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RICHMOND — Virginia Gov. Ralph Northam says a combination of local disregard for basic COVID-19 control measures and a lax mask policy by Tennessee officials is fueling the case and death spike in Southwest Virginia.

Northam, in a press conference on Wednesday, said Virginians can see hope with the arrival of COVID-19 vaccine doses by mid-December, but he blamed indoor social and church gatherings and a disregard for mask wearing and social distancing by many in the region for contributing to rising numbers of infections and deaths.

Virginia’s seven-day case incidence of 28 cases per 100,000 people is lower than 45 other states, Northam said, but four states bordering Southwest Virginia have higher incidence rates. North Carolina has about 34 cases per 100,000; West Virginia, 54; Kentucky, 66; and Tennessee, 69.

“Health officials believe that Tennessee’s lack of a mask requirement and other restrictions have increased the spread of the virus in neighboring Virginia communities,” he said, noting that many Southwest Virginia residents cross into Tennessee to shop, work and visit relatives.

Northam said health officials have also identified a combination of church and small social gatherings and after-work and after-school socializing as a major source of COVID-19 community spread. While schools and workplaces have generally done well with disease control and mitigation measures, he said, community spread is still the major source of infection. The Thanks- giving holiday might have added to the spread, he added.

“Virginians, you know the truth,” Northam said. “You don’t wear masks and you don’t social distance and you think your right to ignore public health advice trumps your neighbors’ right to not get infected by you. These cases will continue going up. It’s just selfish.”

Northam pointed to Ballad Health’s growing patient case and hospitalization numbers in recent weeks, combined with a shortage of nursing staff to cope with the case load.

Hospitals in Virginia generally have a surge capacity for COVID-19 case beds, Northam said, “but let’s not put it to the test.”

While health officials are monitoring for any signs of a case rise in the wake of the Thanksgiving holiday, Northam said that “all measures are on the table” if it comes to putting more restrictions on state residents and Southwest Virginia in particular to try and control the disease’s spread.

Virginia Secretary of Health and Human Resources Daniel Carey said state officials have been in discussion with Ballad Health about ways to deal with the case climb and nursing shortage. Possible measures may include using Virginia Medical Reserve Corps volunteers to help cover staffing needs and, if cases outstrip Ballad’s ability to handle them, looking at how patients can be sent to other health systems outside Ballad’s service region.

“Ballad is moving cases around within their hospitals,” Carey said. “Transportation (of patients to other hospital systems) would be a latter-stage change.”

Carey said the “root of the root” in dealing with the case rise still is following basic COVID-19 health guidelines: masks, hand-washing and social distancing.

On the vaccine side, Northam said the state can expect to see its first shipment of about 70,000 doses manufactured by Pfizer and Moderna around mid-December. Under a three-phase plan developed by the Virginia Department of Health, the first people to get the vaccine would be front-line health care workers and nursing home residents. A second shipment of doses — the vaccine requires two doses per person — should arrive about two weeks later. State Epidemiologist Lillian Peake said that the total number of people in those two groups is about a half-million people.

The VDH vaccination plan involves three phases, with health care workers, nursing home residents, and critical infrastructure workers being among the first phase of vaccinations. Medically vulnerable people and other priority groups would fall under phase two, with the general public getting vaccinations in the third phase.

Carey likened the plan to a situation where an airliner loses cabin pressure and people put on their own oxygen masks first so they can help others around them.

“It will be a ways before we get it to the general public,” Carey said.

If not enough vaccines are available initially for the priority groups, Northam — a physician himself — said vaccinations will be given based on medical ethics and protocols from the Virginia Hospitals and Health Association and the state Disaster Medical Advisory Committee.

Northam acknowledged that some Virginians, including a small segment of the state’s black population, may have a historical distrust of vaccinations. He said the Pfizer and Moderna vaccines, along with others including the AstraZeneca and Johnson & Johnson vaccines in trials, have been tested using solid medical protocols.

“We are not the enemy,” Northam said. “The virus is the enemy.”