Who Is Dying from COVID Now, and Why

Who Is Dying from COVID Now, and Why

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 are the people still dying and why?

Older persons were always particularly vulnerable and now account for a greater proportion of COVID deaths than ever before during 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. Even though COVID is still the leading cause of death, nursing home deaths are rising. 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 impacts 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. Despite the fact that the gap is closing, rural residents still die 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.

Discrimination and racism also play a significant role in COVID deaths. Experts predict that while differences in the age-adjusted deaths rates based upon race have been decreasing, they will rise 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 .”

Area chart shows share of COVID deaths in the U.S. by age group (under 65, 65–74, 75–84, 85 ) from Apr. 2020 to Sep. 2022.
Credit: Amanda Montanez; 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. Elizabeth Wrigley-Field, a University of Minnesota sociologist and demographer, says that it is scary to imagine what will happen if there is a new surge.

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.

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. However, COVID deaths at nursing homes have increased 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. According to Justin Feldman, a visiting scientist at Harvard Francois-Xavier Bagnoud Center for Health and Human Rights who studies social inequality, “younger people rarely get sick” under normal circumstances in the U.S. 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.”

Other patterns are emerging when it comes to race, ethnicity, and geography. Experts warn that these changes may be temporary.

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 predict the same pattern of inequity for future surges. “Whites are dying at higher rates when total deaths are lower,” Feldman says. Feldman also says that Black people are dying faster during other times when the death count is higher. “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. People of color are also more affected by changes in life expectancy. 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 by rural areas that have poorer access to healthcare and a sicker and older population, and frequently lower vaccination rates.

COVID vaccinations have helped to reduce some disparities. “Vaccination shrinks racial inequality,” Feldman says. Feldman says, “Vaccination reduces racial inequality.” 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.

The majority of COVID deaths now occur among people who have had at least one shot of vaccine. In July 59 percent of COVID deaths were among the vaccinated, and 39 percent were among people who had one booster or more. The vaccines still work well and reduce the risk of serious illness and death. Vaccines’ effectiveness decreases over time and boosters must be used in conjunction with other preventative measures to avoid 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. Wrigley-Field states that boosters have never been made available and easily accessible in the same way as primary series vaccinations. Boosters are essential not only to reduce hospitalizations and deaths but also to weaken transmission chains and protect the most vulnerable.

Both monoclonal antibodies and antiviral drugs, which can be very effective in preventing hospitalizations and deaths, are often underused and not distributed equally. 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.

Nearly 8.7 million Americans have immunocompromised conditions, which puts them at higher risk of dying 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 this crisis,” Urquiza states. “The most vulnerable will not be left behind, but will be sentenced .”

This might sound 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. Goldstein states that we all lose something when a loved one dies. “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 believe we are proving ourselves completely incapable of handling these types of challenges. And that scares me for the future.”

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.

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