Area doctors cite lower vaccination uptake among younger people

JOHNSON CITY, Tenn. (WJHL) – With reported COVID deaths from the delta variant beginning to mount, a different trend is emerging from the winter surge: people under 60 are accounting for almost triple the share of total deaths that they were last winter.

“The winter surge was an entirely different ballgame,” Ballad Health Chief Clinical Officer Dr. Amit Vashist told News Channel 11 Tuesday.

COVID deaths among Tennesseans ages 21 to 60 as a share of the total was 1 in 8 during last winter’s surge. It’s risen to 1 in 3 the past three months.

“We had a considerably larger number of older patients, patients from nursing homes, post-acute care facilities patients with co-morbid illnesses who were getting admitted who were already very frail.”

During a three-month period of the winter surge, just one in eight deaths was among people 60 and under, Tennessee Department of Health (TDH) data show. That jumped to more than one in three COVID deaths between July 19 and Sept. 19.

Vashist said the statewide numbers didn’t surprise him and that the shift has also occurred at Ballad.

“Now we see younger patients getting admitted, not only to our med-surg floors but getting admitted to our ICU and being put on ventilators.”

Vashist and two area public health doctors — Stephen May of the Sullivan County Regional Health Department and Randy Wykoff, dean of East Tennessee State University’s College of Public Health — all pointed to the same primary culprit for the shift.

“We know that vaccine is very protective, and we are seeing a much younger age group associated with hospitalization and death now,” May said.

Wykoff said that’s playing out at statewide levels across all age groups.

Area medical leaders say gaps in vaccination rates are a major reason a higher share of COVID deaths now are among younger people.

“The greatest number of deaths, we’re seeing are in those states that are the least vaccinated, and Tennessee is the eighth least vaccinated state in the country, and our region is slightly less vaccinated than the state overall,” he said.

So why the shift? Vaccination uptake rates among age groups vary widely. Among those over 61 in Tennessee, 73% are fully vaccinated. Among those 21 to 60, that rate is just 46%.

The result of that gap is hitting people working in area hospitals hard, Vashist said.

More young people are being hospitalized and dying of COVID at a time when vaccinations appear to make that outcome almost completely preventable.

And it’s impacting nurses and other clinical staff differently than the pre-vaccine deaths — hard as they were — that were mostly occurring among grandparents and great-grandparents.

“(Y)ou’re seeing much younger patients, patients who are in their 20s, 30s, 40s, and 50s roughly the same age as our frontline caregivers,” Vashist said.

“Most of them, us being in a rural small community, they know each other, or their kids know each other,” he said of the Ballad staff and those being hospitalized and dying. “So I think this hits home hard in a way that it has not had at any stage of this pandemic before.”

Breaking down the numbers

The two compared periods had widely different death totals — with 5,665 deaths in the December-March period and just 1,941 in the past three months.

But that 3,700-plus decrease in raw numbers came almost entirely from a drop in deaths for those 61-plus. They dropped by almost three quarters, from 4,975 in the winter to 1,276.

Deaths among 21 to 60-year-olds, meanwhile, were flat — 688 in the winter, 655 in the past three months.

And the youngest in those groups actually saw increases. People in their 20s still account for a very small portion of overall deaths, but where just nine of them died during the three winter months, 38 have died since late June.

Put another way, 20-somethings accounted for just one of every 625 deaths last winter, but have accounted for 12 times as high a share, one in 51, since late June.

Deaths among people in their 30s were also higher in sheer numbers, rising from 57 in the winter to 91 the past three months. They accounted for one in 99 deaths in the winter, but one out of every 21 the past three months.

The raw total for people in their 40s rose 9%, from 174 to 189, and they went from one in 33 COVID deaths to one in 10.

The total number of 50-somethings dying dropped from 474 to 337, but it went from one out of 13 total deaths to one out of 6.

It’s the opposite picture at the oldest end of the spectrum. Where 2,145 people over 81 died in the winter period, that dropped to just 336 for the most recent period.

That’s a decline from 37.8% of deaths to 17.3%.

For people in their 70s, the total dropped from 1,780 deaths to 497, while those in their 60s saw their death total drop from 1,050 to 443.

Death changes not just due to overall share of cases

The percentage of cases that result in death also dropped among older people.

That suggests the possibility, if not the likelihood, that a number of recent deaths were breakthrough cases and that most vaccinated seniors who got COVID did better on the whole than before vaccines were available.

In the winter, 24.7% of cases among those over 81 resulted in death. That portion was just 6.8% in the most recent three months. For people in their 70s, the percentage dropped from 10.2% to 4%.

Those in their 60s saw a decline from 3.4% to 1.9%.

For people in their 20s and 30s, deaths as a percentage of total cases — while tiny at a fraction of a percent — was higher the past three months than it was in the winter.

Deaths as a percentage of cases were roughly the same for those in their 40s and 50s for both periods.

May said that jibes with overall data about vaccines and how they protect people from getting infected, and from getting as sick if they do get infected.

“So infections do occur, there are breakthrough infections, but the reduction in hospitalization for those who have had the vaccine is 93%,” May said.

“In other words, 93% of our hospitalizations could have been prevented by vaccination and 98 to 99% of deaths can be prevented by vaccination.”

Doctors say relaxed mitigation measures aren’t helping

May and Vashist also expressed frustration over what they see as a less vigilant approach to preventing transmission compared to a year ago.

“This last wave I think was essentially preventable, we had the appropriate tools in place, but we relaxed all of our safety measures,” May said. “And people have become recalcitrant as far as following these safety measures that we know works.”

Vashist said he wouldn’t have predicted the havoc the delta variant is wreaking in the region.

“That was totally unforeseen, and the reason it was unforeseen was because back in winter, when we had our last surge before the Delta variant, we had some mitigation strategies in place,” he said.

“People were still masking, to a certain degree, they were socially distancing, all those public health measures were still being enforced, respected, and vaccinations were coming in the pipeline.”

Vashist said vaccination appears to have plateaued, a sizeable contingent of people seem resistant to vaccination, and public health measures are being adhered to much less.

Vashist said all of it is really taking a toll on clinical staff.

“I think physical exhaustion is one thing we could take care of that through various strategies, but we are battling a mental and emotional exhaustion that we have never seen before,” he said.

“I can tell you personally as a frontline caregiver, I thought I was used to taking care of suffering, taking care of illnesses but I have never encountered so far in my professional career, the level of death and suffering that I have seen in the past 18 months.”

A longer peak than the winter?

After a steep runup in cases, the winter surge fell back almost as sharply as it had risen. Wykoff and Vashist both said they expect the current surge to remain elevated for a longer period.

“I think in the short term, we would probably expect maybe six to eight weeks length of time that we’ll be sort of in the midst of it,” Wykoff said.

“The way our modeling data looks … we are going to be in a state of plateau,” Vashist said. He said that modeling anticipates no more sharp increases, but any decline coming slowly in “stair step fashion.”

And even though fewer people are dying thanks to vaccines, monoclonal antibodies and other therapies, he said that will mean a prolonged period of deaths around the recent elevated level.

“I do not see this curve, bending down anytime soon, if at all,” he said. “We will see the curve to kind of flatten at a very high level, but it will be a while. Honestly I think it will be weeks before we see any substantial reduction in the level of illness and death.”

Vashist said the level of skepticism and resistance surrounding COVID vaccine “befuddles me and it disappoints me.

“I’m also amazed at the level of misinformation that is prevalent in the community including that is being spread around, if you look at social media, the TV news channels and all those kinds of things.

“I often say that more than this being the pandemic of the unvaccinated, this has become a pandemic of the misinformed and the uninformed.”

All three men said the virus will continue doing what viruses do — trying to replicate and mutating in ways that may allow it to continue spreading and wreaking havoc.

“I think until we get more people vaccinated, we’re going to continue to see hospitalization and deaths,” Wykoff said.

“And I think also that if we start seeing the numbers come down again, as we did in March, April, May, June of this year, we can’t let up our guard. We can’t assume that this has gone away. So I think we need to keep pushing folks to get vaccinated and to take the other measures we know make a difference.”