In super-vaxxed Vermont, COVID strikes—but packs far less punch

Even Eden, a snow-covered paradise in northern Vermont, is poisoned by omicron.

The nearly vertical ascent of new coronavirus cases in recent weeks, before peaking in mid-January, affected nearly every mountain hamlet, every shuttered factory town, every frozen bucolic college campus in this state despite its near-perfect vaccination record.

Of all the states, Vermont appeared best prepared for the omicron battle: It is the nation's most vaccinated state against COVID, with nearly 80% of residents fully vaccinated—and 95% of residents age 65 and up, the age group considered most vulnerable to serious risk of COVID.

Yet, even this super-vaxxed state has not proved impenetrable. The state in mid-January hit record highs for residents hospitalized with COVID-19; elective surgeries in some Vermont hospitals are on hold; and schools and day care centers are in a tailspin from the numbers of staff and teacher absences and students quarantined at home. Hospitals are leaning on Federal Emergency Management Agency paramedics and EMTs.

And, in a troubling sign of what lies ahead for the remaining winter months: about 1 in 10 COVID tests in Vermont are positive, a startling rise from the summer months when the delta variant on the loose elsewhere in the country barely registered here.

"It shows how transmissible omicron is," said Dr. Trey Dobson, chief medical officer at Southwestern Vermont Medical Center, a nonprofit hospital in Bennington. "Even if someone is vaccinated, you're going to breathe it in, it's going to replicate, and if you test, you're going to be positive."

But experts are quick to note that Vermont also serves as a window into what's possible as the U.S. learns to live with COVID. Although nearly universal vaccination could not keep the highly mutated omicron variant from sweeping through the state, Vermont's collective measures do appear to be protecting residents from the worst of the contagion's damage. Vermont's COVID-related hospitalization rates, while higher than last winter's peak, still rank last in the nation. And overall death rates also rank comparatively low.

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Children in Vermont are testing positive for COVID, and pediatric hospitalizations have increased. But an accompanying decrease in other seasonal pediatric illnesses, like influenza and respiratory syncytial virus, and the vaccinated status of the majority of the state's eligible children has eased the strain on hospitals that many other states are facing.

"I have to remind people that cases don't mean disease, and I think we're seeing that in Vermont," said Dr. Rebecca Bell, a pediatric critical care specialist at the University of Vermont Health Network in Burlington, the only pediatric intensive-care hospital in the state. "We have a lot of cases, but we're not seeing a lot of severe disease and hospitalization."

She added, "I have not admitted a vaccinated child to the hospital with COVID."

Vermont in many ways embodies the future the Biden administration and public health officials aim to usher in: high vaccination rates across all races and ethnicities; adherence to evolving public health guidelines; and a stick-to-itiveness and social cohesion when the virus is swarming. There is no "good enough" in Vermont, a state of just 645,000 residents. While vaccination efforts among adults and children have stalled elsewhere, Vermont is pressing hard to better its near-perfect score.
"We have a high percentage of kids vaccinated, but we could do better," said Dobson.

He continues to urge unvaccinated patients to attend his weekly vaccination clinic. The "first-timers" showing up seem to have held off due to schedules or indifference rather than major reservations about the vaccines. "They are nonchalant about it," he said. "I ask, 'Why now?' And they say, 'My job required it.' "

Replicating Vermont's success may prove difficult.

"There is a New England small-town dynamic," said Dr. Tim Lahey, director of clinical ethics at the University of Vermont Medical Center in Burlington. "It's easy to imagine how your behavior impacts your neighbor and an expectation that we take care of each other."

While other rural states in the Midwest and South have struggled to boost vaccination rates, New England, in general, is outpacing the pack. Behind Vermont, Rhode Island, Maine, and Connecticut have the highest percentage of fully vaccinated residents in the country.

"It's something beyond just the size," said Dr. Ben Lee, an associate professor at the Robert Larner, M.D. College of Medicine at the University of Vermont. "There is a sense of communal responsibility here that is a bit unique."

In a state with the motto "Freedom and Unity," freedom has largely yielded to unity, and the state's pandemic response has been met with eager compliance. "The general attitude here has been enthusiasm to be safer," said Lahey.

Lahey credits the state's Republican governor, Phil Scott, who has been "unambivalent about pro-vax messaging." Combined with a "tendency to trust the vaccine, you get a different outcome than in places where political leaders are exploiting that minority voice and whipping people up in anger."

Vermont's medical leaders are advising state leaders to shift from a COVID war footing—surveillance testing, contact tracing, quarantines, and lockdowns—to rapprochement: testing for COVID only if the outcome will change how doctors treat a patient; ceasing school-based surveillance testing and contact tracing; and recommending that students with symptoms simply recuperate at home.

Once the omicron wave passes and less virus is circulating, Dobson said, a highly vaccinated state like Vermont "could really drop nearly all mitigation measures and society would function well." Vermonters will become accustomed to taking appropriate measures to protect themselves, he said, not unlike wearing seat belts and driving cautiously to mitigate the risk of a car accident. "And yet," he added, "it's never zero risk."

Spared the acrimony and bitterness that has alienated neighbor from neighbor in other states, Vermont may have something else in short supply elsewhere: stamina.

"All of us are just exhausted," said Lahey, the ethics director. But "we're exhausted with friends."

Kaiser Health News is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.