Virginia's hospitals are filling up with COVID patients. Its rural, unvaccinated population may be the cause.

• Virginia has one of the highest vaccination rates in the US.
• But it has seen a substantial rise in hospitalization in recent weeks.
• An expert told Insider that uneven distribution of vaccinated people gives the virus an opening.

Virginia is the country's 12th most vaccinated state, with almost 60% fully vaccinated.

Vaccination is known to greatly reduce the risk of hospitalization from COVID-19.

Yet, in the latest wave of COVID-19, hospitalization rates in Virginia rose to about two thirds of the state's highest-ever levels, recalling a time when almost nobody was vaccinated.

The pattern has not been mirrored in other states, where despite a general uptick in cases, the vaccines did a much more pronounced job of keeping people out of the hospital.

Insider spoke to an expert to find out why.

He said that the state's top-level stats masked the reality that large parts of Virginia's population - mainly those in rural areas - have avoided vaccination, and are now falling sick.

Rural counties have lower vaccination rates

COVID-19 hospitalization in Virginia rose about 1,000% compared to July, the Virginia Hospital & Healthcare Association (VHHA) said in a statement last week.

But it is not the vaccinated who are driving the rise in severe disease, said Bryan Lewis, a professor at the University of Virginia who has been modeling the spread of COVID-19 for the state.

Instead, Lewis told Insider that the rise in hospitalization can be explained by individual counties' wildly different vaccination rates.

Uptake has been good in the most populated counties, like those in the North, East, and Southeast. Fairfax County, for instance, which overlaps with parts of Washington D.C., has fully vaccinated 73% of its population.

But in the more rural areas of the state, like those in the southwest, vaccination rates have been lower. For example, Lee, the western-most county, has only vaccinated 38%.

Cases have risen where vaccination is low. According to data from the state's department of health, fully vaccinated people in Virginia are eight times less likely to get COVID-19 than unvaccinated people.

The rate of COVID-19 in Southwest Virginia is mid-September was two times higher than statewide, said Breanne Forbes Hubbard, Public Health Manager for the Mount Rogers Health District, according to WJHL local news station.

Hospitalizations have followed, with rates in southwestern counties much higher than in the north.

As of Tuesday, Washington County in the southwest had reported a cumulative 934 COVID-19 hospitalizations per 100,000 people, compared to Loudoun, in the north, which reported 284.

People in rural areas might be meeting the virus for the first time

Like the rest of the US, Lewis said, those who haven't been vaccinated are not that confident in the vaccine. "There's a little bit of a political element. There's a little bit of personal freedom element. There's a lot of sort of disbelief in the safety and efficacy of the vaccine," he said.

The vaccination divide follows the political lines, Lewis said, with the most conservative being more vaccine hesitant.

The state may have elected Joe Biden in November 2020, but the state map is overwhelmingly red, per Politico. That's because more than half of the state's population live in 11 counties.

The other 4 million are spread out over 122 counties, according to University of Virginia data from 2020.

That people in those counties are far and few between might have played a part in the hesitancy: rural communities were mostly spared in the previous waves of COVID-19 in the state, so many would not have seen the effects of COVID-19 firsthand, Lewis said.

This provided a false sense of safety in the rural areas. They were left unprotected as waves of people came into these areas in the summer, bringing with them the coronavirus.

Hospitals under increased pressure

For now, the health system is coping with the surge in hospitalizations. More than 20% of the ICU beds in the state are open, per data from the Department of Health and Human Services.

But the arrival of Afghan refugees to the state is compounding the pressure, the Virginia Hospital & Healthcare Association (VHHA) said in a statement last week.

"Our hospitals are already almost at capacity," Kristin Nickerson, the executive director of the Northern Virginia Emergency Response System, told the Washington Post.

"It's not like they have tons of free beds available. We are still in the middle of a pandemic."