Californians age 75 and older made up 53% of covid deaths through July in 2022, up from 46% in 2020 and 2021. Only about 6% of the state’s residents are 75 and older. And white Californians 75 and older outnumber Latinos in that age group about 3 to 1.
In the initial vaccination rollout, California prioritized seniors, first responders, and other essential workers, and for several months in 2021 older residents were much more likely to be vaccinated than younger Californians.
“Now, the vaccination rates have caught up pretty much with everybody except for kids, people under 18,” Brewer said. “You’re seeing it go back to what we saw before, which is that age remains the most important risk factor for death.”
Start with the vaccine formula—or formulas, actually, because there are two. They were born from a ferocious mid-20th century rivalry between scientists Jonas Salk and Albert Sabin. Salk’s formula, the first to be approved, is injected; it uses an inactivated version of the virus, and protects against developing disease, but does not stop viral transmission. Sabin’s formula, which came a few years later, used an artificially-weakened live virus. It does block transmission, and—because it is a liquid that gets squirted into a child’s mouth—it is cheaper to make and easier to distribute, since it doesn’t require trained healthcare workers or careful disposal of needles. Those qualities made the Sabin oral version, known as OPV, the bulwark of polio control, and eventually the main weapon in the global eradication campaign.
The oral vaccine had a unique benefit. Wild-type polio is actually a gut virus: It locks onto receptors in the intestinal lining and replicates there before migrating to the nerve cells that control muscles. But because it’s in the gut, it also passes out of the body in feces and then spreads to other people in contaminated water. The Sabin vaccine takes advantage of that process: The vaccine virus replicates in a child, gets pooped out, and spreads its protection to unvaccinated neighbors.
Yet that benefit concealed a tragic flaw. Once out of every several million doses, the weakened virus reverted to the neurovirulence of the wild type, destroying those motor neurons and causing polio paralysis. That mutation would also make a child who harbored the reverted virus a potential source of infection, rather than protection. That risk is what caused rich nations to abandon the oral version: In 1996, when wild polio was no longer occurring in the US, the oral vaccine caused about 10 cases of polio paralysis in children. The US switched to the injectable formula, known as IPV, in 2000, and the UK followed in 2004.
Polio vaccination requires several doses to create full protection, and once that occurs, children are protected against both wild-type and vaccine-derived versions of the virus. So the international vaccination campaign continued to rely on OPV, arguing that the risk would diminish as more children received protection. That was a reasonable gamble when the effort was new and health authorities thought it would take 10 to 12 years to achieve eradication. But thanks to funding shortfalls, political and religious unrest, and the Covid pandemic—which imposed a slowdown not just on eradication activities but on all childhood vaccines—it’s now been 34 years, and the job is not done. Meanwhile, last year in 20 countries there were a total of 688 cases of paralysis of what’s called “circulating vaccine-derived poliovirus,” and only six cases of wild-type polio, in three nations.
The pandemic is not done. The number of new infections — surely an undercount due to unreported home tests — again tops 75,000 per day. The number of hospitalizations has climbed 20 percent over the past two weeks. The Biden administration has warned there could be 100 million more Americans infected by early next year. Yet Congress seems unwilling to provide more money for basic responses such as tests and vaccines, even as it becomes increasingly clear that even mild cases can lead to dangerous long-term damage.
Yet there are positive developments to consider as well. Vaccinations and certainly boosters are not where they should be, but three out of four Americans have received at least a single dose and two-thirds are fully vaccinated. The Commonwealth Fund has estimated that, absent vaccines, an additional 2.3 million Americans would have died, and 17 million more would have been hospitalized. Public health measures such as masking have largely fallen out of favor, but they helped prevent a death toll that could have been even more terrible.
“A million is way too many people, but as a result of the work that has been done, through public health and vaccination, it’s a number that’s a lot lower than it might have been,” says David Fleming, a distinguished visiting fellow at the Trust for America’s Health. “If we did not do those things, we would not be looking at the 1 million death threshold, we’d be looking at the 3 million death threshold.”
The two zip codes encompassing this region — 11224 and 11235 — have experienced 75 deaths per 100,000 people over the last month, a fatality rate nearly three times the citywide average. The pair of zip codes ranked only behind East New York when it came to the pace of COVID deaths between December 24th and January 20th, while their hospitalization rates were also among the highest in the city.
These two zip codes in southern Brooklyn also have lower vaccination coverage than the city as a whole, a common thread between most of the places hit hardest this winter. The area is averaging 66% full vaccination, compared with 75% citywide. In adjacent Gravesend, fewer than two-thirds of residents are fully vaccinated, and meanwhile, some parts of the city are approaching universal coverage.
Hospital leaders said undervaccination is having an outsized effect on these oceanside communities because the area’s demographics make residents prone to severe illness from COVID-19. In Brighton Beach and Coney Island, 26% of residents are over the age of 65, compared with about 14% in the borough as a whole. Many of those elderly residents also have underlying health conditions.
Citywide, 89% of New Yorkers between ages 65 to 74 are fully vaccinated, but the rate drops to 63% for people older than 85. Municipal data also show coverage varies by region and by other demographics. For instance, just 62% of white seniors in the Bronx are fully vaccinated, and only 65% of Black seniors in Brooklyn.
Beginning Monday, at the order of Democratic Governor Kathy Hochul, every business in the state was required by law to have every employee and customer show proof of full COVID-19 vaccination, or make everyone inside their doors over the age of 2 wear a mask.
Violators face fines of up to $1,000. Enforcement is being left to county governments, of which an estimated one-quarter—almost all run by Republicans—have indicated they will not participate in.
The two-shot vaccination rate for New Yorkers ages 12 and older currently stands at 81 percent. Six months ago, when Hochul’s predecessor Andrew Cuomo lifted almost all statewide COVID restrictions, he did so because the Empire State had crossed the 70 percent threshold set by the Centers for Disease Control and Prevention (CDC)—not for full vaccination of everyone over age 12, mind you, but for single shots among adults.
Contra Hochul, it is far from clear that even 100 percent vaccination would have prevented a third consecutive winter surge across the northeast, which currently has the highest rates of vaccination and coronavirus cases in the United States.
The SARS-CoV-2 B.1.617.2 (Delta) variant is highly transmissible; however, whether it causes more severe disease in adults has been uncertain.
What is added by this report?
Analysis of COVID-NET data from 14 states found no significant increases in the proportion of hospitalized COVID-19 patients with severe outcomes during the Delta period. The proportion of hospitalized unvaccinated COVID-19 patients aged 18–49 years significantly increased during the Delta period.
What are the implications for public health practice?
Lower vaccination coverage in adults aged 18–49 years likely contributed to the increase in hospitalized patients during the Delta period. COVID-19 vaccination is critical for all eligible adults, including adults aged <50 years who have relatively low vaccination rates compared with older adults.
Author(s): Christopher A. Taylor, PhD1; Kadam Patel, MPH1,2; Huong Pham, MPH1; Michael Whitaker, MPH1; Onika Anglin, MPH1,2; Anita K. Kambhampati, MPH1; Jennifer Milucky, MSPH1; Shua J. Chai, MD3,4; Pam Daily Kirley, MPH4; Nisha B. Alden, MPH5; Isaac Armistead, MD5; James Meek, MPH6; Kimberly Yousey-Hindes, MPH6; Evan J. Anderson, MD7,8,9; Kyle P. Openo, DrPH7,8; Kenzie Teno, MPH10; Andy Weigel10; Maya L. Monroe, MPH11; Patricia A. Ryan, MS11; Justin Henderson, MPH12; Val Tellez Nunez, MPH12; Erica Bye, MPH13; Ruth Lynfield, MD13; Mayvilynne Poblete, MA, MPH14; Chad Smelser, MD15; Grant R. Barney, MPH16; Nancy L. Spina, MPH16; Nancy M. Bennett, MD17; Kevin Popham, MPH18; Laurie M. Billing, MPH19; Eli Shiltz, MPH19; Nasreen Abdullah, MD20; Melissa Sutton, MD20; William Schaffner, MD21; H. Keipp Talbot, MD21; Jake Ortega, MPH22; Andrea Price22; Shikha Garg, MD1; Fiona P. Havers, MD1; COVID-NET Surveillance Team
So what the chart in the tweet linked above is really showing is that, within the 10-59 age band, the average unvaccinated person is much younger than the average vaccinated person, and therefore has a lower death rate. Any benefit from the vaccines is swamped by the increase in all-cause mortality rates with age.
I have mocked up some illustrative numbers in the table below to hopefully show Simpson’s Paradox in action here. I’ve split the 10-59 age band into 10-29 and 30-59. Within each group the death rate for unvaccinated people is twice as high as for vaccinated people. However, within the combined group this reverses – the vaccinated group have higher death rates on average!
I and others have written to ONS, altering them to the concerns that this data is causing. It appears from a new blog they have released that they are aware of the issue and will use narrower age bands in the next release.
Author(s): Stuart Macdonald
Publication Date: 22 Nov 2021
Publication Site: COVID-19 Actuaries Response Group
The high vaccination rate stands in contrast to Puerto Rico’s initial vulnerability to the coronavirus. Four years after Hurricane Maria destroyed the electricity grid, power outages still occur regularly. Many municipalities face a shortage of health care facilities and workers.
The U.S. territory responded with some of the strictest pandemic measures in the country, including nonessential-business closures, stay-at-home orders and mask mandates.
Its successes aside, Feliú-Mójer noted that COVID-19 has still killed over 3,200 people in Puerto Rico. And she remains concerned about vaccine equity — particularly in rural communities or among older adults who can’t get out of their homes or don’t know how to make an appointment. She says the high overall vaccination rate can hide gaps in coverage.
“You have to look beyond that big number,” she said in a separate interview with NPR. “But then you look at certain municipalities like Loíza, a town in coastal northern Puerto Rico that’s predominantly Black and [a] very poor municipality. Their vaccination rate is about 55%. And so when you look at some of the social determinants that impact communities like Loíza, then they’re not doing as well.”
Author(s): PATRICK JARENWATTANANON, AYEN BIOR, SARAH HANDEL
Trends in vaccinations and cases by age group, at the US national level. Data is stratified by at least one dose and fully vaccinated. Data also represents all vaccine partners including jurisdictional partner clinics, retail pharmacies, long-term care facilities, dialysis centers, Federal Emergency Management Agency and Health Resources and Services Administration partner sites, and federal entity facilities.
According to a new survey from the Kaiser Family Foundation, as the rate of U.S. adults who report having received at least one dose of the COVID-19 vaccines continues to climb, the rates among racial groups are now basically identical, comprising 71 percent of white adults, 70 percent of black adults, and 73 percent of Hispanic adults. President Joe Biden’s proposed mandate for all private-sector employees to be vaccinated has yet to take effect, so this is a good sign for the efficacy of general persuasion over a top-down mandate.
Russia’s daily tolls of coronavirus infections and deaths surged to another record on Friday, a quickly mounting figure that has put a severe strain on the country’s health care system.
The government’s coronavirus task force reported 32,196 new confirmed coronavirus cases and 999 deaths in the past 24 hours.
The record for daily COVID-19 deaths in Russia has been broken repeatedly over the past few weeks, as fatalities steadily approach 1,000 in a single day. It comes amid increasing infections and a reluctance by authorities to toughen restrictions that would further cripple the economy.
The government said this week that about 43 million Russians, or just about 29% of the country’s nearly 146 million people, are fully vaccinated. Authorities have tried to speed up the pace of vaccination with lotteries, bonuses and other incentives, but widespread vaccine skepticism and conflicting signals from officials stymied the efforts.