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Doctors in MichiganÌýare urging people in the largely to get vaccinated, as the US contends with its fourth wave ofÌý.

Ìýhas become one of the hardest-hit US states with Covid-19, requiring teams of out-of-state medical personnel, doctors to work in theÌýstate's southeast.

"It’s been exhausting. During the very first surge, there was a newness about it. At that time, we stopped doing outpatient surgeries. We got a lot of help from other areas of the hospital,"ÌýMona Obeidy, a critical care physician in southeast Michigan, tells °®Âþµº.

"In waves two, three and four, we have the usual care patients. A lot of patients left sicker than before because of delays in getting care,"Ìýshe says, referring to a high volume of patients,Ìýincluding a higher volume of younger ones with the current wave, combined with a shortage of staff caused by illness, attrition and retirement. ÌýÌýÌýÌýÌýÌý

"We're taking care of more patients with less staff. That’s why applied for help and got extra staff."

Amid the - now breaking records as daily cases reach 500,000 - Michigan is among the hardest hit states.

In November, when the state ranked the highest in the country for Covid infections, it was the first to seek federal help for this wave, as the government sent .

At the end of December, a fourth teamÌý - adding to three teams, whose stays have been extended -Ìýwas being sent over the keep up with high volume of hospitalisations of the virus.

The United States is around 60 percent fully vaccinated, while Michigan'sÌýrate is around 55 percent, both far short of the 70 percent estimated for herd immunity. Moreover, the state ranks 30th in the country for vaccinations.

Michigan's high rate of covid infections is likely due to a combination of factors. First, the state's northern location means more travel to and from Canada and more people gathered indoors to shelter from the winter weather earlier than other states.

Second, the relatively low rate of vaccinations has led to high volumes of unvaccinated patients seeking care, which also comes at a time when many restrictions have been lifted.

Third, much of the vaccine hesitancy comes from parents who are afraid of the effects on their children.

Fourth, the high populations of immigrant communities in southeast Michigan often means intergenerational living in close quarters as well asÌýa mistrust of vaccines.

"We’re seeing vaccine hesitancy among Arabs and Muslims the same as other minority communities,"ÌýHasan Shanawani, a pulmonologist (lung doctor) in Dearborn toldÌý°®Âþµº.

"There's a stereotype that it’s just white right-wing groups, but that's just not the case. The issue is not that they're politically conservative. What correlates is a fundamental distrust of government and big business," he adds.

"I want to remind doctors and nurses that it's not their job to trust people. It's your job to earn their trust."

Muzammil Ahmed, a urologist who practices at Beaumont Hospital in Dearborn, one of the facilities where the federal help has been deployed, is also concerned about the low level of compliance, including in the Arab and Muslim communities.

Though it has improved since the beginning of the pandemic, the state's overall low vaccination rate has led to the current high number ofÌýhospitalisations. The vast majority of Covid patients are unvaccinated.

"The hospital here has served one of the highest numbers of covid patients since the beginning of the pandemic. It’s been an epicentre,"Ìýhe toldÌý°®Âþµº.

"As healthcare workers, we come across noncompliance frequently. The biggest frustration of noncompliance is so many people getting sick."

The federal help has come at an important time, as healthcare workers have been spending the holidays working overtime with the surge.

"They are allowing us to transfer patients to Beaumont Dearborn hospital. Our emergency rooms are backed up. This allows us to send more patients back to the main hospitals,"Ìýhe says.

"Everyone is working extra shifts. When you hear reinforcements are coming, it allows you to feel a little bit of breathing space. That emotional ability to say wow, there's some back-up is very heartening. The extra challenge with the holidays is that everyone wants to spend more time at home. Working overtime is emotionally draining."

For Ahmed, the heavy workload comes with pride in his community, as he and others with Muslim and Arab backgrounds are caring for some of the sickest Covid patients. According to a 2020 report by the Migration Policy Institute, immigrants in the US represent 17 percent of the overall civilian workforce, but they account for 28 percent of physicians.

"The communities we serve, especially in Dearborn, have many healthcare workers from Arab and Muslim backgrounds,"Ìýhe says.

"The has really helped change the paradigm about Arabs and Muslims in America. Before, we were viewed with suspicion. Now we're on the frontlines helping our neighbours. Hopefully this will help people shift their understanding of the impact our community has.

"This has allowed us to step up. It's great to see. We’re putting our culture and values into action."