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Health Care


WHO IS DYING FROM COVID NOW AND WHY

Nearly three years into the pandemic, COVID’s mortality burden is growing in
certain groups of people

 * By Melody Schreiber on November 16, 2022

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Credit: EllenaZ/Getty Images

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Today in the U.S., about 335 people will die from COVID—a disease for which
there are highly effective vaccines, treatments and precautions. Who is still
dying, and why?

Older people were always especially vulnerable and now make up a higher
proportion of COVID fatalities than ever before in the pandemic. While the total
number of COVID deaths has fallen, the burden of mortality is shifting even more
to people older than age 64. And deaths in nursing homes are ticking back up,
even as COVID remains one of the top causes of death for all ages. COVID deaths
among people age 65 and older more than doubled between April and July this
year, rising by 125 percent, according to a recent analysis from the Kaiser
Family Foundation. This trend increased with age: more than a quarter of all
COVID fatalities were among those age 85 and older throughout the pandemic, but
that share has risen to at least 38 percent since May.

Where people live also affects their risk level. The pandemic first hit urban
areas harder, but mortality rose dramatically in rural areas by the summer of
2020—a pattern that has held. The gap is currently narrowing, but people living
in rural areas are still dying at significantly higher rates. Rural death rates
fell from 92.2 percent higher than urban rates at the end of September to 38.9
percent higher in mid-October.


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Racism and discrimination also play an outsize role in COVID deaths. While
differences in age-adjusted death rates based on race have recently become
smaller, experts predict inequities will likely skyrocket again during surges.

For the past several weeks, the COVID death rate in the U.S. has stayed fairly
steady, with 2,344 people dying of the illness in the seven-day period ending on
November 9, according to the U.S. Centers for Disease Control and Prevention.
Even so, the U.S. still accounts for a large portion of all confirmed COVID
deaths happening around the globe, and it has the highest number of confirmed
COVID deaths of any country. There have been 1.2 million excess deaths in the
U.S. since February 2020, according to the CDC—losses that have reshaped almost
every part of American life. The viral illness has remained a leading cause of
death throughout the pandemic. And overall U.S. life expectancy has dropped
significantly since the crisis began. “That is unprecedented,” says Kristin
Urquiza, co-founder of Marked by COVID, an advocacy network memorializing the
victims of the illness. “And I don’t think that’s going to stop anytime soon.”


Credit: Amanda Montañez; Source: Kaiser Family Foundation

More than 200,000 people have already died because of COVID in the U.S. in 2022,
and President Joe Biden’s administration is bracing for 30,000 to 70,000 more
deaths this winter. A bad flu year, in comparison, brings about 50,000 deaths.

Yet public funding has dwindled or vanished for the very vaccines and treatments
that have lowered the risk of COVID death. In the next four months or so, these
key tools will only be available to those who can afford them on the private
market as current federal subsidies dry up—a situation that could affect access
and uptake. “It’s scary to think about what happens when there’s a next surge if
those things don’t come back,” says Elizabeth Wrigley-Field, a demographer and
sociologist at the University of Minnesota.

At the peak of the most recent surge of fatalities in August, 91.9 percent of
all deaths around the country were among people 65 and older—the biggest share
of any surge in the pandemic, even higher than in April 2020.


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Long-term care facilities were hit extremely hard during the pandemic, with
residents and staff accounting for about one fifth of all COVID deaths. In 2021
vaccinations and treatments helped lessen these blows. But COVID deaths in
nursing homes have now risen again. From April to August this year, this number
more than tripled.

Although most COVID deaths are among the elderly, younger people are still dying
at higher rates than usual because of the illness—especially those who work in
essential fields, research shows. Under normal conditions in the U.S., “younger
people rarely die,” says Justin Feldman, a visiting scientist at the Harvard
François-Xavier Bagnoud Center for Health and Human Rights, who studies social
inequality. But now, he says, “excess mortality for all age groups is quite high
and uniquely high in the U.S., compared to other wealthy countries.”

When it comes to race and ethnicity, as well as geography, other patterns are
emerging as well. But experts note that such changes are likely to be temporary.



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Each fall COVID mortality rates among white people have edged closer to or
higher than those among Black people. But deaths of racially minoritized people
have jumped again during surges, when the total COVID death rate climbs. Experts
expect the same pattern of inequity in future surges. “White people are dying at
higher rates during particular time periods when the total death counts are
lower. And Black people are dying at higher rates during other time periods when
death counts are higher,” Feldman says. “And that’s not even acknowledging
American Indians, Alaska Natives and Pacific Islanders, who’ve had consistently
the highest death rates this entire time, at every point in time, and often are
excluded from these kinds of analyses.”

Two years into the pandemic, deaths from all causes were higher for Indigenous
peoples and Pacific Islanders, compared with pre-COVID levels, according to a
study published in September. Changes in life expectancy have also hit people of
color harder. Black, Hispanic and Indigenous people in rural areas had the
deadliest 2021 from COVID among all relatively large racial or ethnic groups in
the U.S., according to a preprint paper that has not yet been peer-reviewed.
These disparities are often exacerbated in rural areas with poorer access to
health care and an older and sicker population—and frequently lower vaccination
rates.


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COVID vaccines have helped reduce some disparities. “Vaccination shrinks racial
inequality,” Feldman says. “It’s that simple.” But the same factors putting many
people of color at risk, including racism and systemic oppression, persist. For
example, booster access in communities of color has been inequitable, driving
death rates higher.

Being unvaccinated is still a major risk factor for dying from COVID. In August
2022 unvaccinated people died at six times the rate of those who got at least
the primary series of the vaccine, according to the CDC. And unvaccinated people
age 50 and older were 12 times more likely to die than vaccinated and
double-boosted peers.

Because a large portion of the U.S. population has at least one COVID shot, the
majority of deaths are now among vaccinated people. In July 59 percent of COVID
deaths were among the vaccinated, and 39 percent were among people who had one
booster or more. That doesn’t mean the vaccines are not working anymore; they
are still highly effective at reducing the risks of severe illness and death.
But their efficacy wanes over time, and continued boosters need to be combined
with other precautions to prevent illness and death. In August, people age 50
and older who were vaccinated and had just one booster were three times more
likely to die than people with two or more boosters, according to the CDC.

Only 10.1 percent of Americans age five and older have received the relatively
new bivalent booster, which is highly effective against the Omicron variants of
SARS-CoV-2, the virus that causes COVID. More than 14 million Americans 65 or
older (or nearly 27 percent) have gotten the updated jab—a higher rate than
among younger Americans but nothing like the uptake for the initial two doses.
“We’ve never had the same kind of efforts to make boosters available and
accessible the way that we did primary series vaccinations,” Wrigley-Field says.
Boosters are critical not just to reduce hospitalization and death for everyone
but also to weaken chains of transmission and help protect the most vulnerable.

Antiviral drugs and monoclonal antibody treatments, both of which can be
extremely effective at preventing hospitalization and death, are also underused
and inequitably distributed. Zip codes with the most vulnerable people have the
lowest uptake of antivirals despite having the most dispensing sites, one CDC
study found. Another CDC study showed that people of color are less likely than
white people to receive monoclonal antibodies. Between May and early July, only
11 percent of people who tested positive for COVID reported being prescribed
antivirals. Notably, those with higher incomes received the highly effective
antiviral Paxlovid at more than twice the rate of those with lower incomes,
according to another study. An estimated 42 percent of U.S. counties were
“Paxlovid deserts” as of March, according to one analysis from a
medication-dispensing site.


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About 8.7 million Americans are immunocompromised, putting them at greater risk
of death from COVID. Yet only about 5.3 percent of them have received Evusheld,
a treatment that can prevent severe outcomes for six months at a time, the CDC
estimated in September.

“We’re still in the middle of this crisis,” Urquiza says. “The most vulnerable
will not just be left behind but will be sentenced to death.”

This might seem like a story about numbers. It’s not. It’s a story about people.
Many of their stories have been compiled by Alex Goldstein, founder of Faces of
COVID, an online project established to show the stories behind the
statistics—and to honor the lives lost and those who grieve them. “We all lost
something when your loved one died,” Goldstein says. “My biggest fear has always
been that if we fail to learn the lessons of this pandemic, which I believe we
are in the process of doing, we will be hit 10 times harder by the next one,” he
adds. “I think we’re proving ourselves to be completely unable to wrap our arms
around those types of challenges. And that scares me for the future.”

Rights & Permissions


ABOUT THE AUTHOR(S)

Melody Schreiber is a journalist who has reported from every inhabited
continent, and is the editor of What We Didn’t Expect: Personal Stories of
Premature Birth (Melville House, Nov. 2020). Follow her on Twitter @m_scribe.

RECENT ARTICLES BY MELODY SCHREIBER

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