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.
New hospital admissions for patients with COVID-19. CDC
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.
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%.
A map of vaccine uptake in Virginia. Virginia
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.
A car drives past a church with a Covid-19 message near Martinsville, Virginia on after the last wave of the pandemic on March 12, 2021. Andrew Caballero-Reynolds/AFP/Getty Images
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.
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.
People wearing masks walk across the Lawn at the University of Virginia in Charlottesville, Virginia. Julia Rendleman for The Washington Post via Getty Images
"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."
