ALPENA, Mich. — Snow fell as Richard Bates opened the passenger door of his silver Honda pickup truck. He placed a blue cooler packed with 130 doses of coronavirus vaccine on the front seat and buckled it in.

For the next three hours he traversed more than 140 miles, largely on two-lane highways, from MidMichigan Medical Center-Midland in Midland, Mich., to a rural community hospital here. Bates instinctively put his arm out in front of the cooler to keep it from sliding off, as if it was a toddler in the front seat, when he slowed down or hit the brakes.

The nation’s first coronavirus vaccines have largely gone to large medical centers in major cities, meaning many rural health-care workers will have to wait to get vaccinated as cases skyrocket nationwide.

UC Davis Health received its first shipment of the Pfizer-BioNTech vaccine on December 15, with emergency department employees receiving the first doses. (The Washington Post)

But at MidMichigan Medical Center-Alpena, Michigan’s most geographically isolated hospital, doses are being injected into the arms of health-care workers in a hospital 70 miles from the nearest interstate exit — thanks to Bates’s road trips. Bates likened the journeys to what he has spent much of his career doing: delivering babies and handing them to their parents for the first time.

“The only thing I can liken this to really is that feeling,” he said. “Once the baby is in your hands, you don't think about the pain of labor anymore … all the hopes and dreams are there.”

For the next several weeks, he’ll be tasked with transporting the vaccine from a hospital three hours away. He made the first trek nearly two weeks ago.

“And so I get to deliver again,” he said.

A general surgeon, a pulmonologist, an EMT and a nurse were among those vaccinated Dec. 16, becoming the first health-care workers in Northern Michigan to get the vaccine.

By having the vaccine in Alpena hours after it arrived in Midland, and seeing the nurses there get their first shots the same day as nurses in Detroit, Daniel L. Maxwell, chair of the hospital’s department of medicine, hopes people in the community will see that people in Alpena are getting the same treatments and the same vaccine as everyone else.

“We’re not getting it six months after Detroit or New York or San Francisco; we’re getting it at the same time,” he said. “To me and to our community, that’s a really important message.”

Northern Michigan did not see much coronavirus over the spring and summer, but cases skyrocketed this fall. Cases mounted toward the end of October and peaked in the weeks after Thanksgiving. In recent days, the numbers appear to be tapering off, but hospital admissions are still increasing. More than 1,100 people in Alpena County have contracted the coronavirus since the beginning of the pandemic, and 24 have died.

“We’re holding our own right now. We’re doing okay,” Maxwell said as he stood off to the side watching his staff line up for the vaccine.

They have enough hospital beds and ventilators, but staffing is strained. They’re losing workers to illness, whether they’re sick themselves or someone else at home is. Nurses are picking up extra shifts, working 12 hours, five days a week, and it’s starting to take a toll.

The hospital does what it can to get extra help, but sometimes, in a county of fewer than 30,000 people where the next closest hospital is two hours away, there just isn’t anyone else. The Alpena hospital serves a population of about 100,000 people in northeastern Michigan spread across seven counties. It’s not uncommon for patients to travel 60 miles to get there.

Maxwell said big-city hospitals have the same issues, but they also have other medical centers and a larger reserve of staff.

“The difference is that we’re us and we’re it,” he said.

In the conference-room-turned-vaccine-clinic, long card tables were set up as stations for different parts of the process: checking in, getting the vaccine and being observed for a few minutes afterward. Blue stickers on the floor ensure staff stay six feet apart as they wait in line to roll up their sleeves for shots in their right arms.

Katie Torok, who works in the hospital’s clinical education department and serves as a volunteer paramedic, is part of the small team that will staff the vaccine clinic this winter. She had no hesitation about being in the first wave to get the shots.

“I’ve got six children, 10 grandkids. I always tell my family I’m going to live to be 129,” she said. “Whatever little steps I have to take to do that, I will.”

She couldn’t believe how quickly the vaccine had made its way to Alpena. She assumed it would be months before it got to them. That mind-set is exactly why Maxwell says he wanted to get the vaccine here as fast as possible and pushed to make it happen.

“Sometimes when you live up here, you feel different,” he said. “I want our community to know that we are part of all this.”

Freezers are a major reason Alpena got the vaccine. MidMichigan health system is affiliated with the University of Michigan and serves 23 counties. Throughout the pandemic MidMichigan’s lead pharmacist and head of ancillary services, Bryan Cross, closely followed vaccine research. The vaccine from Pfizer and BioNTech appeared to be ahead of the pack — and if it succeeded, it would need to be stored in ultracold freezers. So in early October, he purchased two, just in case. In November, when Pfizer’s successful trial results were released and hospitals around the country scrambled to purchase the freezers, Midland was all set. They arrived the first week of December, just before the Food and Drug Administration authorized Pfizer’s vaccine for emergency use.

As the vaccine was going through the final stages of approval, MidMichigan Health landed on a list of five hospitals that the state said were “pre-positioned” to receive the first shipments as soon as they went out. The health system, which includes the main hospital in Midland and six other rural hospitals, also learned it would receive roughly 2,900 doses — nearly three times what was anticipated.

MidMichigan’s chief medical officer, Lydia Watson, isn’t sure why her hospital found itself at the top of the list, but she believes it has to do with the freezer procurement, and that the doses would go to nearly 7,000 health-care workers across Central and Northern Michigan. Bates drives the vaccines from the ultracold freezer in Midland to Alpena.

“They saw that we were going to be able to take care of the smaller community hospital that otherwise probably couldn’t get the vaccine,” she said.

A second vaccine, from Moderna, has since been given FDA emergency authorization. It can be stored in a standard refrigerator.

Alexa Ramacher, a registered nurse and supervisor, took a break from her evening shift to get the vaccine. Afterward, she described the challenges they’ve faced this fall.

“I don’t even know. It’s just stressful,” she said, trailing off. “It’s hard. Twelve hours working with these covid patients. And they’re sick; these patients are super sick.”

Nine months into the American pandemic, Ramacher says she’s just ready for it to be over. She’s overwhelmed by what she’s seeing day in and day out at work, and inundated with fears of being the one who gets her loved ones sick.

“I have babies at home. I just don’t want to take it home to them, [to] my family,” she said. Ramacher’s grandmother lives with her mother, and her mother watches her kids. That potential chain of transmission weighs on her.

“I try to do everything I can to keep this here and not take it home,” she said.

Thomas Thornton, a general surgeon and the vice president of medical affairs at the Alpena hospital, said the vaccine’s arrival finally offers some semblance of control.

“We're doing everything we can with social distancing and avoiding things, but otherwise you feel helpless against this,” he said. “[The vaccine] is the first step of really being able to actively reach out and combat this pandemic.”

Thornton, who grew up in Michigan’s rural Upper Peninsula and has worked in Alpena for about five years, hopes the community can reach herd immunity by vaccinating 70 percent of residents.

“I hope we can get there in northeast Michigan, but I think there definitely is a bit of an uphill battle,” he said.

The pandemic has become especially politicized in Michigan, where Gov. Gretchen Whitmer (D) has taken aggressive measures to curb the spread of the virus. For Ramacher, seeing people in the community, including her own family members, not take the coronavirus seriously makes her work even harder.

“I see what I see here. I see those family members being brought in. I see them super sick. I see them passing. I see it not going well. And then I have the other side,” she said.

Many people in her life — including her husband — don’t take the virus as seriously as she wishes they would.

“I come here and I wear a mask the whole time and, you know, I’m stripping down in the garage every night. I get home and showering and all that before I come in,” she said. “It’s frustrating to see those people that think it’s a hoax.”

Because some people in the community are not wearing masks or social distancing, it’s crucial to see people they know and trust getting the vaccine.

“It’s a small community. These guys walk into Walmart, everybody knows who they are, and they see that they are trusting this vaccine that they took; that speaks volumes,” Bates said.

Maxwell said he has been getting more and more questions about the vaccine this fall. Many patients told him they’d wait to see what his verdict was before they made up their mind.

“Let’s walk the walk,” he said. “We want to set an example for the community that says, ‘Yeah, we need to do this and we need to do this together.’ ”

Over the next several weeks, Bates will stay at his home in Alpena, shuttling down state every five days to pick up another batch of the vaccine. Even during the first three-hour journey, he was struck by the task ahead of them.

“I drove up and I’m just going through all those small towns and I’m thinking, how? My mind was just running,” he said. “All of this for this many people? Imagine trying to vaccinate whole towns.”

Part of the problem in rural medicine, he explained, isn’t just that there aren’t enough doctors; there are also obstacles to simply accessing care — such as people having to travel 25 miles on dirt roads that may or may not be plowed after a winter storm.

“Thinking about what we’re doing today and what needs to be done,” he said. “I think the challenge is ahead of us.”