Today in the United States, approximately 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 have always been particularly vulnerable and now account for a higher proportion of COVID deaths 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 over the age of 64. And deaths in nursing homes are falling, even though COVID remains a leading cause of death for all ages. COVID deaths among people aged 65 and over more than doubled between April and July this year, rising 125%, according to recent analysis by the Kaiser Family Foundation. This trend has increased with age: more than a quarter of all COVID deaths were among people aged 85 and over throughout the pandemic, but that share has risen to at least 38% since May.
Where people live also affects their level of risk. The pandemic initially hit urban areas hardest, but mortality increased dramatically in rural areas in the summer of 2020, a trend that has continued. The gap is now narrowing, but people living in rural areas are still dying at significantly higher rates. Rural death rates fell from 92.2% higher than urban rates at the end of September to 38.9% higher in mid-October.
Racism and discrimination also play an outsized role in COVID deaths. While differences in age-adjusted death rates by race have narrowed recently, experts predict inequality is likely to soar again during the surges.
In recent weeks, the death rate from COVID in the United States has remained fairly stable, with 2,344 people dying from the disease in the seven-day period ending November 9, according to the Centers for Disease Control and Prevention of the United States. Even so, the United States still accounts for a large portion of all confirmed COVID deaths worldwide, and it has the highest number of confirmed COVID deaths of any country. According to the CDC, there have been 1.2 million additional deaths in the United States since February 2020, losses that have reshaped nearly every aspect of American life. The viral illness has remained one of the leading causes of death throughout the pandemic. And overall life expectancy in the United States has dropped significantly since the crisis began. “This is unprecedented,” says Kristin Urquiza, co-founder of Marked by COVID, an advocacy network that commemorates victims of the disease. “And I don’t think it’s going to stop anytime soon.”
More than 200,000 people have already died from COVID in the United States in 2022, and President Joe Biden’s administration is preparing for 30,000 to 70,000 more deaths this winter. A bad flu year, by comparison, results in around 50,000 deaths.
Yet public funding has dwindled or disappeared for the very vaccines and treatments that reduced the risk of death from COVID. For the next four months or so, these key tools will only be available to those who can afford them in the private market as current federal subsidies dry up, a situation that could affect access and adoption. “It’s scary to think about what will happen in the next flare-up if these things don’t come back,” says Elizabeth Wrigley-Field, a demographer and sociologist at the University of Minnesota.
At the height of the last death spike in August, 91.9% of all deaths in the country were among people aged 65 and over – the largest share of any outbreak in the pandemic, even higher than in April 2020.
Long-term care facilities have been hit extremely hard during the pandemic, with residents and staff accounting for around a fifth of all COVID deaths. In 2021, vaccinations and treatments have mitigated these blows. But COVID deaths in nursing homes have risen again. From April to August of this year, that number more than tripled.
Although most COVID deaths are in the elderly, young people are still dying at higher than usual rates from the disease, especially those working in essential fields, the research has found. Under normal conditions in the United States, “young people rarely die,” says Justin Feldman, a visiting scholar at the Harvard François-Xavier Bagnoud Center for Health and Human Rights, who studies social inequality. But now, he says, “the excess mortality for all age groups is quite high and particularly high in the United States, compared to other wealthy countries.”
When it comes to race and ethnicity, as well as geography, other patterns are also emerging. But experts note that these changes are likely to be temporary.
Each fall, COVID death rates among whites have approached or exceeded those among blacks. But deaths of racially minority people jumped again during surges, when the total death rate from COVID climbs. Experts expect the same pattern of inequity in future surges. “White people are dying at higher rates during particular times when the total number of deaths is lower. And black people are dying at higher rates during other times when there are higher death tolls,” Feldman says. “And that’s not even taking into account the American Indians, the Alaska Natives, and the Pacific Islanders, who have always had the highest death rates throughout this period, at any time, and are often excluded from this type of analysis.
Two years into the pandemic, deaths from all causes were higher for Indigenous peoples and Pacific Islanders, compared to pre-COVID levels, according to a study published in September. Changes in life expectancy have also hit people of color harder. Black, Hispanic, and rural Indigenous people have experienced the deadliest COVID 2021 of any relatively large racial or ethnic group in the United States, according to a preprint article that has yet to be peer-reviewed. These disparities are often exacerbated in rural areas with more limited access to health care and an older, sicker population, and often lower vaccination rates.
COVID vaccines have helped reduce some disparities. “Vaccination reduces racial inequalities,” says Feldman. “It’s so simple.” But the same factors that endanger many people of color, including racism and systemic oppression, persist. For example, access to boosters in communities of color has been inequitable, resulting in higher death rates.
Not being vaccinated remains a major risk factor for dying from COVID. In August 2022, unvaccinated people died six times more than those who received at least the primary series of the vaccine, according to the CDC. And unvaccinated people aged 50 and over were 12 times more likely to die than their vaccinated, doubly-boosted peers.
Because a large portion of the US population has at least one COVID vaccine, the majority of deaths are now among vaccinated people. In July, 59% of COVID deaths were among those vaccinated and 39% among those who received one or more boosters. This does not mean that vaccines no longer work; they are still very effective in reducing the risk of serious illness and death. But their effectiveness wanes over time, and continuous boosters must be combined with other precautions to prevent illness and death. In August, people aged 50 and older who were vaccinated and received only one booster were three times more likely to die than people who received two or more boosters, according to the CDC.
Only 10.1% of Americans aged five and older received the relatively new bivalent booster, which is highly effective against Omicron variants of SARS-CoV-2, the virus that causes COVID. More than 14 million Americans 65 or older (nearly 27%) have received the updated vaccine — a higher rate than among younger Americans, but nothing like taking the initial two doses. “We’ve never had the same kind of effort to make boosters available and accessible that we did the primary vaccination rounds,” Wrigley-Field says. Recalls are essential not only to reduce hospitalizations and deaths for everyone, but also to weaken the chains of transmission and help protect the most vulnerable.
Antiviral drugs and monoclonal antibody treatments, both of which can be extremely effective in preventing hospitalizations and deaths, are also underused and inequitably distributed. ZIP codes with the most vulnerable people have the lowest uptake of antivirals despite having the most distribution sites, a 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% of people who tested positive for COVID said they were prescribed antivirals. Notably, high-income people received the highly effective antiviral Paxlovid at more than twice the rate of those on low incomes, another study found. According to an analysis of a drug distribution site, about 42% of US counties were “Paxlovid deserts” in March.
About 8.7 million Americans are immunocompromised, putting them at increased risk of death from COVID. Yet only about 5.3% of them received Evusheld, a treatment that can prevent serious consequences for six months at a time, the CDC estimated in September.
“We are still in the middle of this crisis,” Urquiza says. “The most vulnerable will not only be left behind but will be sentenced to death.”
It might sound like a numbers thing. It’s not. It’s a story of people. Many of their stories were compiled by Alex Goldstein, founder of Faces of COVID, an online project created to show the stories behind the statistics and to honor the lives lost and those who mourn them. “We all lost something when your loved one died,” Goldstein says. “My biggest fear has always been that if we don’t learn from this pandemic, which I believe we are doing, we will be hit 10 times harder by the next one,” he adds. “I think we are completely incapable of dealing with these kinds of challenges. And that scares me for the future.