A deeper dive into COVID data

I’m taking a deeper dive into some COVID-19 data today. I’m concerned and frustrated that the coverage of the virus has been, and continues to be, too shallow. We’re focusing on things like cumulative numbers of deaths, which has been terrible and significant, certainly. But the real story is much more complex than that, which makes it more difficult to comprehend and results in media stories that focus on things like temporary upticks in positive cases – spring breakers! high school athletes! anti-mask protests! – instead of the generally positive impact that the still-early rollout of vaccines has had already, and what that promises for later this spring and summer.

Overall vaccination numbers are improving

The fact that we have one vaccine for the coronavirus that causes COVID is amazing, though it’s the result of not just months of hard work but years of research into the types of vaccines that are being used, such as the messenger RNA (mRNA) type used in the development of the Moderna and Pfizer/BioNTech vaccines. COVID provided a real-time stress test of the ability to develop such vaccines quickly and safely, and the concept bodes well for future similar viruses in the future.

The COVID-19 pandemic was declared in March 2020, and by the end of the year, we already had vaccines being administered in the U.S. and elsewhere. The pace of vaccinations was painfully slow at first, as supply lines were developed, but has been ramping up significantly over the past several weeks. Specifically, on New Year’s Day 2021, only 22,194 Americans had been fully vaccinated (statistics are all from the Centers for Disease Control and Prevention’s COVID website at covid.cdc.gov unless otherwise noted). As of March 24, 46,365,516 Americans are fully vaccinated, and over 85 million have received at least one dose of the two-dose regimens (myself included). The whole thing is a remarkable achievement and worth feeling very good about.

Hospitalizations have dropped

Around the end of 2020 during the holidays, hospitalization rates rose to a level that hadn’t even been seen during the initial months of the pandemic in March and April. The peak week for COVID-19-related hospitalizations was the week of January 9, 2021. Since then, the number of hospitalizations due to COVID has dropped sharply, as shown in the following chart:

Notice how the numbers haven’t just dropped overall, but the proportions between the different age cohorts have changed as well. Previously, older Americans were being hospitalized at much greater rates than younger people, with about 77% of those in the hospital being 50 or older (and 51% over the age of 65). In the most recent week’s data from March 13, only 69% are 50 or older and only 37% over the age of 65. That’s huge, and likely due to the focus on vaccinating older Americans first after healthcare and other essential workers.

COVID-19 has killed older people almost exclusively

Take a look at these two graphs:

This data includes roughly 408,000 U.S. deaths related to COVID-19, so not everyone who has died so far. But it’s unlikely that the numbers would change much if all of the data were included. Out of over 23 million positive cases of COVID-19 in the CDC’s database, most of them are people between the ages of 18 and 64; in other words, active adults, going to work, maybe not being as careful with social distancing, etc. That’s not surprising, especially when you consider how many K-12 schools went remote during 2020 in response to the pandemic.

But the death rates don’t parallel those case numbers at all. In fact, they’re completely skewed toward older Americans. While those 85 years and older make up only 2.4 percent of the total cases, they resulted in 31.9% of the deaths (and, assuming the case and death numbers come from the same dataset), 23.7 percent of people 85 and older who contracted COVID-19 died.

The same pattern happens all the way down the age cohorts: those aged 75 to 84 made up 4.1% of positive cases, but 27.7% of deaths, and had a death rate of 12.1%; 65-74 were 7.8% of cases but 21.3% of deaths (and a death rate of 4.9%). Compare that to children from infancy to 17 years old: 11.7% of all positive cases, but only around 0.1% of all deaths (and a death rate of 0.01%!).

You can do the rest of the math if you like, but in short, with very few exceptions, the risk of dying from COVID-19 belongs almost completely to those 50 and older, and in particular, those 65 and older. Nearly 81 percent of all deaths have been in that 65+ cohort. Children have almost no chance of dying from COVID-19.

Now, before I get accused of the same kind of insensitivity Texas Lt. Gov. Dan Patrick showed a year ago when he suggested that grandparents were willing to die to save the economy (despite being 69 years old himself), let me point out that I’m in the 50+ cohort and would be more susceptible to a serious case of COVID-19, and so I’ve largely stayed home for much of the last twelve months. COVID-19 is serious… but not to everyone, and treating it as a universal health concern when setting public policy is misinformed at best and pandering to peoples’ fears at worst.

COVID shortened the lifespan of older Americans

This is one of the most contentious claims on social media: Many older Americans have one or more pre-existing conditions that may have contributed to their dying from COVID-19. In other words, it’s difficult to tell whether an elderly person, already suffering from medical issues, actually died from COVID.

While it’s true that many of those who died from COVID-19 in the past year had underlying medical concerns, including previous heart failure (12.5%), chronic kidney disease (16.8%), diabetes (35.7%), obesity (48.5%), hypertension (58.4%), asthma (11.9%), and COPD/emphysema (10.2%), most of those diseases – unless very far long in their progression or when combined with a weakened immune system typical of the elderly – were unlikely to kill someone immediately by themselves. COVID-19 has many far-reaching effects on the human body, but its initial focus is on the cardiopulmonary system, making pre-existing conditions in those parts of the body particularly risky. However, it can’t be assumed that someone with one or more of those conditions (I have three of them myself) was going to die in 2020. I have mild hypertension and had a minor heart attack several years ago and have been overweight for decades (all of which have been significantly alleviated over this pandemic year by losing about 60 pounds), so all in all, I was as likely to die by getting hit by a car while riding my bike as any of my pre-existing conditions.

However, I’m pretty sure that my mother, who died in April 2019 at the age of 79, would not have survived COVID if she’d contracted it last year. She was already very ill from several medical conditions, most significantly renal failure. If she’d somehow held on into 2020 and got COVID, it certainly would have been the last straw. But it would have been difficult to say that’s what she died from, since she was already very ill. It’s like watching someone racing toward a cliff in a car who suddenly floors the accelerator at the last second. You could say “If they just hadn’t sped up at the end…” but believe me, they were going over the edge no matter what at that point. While I’m still sad that Mom died, I’m relieved that my family didn’t have to go through the pain of not being able to visit her or be present when she was in their final days, which we were able to do a year earlier.

An elderly person, with or without one or more medical concerns, is at significant risk of dying if they contract COVID. The statistics bear this out. That’s why it’s been so baffling why so many older Americans continued to support the lack of effort by the previous president and his administration to enforce simple protective measures like masks, social distancing, and temporary restrictions on businesses to keep people – especially themselves! – safer.

Vaccines also reduce the severity of illness from COVID

While it’s not time to go back to normal completely, there are really good reasons to believe that we can do so sooner rather than later. If we continue to vaccinate against COVID-19 at the current rate – or even speed that up – we should reach a point of “herd immunity” sometime this summer. We’ll still need to be cautious at times, especially if you’re in the older age groups that will still be more susceptible to serious illness or death, but the vaccines also appear to significantly reduce the severity of the illness.

Recent reports of “breakthrough” infections from COVID in those who have had vaccines show that the efficacy rate of the various vaccines isn’t perfect. But we knew that from the trial results. A 90 percent efficacy rate means that 10 percent of those in the trial who received the vaccine still contracted COVID. However, the severity of symptoms is reduced, in many cases to the point where those who get COVID after being vaccinated can be described as asymptomatic. If COVID-19 can be reduced to just another mild virus, and one that we can continue to vaccinate against in the future, it no longer will be a major concern in the United States.

Conclusion

The events of the past year are always going to affect those who lived through them, though, much like the generation that lived through World War I and the “Spanish” flu immediately afterwards; the Great Depression; World War II; and other major upheavals in society. We’ll always be looking over our shoulders, waiting for the “next virus” to appear, even if it’s another century before a pandemic of this scale happens again.