals, and there are going to be decisions that have to be made on who is going to live and who is going to die,” Justice said during his COVID-19 press briefing Friday, warning about the consequences of continued low vaccination rates. “It’ll be terrible beyond belief.”

Hospitalizations matched the prior pandemic peak, with 818 people hospitalized Friday compared to the previous high of 818 on Jan. 5. As of Friday, 252 patients were in intensive care and 152 were on a ventilator, shattering previous highs in both categories from the first week of January.

A report released last week by the Centers of Disease Control and Prevention and other health agencies showed West Virginia leading the nation in the rate of COVID-19 spread. Fifty-six percent of West Virginians 12 and older have received a vaccine dose. Only half in that age group are fully vaccinated.

While 51 of the state’s 55 school boards have opted to enforce masking in county schools, 16% of cases in the past week have been in children younger than 12. They are too young to be vaccinated.

The current surge, fueled by the more contagious delta variant, is the worst seen since the pandemic began.

In West Virginia, there were nearly 25,000 active cases Friday. Justice lamented that “many … will die,” but he has yet to return to mandates like those he ordered last year to counter the pandemic.

Dr. Clay Marsh, the state coronavirus czar, said a peak for the current surge could be as far as two weeks away, leaving thousands of people in the meantime to get sick. He and other public health experts have estimated timelines for the surge based on data from other places further along in it than West Virginia.

Dr. Christopher Martin, a professor at West Virginia University’s School of Public Health and at WVU’s School of Medicine, said he’s not so sure it’s possible to predict when the virus will peak here and numerous variables could lead to it lasting longer.

“I hear a lot of people say they think the delta surge will last a certain amount of time, but that’s not how I see things,” Martin said. “I haven’t found a single state that is fully, completely through the delta surge. Everybody’s curves are different, and we have to be cautious about generalizing in different populations that are further along than West Virginia.”

West Virginia, Martin said, is in a different situation than many other states. Temperatures are cooler here than in places such as Florida. Congregant settings — like football games, concerts and festivals drawing thousands of people in often close quarters — can accelerate spread.

On Wednesday, Marsh compared the current surge to smaller brush fires that grew into a large, raging forest fire. Vaccinations are the best firewall, he said.

But applying that firewall is a challenge. Martin cited Kaiser Family Foundation surveys showing 14% of the population opposed to vaccines.

“That’s been a really stable finding. That number has been unaffected by surges, by the delta variant, all the information on hospital deaths and capacity being overwhelmed by the unvaccinated — none of that has changed their minds,” Martin said.

The pandemic, Martin said, has made him rethink much of what he thought he knew. Tiers in prevention include screenings to catch a disease early or lifestyle choices to stave off infections. The primordial level, the fifth in preventative medicine and by far the least discussed, he said, is composed of acting to reduce the harm of environmental, social and economic factors, among others.

“It’s dealing with other factors like systemic racism, widespread poverty that do have a public health effect,” Martin said. “We need to look at this — I like that word, intersectional — that’s how we need to look at this. What are the primordial factors here?”

Those factors can drive down vaccination rates and extend the virus surge. Those problems can’t be solved now or even in coming weeks, he said. But policy could be set to limit future harm to the same populations, which are often those that can least afford to be hard hit by illness.

“Vaccine hesitancy is not a data problem. We have lots of data. It’s not a messaging problem. Lots of people are speaking to the public in different ways. I don’t really believe it’s an education problem, as there are so many avenues today — no matter your background — to find information,” Martin said. “There is no quick fix to where we are right now, but if we don’t say this is unacceptable and that ultimately there are policies that need to be changed, nothing is going to get better. This is not something a physician fixes, but the physician can advocate for much needed policy improvements.”

Martin compared vaccination to wearing a seat belt. When that was first mandated, many people refrained from wearing belts in protest despite evidence showing the restraints saved lives. Today, wearing seat belts is second nature, he said.

“Most people don’t even think about it. It’s a habit, and you don’t hear people seriously shouting against it as they did then,” Martin said. “I draw this comparison because I need optimism. It won’t always be this way.”

But the immediate future is grim.

“Epidemics are like wildfires in that those that have explosive increases will also have explosive declines,” Martin said. “When it goes up quick, it comes down quick, with a trail of wreckage in its wake. Tragically, what we’re seeing is this virus ravaging a large unvaccinated population. On the other side, we’re going to see a lot of people either die or develop natural immunity, often with long-term side effects we don’t really understand yet. It’s going to be tragic.”

Caity Coyne covers health. She can be reached at 304-348-7939 or caity.coyne@hdmediallc.com. Follow @CaityCoyne on Twitter.

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