Mississippi View of COVID-19 and Kidney Failure

CKD has been an increasing problem in Mississippi, especially with contributing factors such as high rates of obesity, diabetes, and high BP. According to U.S. News, Mississippi is currently ranked last in health care in the United States.1 The article “Kidney Biopsy Findings in Patients with SARS-CoV-2 Infection or After COVID-19 Vaccination,” published in this issue of CJASN, is critically important for Mississippians because it shows the effects of the coronavirus 2019 (COVID-19) pandemic on people with kidney failure.2

Personally, I find some flaws and positives with the research, outside of the limitations of lack of follow-up biopsies due to various reasons. I would also like to see the effects on younger generations and women with COVID-19, such as whether getting the vaccine affects fertility issues with immunosuppressed women. I have met with women in both Vicksburg and Jackson, Mississippi, who were urged by their doctors to get vaccinated, but they expressed apprehension because of the high infant mortality rates in Mississippi. According to the CJASN article, however, the postvaccination and COVID-19 infection groups had kidney function recovery rates of 69% and 73%, respectively.2 I find these numbers to be a great resource for dissenting opinions in Mississippi where there has been a long-standing struggle with low vaccination numbers.

Infection after COVID-19 vaccination has also had a long struggle in the health care system in Mississippi, as rural hospitals continue to close and rural areas oftentimes do not have access to medical attention, especially specialists such as nephrologists. Outside of metropolitan areas, such as Jackson, patients may have to travel over 40 miles to seek emergency medical attention, and for visits with nephrologists, that number could be at least 50 miles. COVID-19 placed a severe strain on hospitals, and according to Mississippi Today, “The October version of the [Center for Healthcare Quality and Payment Reform] report, which the organization releases every three months, said that over half, or 38, of Mississippi's 70 rural hospitals were at risk of closing. Of those, 24 were at risk of closing imminently.”3 Only three of 82 counties in Mississippi have a vaccination rate higher than 70%, and none of those three counties have a hospital within 30 miles of their counties' border.4 Mississippi was, at several times, considered to be the COVID-19 capital of the world because of the high number per capita, with poor access to care as the main determinant of the high COVID-19 numbers.5

Since 2020, Mississippi has fallen from 47th to 49th in kidney failure rates as more than 2000 people have been added to the official kidney failure statistics.5 Although these numbers are not a direct result of COVID-19, the indirect result of more people going to doctors' appointments allowed more people to find out they were in kidney failure.

Mississippi, Texas, Iowa, Montana, and North Dakota were the first five states to end the mask mandate after nearly 1 year into the COVID-19 pandemic. Mississippi's conservative political climate made it extremely difficult to increase vaccination rates after Governor Tate Reeves signed House Bill 1509, which made it illegal to require children to receive a COVID-19 vaccine as a condition of attending a school, kindergarten, or similar type of facility intended for the instruction of children, whether public or private.6 The bill bans state agencies, public officials, state colleges and universities, junior colleges, and municipalities from refusing services, health care access, or employment on the basis of a person's vaccination status. The Associated Press published an article6 in late August 2021 that quotes Governor Reeves during one of his weekly COVID-19 news briefings stating: “the Bible is very clear that ‘Whosoever believeth in him shall not perish but have everlasting life…. And, that is my worldview, it is how I believe, it is what drives me every single day, and I think it is what drives many Mississippians. We should take necessary precautions with respect to COVID-19, but we also understand that we do have everlasting life if we believe in Jesus, if we believe in God the father, and I certainly do…. I am often asked by some of my friends on the other side of the aisle about COVID-19… and why it seems like folks in Mississippi and maybe in the Mid-South are a little less scared, shall we say…. When you believe in eternal life—when you believe that living on this earth is but a blip on the screen, then you do not have to be so scared of things.”

At the time of the article's release, Mississippi had the highest per capita rate of new coronavirus cases and deaths in the United States, followed by Florida, Tennessee, South Carolina, and Louisiana. Despite having one of the lowest vaccination rates, Mississippi's Attorney General, Lynn Fitch, was one of the leading members of a lawsuit suing China because of COVID-19. In an April 25, 2020, interview with Fox News, Fitch said that the lawsuit “allows Mississippians to seek justice and hold China accountable. Because if you look at what they have done, this has been very malicious… a very dangerous cover-up. The coronavirus has killed. The coronavirus has caused serious medical damage and harm across our country and our state. It has destroyed our businesses, and it functionally altered the way Americans will live…. We see the damages, the issues that they [China] have caused Mississippians. So, I am bringing the suit on behalf of Mississippians.”7 The counties that have the lowest vaccination rates also ranked highest in death rates and hospitalization, coinciding with the counties that have the lowest educational attainment.

As Executive Director of the Mississippi Kidney Foundation, I have met several patients who have been on dialysis since contracting COVID-19. Kevin M. in Canton, Mississippi, recalled seeing a “white light” while being unconscious in the University of Mississippi Medical Center, an indicator that he believed was death. Kevin was an unvaccinated line worker at the Nissan factory and stated that he wished he had taken the vaccination. Kevin refused to take the vaccination due to a government conspiracy theory he heard from other family members. Kevin stated, “the government has never given anyone anything, so why should I trust that shot.” But he expressed a sense of regret for not getting it: “I wish I had known what I know now because I probably would not be on dialysis now.” Amanda H. of Brandon, Mississippi, was a vaccinated dialysis patient and mentioned that she felt her urine output was worsened by the COVID-19 vaccination and booster. Amanda believed that the vaccination weakened her kidneys, despite being on dialysis for 6 years at that point.

Overall, I found this study to be eye-opening, and I am interested to see the continuous research that comes about. I find it intriguing because it shows the effect of COVID-19 due to clear biopsy research, despite the lack of diversity in the research. In a state like Mississippi where people have struggled to understand the effects of the COVID-19 vaccine, I was happy to know that it did not affect kidney functions, despite the opinions of several people in my state. I would recommend that we continue to do research despite the waning days of the public health crisis and publish this information even in noncrisis situations to stop conspiracy theories.

Disclosures

The author has nothing to disclose.

Funding

None.

Acknowledgments

The content of this article reflects the personal experience and views of the author(s) and should not be considered medical advice or recommendation. The content does not reflect the views or opinions of the American Society of Nephrology (ASN) or CJASN. Responsibility for the information and views expressed herein lies entirely with the author(s). Content does not reflect the views of the Mississippi Kidney Foundation. The author also wishes to acknowledge Kevin Fowler and dedicate the article to Madison J. Mayfield and Tahj J. Mayfield.

Author Contributions

Writing – original draft: T.J. Mayfield.

Writing – review & editing: T.J. Mayfield.

References 1. U.S. News. Mississippi Rankings and Facts. U.S. News. https://www.usnews.com/news/best-states/mississippi 2. de las Mercedes Noriega M, Husain-Syed F, Wulf S, et al.; CoV-Kidney Investigators. Kidney biopsy findings in patients with SARS-CoV-2 infection or after COVID-19 vaccination. Clin J Am Soc Nephrol. 2023;18(5):613–625. doi:10.2215/CJN.0000000000000106 3. Bose D. “‘Slightly More Breathing Room’: Fewer Rural Hospitals at Risk of Closure, but Threat Still Looms.“ Mississippi Today. February 8, 2023. https://mississippitoday.org/2023/02/08/mississippi-rural-hospital-closure-report/ 4. The New York Times. “Tracking Coronavirus in Mississippi: Latest Map and Case Count.” The New York Times. Updated March 23, 2023. https://www.nytimes.com/interactive/2021/us/mississippi-covid-cases.html 5. Mississippi State Department of Health. Coronavirus Disease 2019 (COVID-19). https://msdh.ms.gov/page/14,0,420.html 6. The Associated Press. “Tate Reeves: Christians are ‘Less Scared’ of COVID Because of their Belief in Eternal Life.” WLBT. August, 30, 2021. https://www.wlbt.com/2021/08/31/tate-reeves-christians-are-less-scared-covid-because-their-belief-eternal-life/ 7. Musto, J. “AG on China Lawsuit: Beijing ‘Cannot Continue to Deceive and Take Advantage of America.’” Fox News. April 25, 2020. https://www.foxnews.com/media/lynn-fitch-mississippi-attorney-general-china-coronavirus-lawsuit

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