US health authorities are calling it “a pandemic of the unvaccinated.” In the last two weeks, average COVID-19 hospitalizations have risen more than 50%, with unvaccinated people now representing the vast majority – around 97% – of hospitalized cases, according to the US Centers for Disease Control and Prevention.
For many of these patients, their illness was a wake-up call.
“I’m admitting young, healthy people to the hospital with very serious COVID infections,” Dr. Brytney Cobia, a hospitalist at Grandview Medical Center in Birmingham, Alabama, wrote on Facebook on Sunday. “One of the last things they do before they’re intubated is beg me for the vaccine. I hold their hand and tell them that I’m sorry, but it’s too late.”
“After what I went through, I would’ve much rather been sick for a couple of days and have the mild symptoms that maybe the shot causes than to go through what I went through,” Spencer said on Thursday.
“It’s like a hammer in my head all the time: ‘Why didn’t you have the vaccine? You had all the chances, the opportunities, the appointments, the letters – everything,'” Fadi said.
These stories may be resonating with unvaccinated Americans lately.
Over the last week, the five states with the highest COVID-19 case rates – Arkansas, Florida, Louisiana, Missouri, and Nevada – had higher vaccination rates than the national average, the CDC said. In Louisiana, the number of first doses administered daily has risen 50% in the last two weeks, from roughly 3,600 to 5,400 per day. Arkansas’s daily first doses also rose 85% during that time, from around 2,800 to 5,300 per day.
“Whether it’s seeing loved ones sick or something else, it’s having an impact,” Ashish Jha, dean of the Brown School of Public Health, wrote of COVID-19 surges in states with rising vaccination rates.
Rising cases and hospitalizations could change the minds of vaccine skeptics
It’s hard to know exactly why vaccinations have risen in some states and not others. At the national level, average daily vaccinations have actually declined 15% in the last week, even though no state has vaccinated more than 75% of its residents so far, and 16 states haven’t crossed the 50% threshold.
“We can’t really say with any certainty why we’re seeing an uptick in vaccinations,” Mindy Faciane, a public information officer for the Louisiana Department of Health, told Insider. But rising hospitalizations may be having some effect, she added.
“We think some Louisianans are also seeing the rising numbers of cases and hospitalizations among the unvaccinated, seeing the more contagious Delta variant in circulation and how it’s affecting their communities, and understanding that it is really urgent,” Faciane said. “They’re working through whatever questions they may have had about the vaccine and are now extra motivated to protect themselves and their loved ones in a way they hadn’t before.”
“Anecdotally, we are hearing from pharmacists and healthcare providers administering shots that more Arkansans are seeing the urgency in the need to get vaccinated as cases increase in the state,” Arkansas’s state health director, Dr. José Romero, told Insider.
Romero said earlier this month that his department’s vaccination strategy includes highlighting stories of unvaccinated people who became severely ill from COVID-19 – like a couple whose baby was delivered while the mother was still on a ventilator.
“Those people are becoming ambassadors and getting these public service messages out,” Romero said, adding, “This couple in particular exemplifies the view that many, many people have in the state – that is, ‘This is nothing, it’s an insignificant viral infection’ – and really shows the consequences of that type of belief.”
Life expectancy in the US fell by a year and a half in 2020, mostly a result of the COVID-19 pandemic, according to a report from the Centers for Disease Control and Prevention’s National Center for Health Statistics.
In 2019, life expectancy was 78.8 years but in 2020 it was 77.3 years, the lowest since 2003.
The report said the drop in life expectancy was mainly due to deaths from COVID-19. Coronavirus deaths were responsible for 73.8% of the decline.
In 2020 men had a life expectancy of 74.5 years compared to 76.3 in 2019. For women, life expectancy in 2020 was 80.2 down from 81.4 in 2019.
“The difference in life expectancy between the sexes was 5.7 years in 2020, increasing from 5.1 in 2019,” the report said.
Since the start of the pandemic, more than 600,000 deaths from the virus have been recorded altogether, nearly two-thirds of them recorded in 2020, CDC data shows.
Hispanic Americans had the most drastic drop in life expectancy compared to any other ethnicity, decreasing from 81.8 years in 2019 to 78.8 years in 2020, a three-year drop. For Hispanic males, that drop was from 79.0 years in 2019 to 75.3 years in 2020, a drop of 3.7 years. Black men had a decline of 3.3 years and non-Hispanic black females had a decline of 2.4 years.
“Among the causes contributing negatively to the change in life expectancy, COVID-19 contributed 90% for the Hispanic population, 67.9% for the non-Hispanic white population, and 59.3% for the non-Hispanic black population,” the report said.
The US is far removed from the deadliest point in its coronavirus outbreak: The country reported more than 3,000 daily coronavirus deaths in January, compared with less than 275 daily deaths, on average, in the past week.
But average daily deaths surged 22% in the past seven days, following a record low of 30 deaths on July 11. In the past two weeks, average daily deaths rose 33%.
The vast majority these deaths are among unvaccinated Americans: Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, told NBC earlier this month that unvaccinated people represented more than 99% of recent coronavirus deaths. The Centers for Disease Control and Prevention also reported Friday that more than 97% of people entering hospitals with symptomatic COVID-19 hadn’t received shots.
“We are seeing outbreaks of cases in parts of the country that have low vaccination coverage because unvaccinated people are at risk, and communities that are fully vaccinated are generally faring well,” Walensky said.
But disease experts worry that allowing the virus to spread among unvaccinated people could give it more opportunities to mutate. That could pose a long-term risk for vaccinated people, too. Already, the Delta variant – now the dominant strain in the US – appears to be more transmissible than any other version of the virus detected so far.
“The worst-case scenario is if Delta mutates into something completely different, a completely different animal, and then our current vaccines are even less effective or ineffective,” Vivek Cherian, an internal-medicine physician in Baltimore, told Insider last month.
Experts also worry that increased transmission could result in more severe breakthrough infections – cases of COVID-19 diagnosed at least two weeks after someone is fully vaccinated – among older people or those who are immunocompromised, since vaccines may already be less effective among these groups.
People over 65 represent about 75% of breakthrough cases that result in hospitalization or death, according to the CDC.
The UK offers insight into what to expect in the US
Disease experts worry that the US could soon follow in the footsteps of the UK, where average deaths have more than doubled in the past two weeks, from 17 to 40 a day. The UK’s average hospitalizations have also increased about 60% during that time, from about 380 to 615 a day.
That’s despite the fact that nearly 70% of UK residents have received at least one vaccine dose.
The country is now administering as many daily vaccine doses as it was in late December, when vaccines were available only to healthcare workers and residents of long-term-care facilities. Just 384,000 daily doses were given out on average over the past week.
Some Americans, particularly in rural counties, may still struggle to access shots, while others can’t afford to take time off work to get vaccinated. But, for the most part, widespread vaccine hesitancy has slowed down vaccination rates.
About 18% of adults surveyed in a recent YouGov poll said they didn’t plan to get vaccinated, while 11% said they were unsure. These rates were significantly higher among Republicans and people in the Midwest and South.
Most vaccine-hesitant people in the survey said they were worried about side effects from coronavirus shots – though studies have shown that vaccine side effects are generally mild and fleeting. The vast majority of them also said they believed that the threat of the virus was exaggerated for political reasons.
Lifting mask and social-distancing mandates could delay herd immunity
Despite lagging vaccination rates, most US states have lifted mask and social-distancing mandates. In states such as Delaware, Florida, Missouri, and South Carolina, masks are recommended but not required for unvaccinated people.
Some disease experts said removing these restrictions too soon could send the wrong message about the state of the pandemic.
“The concern is if you’re on the fence, and then you go outside and you see, ‘Hey, things are back to normal,’ that may decrease the chance of you wanting to even get vaccinated,” Cherian said.
For now, experts are hopeful that the US can still vaccinate at least 70 to 85% of its population – a threshold that may allow the country to reach herd immunity. But a new variant that evades protection from vaccines or prior infection could push that goal even further from view, so public-health officials remain determined to vaccinate more Americans as quickly as possible.
“If you get to that situation, then you essentially get us back to a level” that we were in before March 2020, Cherian said, adding: “That’s just not a place that you want to be.”
Health officials in former President Donald Trump’s administration gloated about their efforts to edit scientific reports on COVID-19 last year to fit Trump’s messaging, according to documents obtained by The Washington Post on Friday.
An investigation by a congressional subcommittee on COVID-19 found that a team of Trump appointees at the Department of Health and Human Services “engaged in a persistent pattern of political interference in the nation’s public health response to the coronavirus pandemic,” Democratic Rep. Jim Clyburn of South Carolina, the subcommittee chair, wrote to two former officials, coronavirus advisor Scott Atlas and science advisor Paul Alexander.
According to The Post, emails reviewed by the panel show that Trump officials had been “overruling and bullying scientists and making harmful decisions that allowed the virus to spread more rapidly,” Clyburn wrote.
In one email sent on September 9, Alexander wrote to Michael Caputo, the then-assistant secretary for public affairs at HHS, touting a “small victory but a victory nonetheless and yippee!!!” about an alleged change to the first line of a CDC report on virus transmission among young people.
In another email sent on September 11, Alexander asked Atlas to help him “craft an op-ed” that would challenge an upcoming CDC report about COVID-19 deaths among young patients.
“Let us advise the President and get permission to preempt this please for it will run for the weekend so we need to blunt the edge as it is misleading,” Alexander wrote to Atlas, The Post said.
As the coronavirus spread across the country last spring, Trump and his allies frequentlysought to downplay the severity of the outbreak. When states pursued lockdown restrictions to combat the spread of the virus, Trump urged governors to reopen the economy, going against the recommendations of his own COVID-19 advisors. The former president and those close to him would also often neglect following public health guidelines advised by the CDC.
“I know the President wants us to enumerate the economic cost of not reopening,” Caputo wrote in an email to Alexander on May 16. “We need solid estimates to be able to say something like: 50,000 more cancer deaths! 40,000 more heart attacks! 25,000 more suicides!”
“You need to take ownership of these numbers,” Caputo wrote in a subsequent email to Alexander, per The Post. “This is singularly important to what you and I want to achieve.”
House Democrats launched an investigation into Trump appointees potentially pressuring career officials to alter the language of scientific reports after Politico first reported on the issue on September 11, 2020. The subcommittee has requested interviews with Alexander and Atlas as well as additional documents to complete its probe, according to The Post.
The Federal Bureau of Investigation is trying to find out if New York Gov. Andrew Cuomo and his advisors provided false numbers on the state’s nursing home deaths during the coronavirus pandemic to the Department of Justice last summer, according to a New York Times report on Friday.
Four people with knowledge of the probe told The Times that federal investigators have subpoenaed Cuomo’s office for documents regarding the data, reached out to lawyers for Cuomo’s aides, and spoken to officials from the state’s Health Department on the matter.
The investigation is part of the FBI’s broader examination of Cuomo’s handling of nursing homes as New York became a COVID-19 hotspot last spring. Cuomo has come under immense scrutiny in recent weeks amid reports that his aides pressured state health officials to undercount the nursing home death toll in a July report.
The DOJ in August requested that a handful of governors, including Cuomo, provide the agency with data on COVID-19 cases and deaths in nursing homes to see if an investigation is warranted. The demand came in response to Cuomo’s controversial March 25 order, which required nursing homes to admit patients with COVID-19 or patients who were suspected to have tested positive for the virus.
“Protecting the rights of some of society’s most vulnerable members, including elderly nursing home residents, is one of our country’s most important obligations,” then-Assistant Attorney General for DOJ’s Civil Rights Division Eric Dreiband said at the time. “We must ensure they are adequately cared for with dignity and respect and not unnecessarily put at risk.”
An outside lawyer representing Cuomo’s office in the federal investigation, Elkan Abramowitz, pushed back on the allegations. In a statement to The Times, he said that “the submission in response to DOJ’s August request was truthful and accurate and any suggestion otherwise is demonstrably false.”
Submitting false information to the DOJ could be a criminal offense, The Times reported.
Cuomo, once celebrated in the early days of the coronavirus outbreak, has faced criticism from both Democrats and Republicans for his COVID-19 policies concerning nursing homes. The new details on the FBI investigation also comes as Cuomo faces pressure to step down as governor after several women have accused him of sexual harassment. Cuomo has refused to resign.
However, as the pandemic goes on, Black and Latino communities across the US are feeling the brunt of it.
NBC News reported that Latinos who have been already disproportionately impacted by COVID-19 are having a higher overdose rate in many states.
Orlando Colón, 55, who directs Casa Esperanza’s residential recovery program for men, a Boston-based behavioral health facility, told NBC News that he’s seeing double the usual demand during the pandemic.
“Unfortunately, we are now full. When one of the 50 beds we have is emptied, we call the next one on the list,” he told the outlet, adding that those who can’t get into treatment usually end up in shelters or homeless, where they most likely continue using drugs.
In Maryland, the Opioid Operational Command Center reported that from January to September 2020, opioid deaths increased by 27.3% for Latinos compared to a rise of 16% among non-Hispanic whites.
NPR reported growing research also shows that Black communities are dealing with higher overdose rates.
Researchers across other states are seeing similar patterns, NPR reported.
“COVID really just acted as salt in the wounds of health and social inequities, perpetuated by structural racism both in Philadelphia and across the country,” Utsha Khatri, a researcher on the Philadelphia study. told NPR.
In August, Stacey Singer DeLoye was finally allowed to visit her mother, Marilyn, at her Minnesota nursing home – as long as they were outdoors, masked, and distant.
“She was totally cheerful,” Stacey told Business Insider. “I was astonished at how happy she was in that place, and I was impressed with how well they did at keeping the pandemic out.”
But a few weeks ago, everything changed.
The Monday after Thanksgiving, a social worker at the nursing home called Singer DeLoye in tears. The worker told her that Marilyn, at age 80, had tested positive for COVID-19.
“They thought Mom was going to rally, but she wasn’t rallying,” Singer DeLoye said. “She seemed to be very, very tired and she was declining.”
On December 6, the nursing home called again: It was time to say goodbye. Marilyn was unconscious. Stacey’s brother Scott grabbed an iPad, donned a mask, and went into their mom’s room in the COVID-19 ward. He video-called Stacey and all of Marilyn’s grandchildren.
“When she’d breathe in and breathe out, it sounded just like crackling cellophane,” Stacey said. “We all told her we loved her. We all remembered a story about something she did that was really special to us.”
An hour later, Marilyn died.
She’s one of more than 47,000 people in the US who have died from COVID-19 since Thanksgiving.
On Wednesday, the US reported a record of 3,448 deaths. In total, more than 312,000 have died in the country since the beginning of the pandemic (though that’s almost certainly an undercount).
This unprecedented and tragic surge in fatalities is, in part, a product of pandemic fatigue, cold weather that has led people indoors, and the patchwork nature state policies on masks and closures – many of which are quite lax. But these recent record-breaking days of death, in particular, are the result of infections contracted around Thanksgiving.
Despite CDC warnings to the contrary, an NPR analysis of mobile phone data found that 13% of Americans ventured more than 31 miles from home on Thanksgiving Day. That’s not a huge drop from last year, when it was 17%.
But it’s common knowledge that the most Thanksgiving travel comes in the days before and after the holiday. The Transportation Security Administration screened 9.5 million airline passengers during the 10-day Thanksgiving travel period. That’s less than half of what the TSA reported in 2019, but it still included some of the busiest days since the pandemic began.
Cases generally take about two weeks to appear in official tallies, since the virus incubates in the body for an average of five days, then people usually wait a few days to get tested after symptoms appear. Then there’s the multiday wait for results, and the subsequent process of reporting them to health agencies.
Deaths, in turn, generally follow one to three weeks after a rise in cases.
Like clockwork, that is what we’re seeing now.
“Every floor I walked in today, everybody’s completely full,” Amy Carlozo, the chaplain at Swedish Covenant Hospital in Chicago, told Business Insider.
“This is so horrifically awful,” she added.
Nursing homes and hospitals are overwhelmed
Singer DeLoye suspects that staffing issues over Thanksgiving week created an opening for the virus to get into her mom’s facility. That week, Minnesota Public Radio reported that the state’s nursing homes were experiencing severe staffing shortages. This forced officials to call in the National Guard and email thousands of state employees in search of temporary staff.
With new people coming into a facility and understaffed workers spread thin, it can be difficult to spot new cases before patients infect others.
Scott Singer told his sister that there were 16 other patients on their mom’s COVID-19 floor – one of two such wards in the nursing home.
Marilyn Singer’s end-of-life isolation did not match the way she’d lived. She’d moved from place to place for most of her years – California, Portugal, Belgium, Illinois, Wisconsin, Florida. She went to business school (the first woman in her program, she always said), appeared as an extra in a few movies, and worked as an accountant. She’d given Stacey and Scott many of her own original oil paintings, which decorate the walls of their homes. She had four grandchildren.
Zoom goodbyes like the one those grandchildren had with Marilyn have become a daily occurrence for Carlozo. Cook County, where Chicago is located, has the third-highest death toll in the US at more than 7,500, according to Johns Hopkins.
Due to a shortage of N95 masks, Carlozo doesn’t go into COVID-19 patients’ rooms unless absolutely necessary.
“It’s almost like doing your job with your hands tied behind your back,” she said.
Instead, she stands outside and calls into the video meetings with family members.
“I just want to do one more thing, and I wish I could do that one more thing for every patient I’ve dealt with,” Carlozo said. “The volume is just so large at times I feel like I can’t do enough.”
She also frequently calls relatives after a patient has died, to listen to their grief and walk them through the process of finding a funeral home. Sometimes it’s the first time Carlozo is meeting them.
“That’s kind of how fast some of this is going. We haven’t developed a relationship with them before their loved one has passed,” she said.
Horror in the hospital
Experts are not surprised that exactly three weeks after Thanksgiving, the number of COVID-19 deaths each day has hit a new record. The virus became the leading cause of death in the US this month, according to an analysis published Thursday in the Journal of the American Medical Association.
“I don’t think we’ve seen the full brunt of what happened during Thanksgiving yet. I think we’re beginning to, but it’s probably going to continue for some time,” Amesh Adalja, an infectious-disease expert at the Johns Hopkins University Center for Health Security, told Business Insider.
That’s because the chain of cases from the holiday are still spreading. Yet hospitalizations were already at all-time high of more than 114,000 as of Thursday. Nearly 22,000 of those people were in the ICU, and more than 7,800 were on ventilators, according to the COVID Tracking Project. In Southern California, intensive-care units have no beds left.
“There’s been times when we’ve had multiple patients having cardiac arrest at the same time, and we’ve had to really triage to figure out which patient to resuscitate first,” Dr. Hari Reddy, the intensivist medical director at St. Bernardine Medical Center in San Bernardino, told The Los Angeles Times. “If there’s multiple emergencies, I try to gauge which patient I can make the most difference in.”
More than 180 hospitals in California have applied for waivers to bypass mandatory staff-patient ratios, the LA Times reported.
“If you have a heart attack, if you get into a car accident, if you fall off a ladder or have a stroke, we may not have a bed for you,” Dr. Brad Spellberg, chief medical officer at Los Angeles County-USC Medical Center, said in a briefing on Friday.
It could get much worse
The upcoming December holidays could spread the virus even more than Thanksgiving, according to Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.
“This cannot be business as usual this Christmas because we’re already in a very difficult situation, and we’re going to make it worse, if we don’t do something about it,” he told The Washington Post.
The Institute for Health Metrics and Evaluation projects that COVID-19 could kill about 148,000 more people in the US by February 1.
“It’s gotten to the point where it’s just sort of numbers whizzing by and charts showing, you know, this horrible curve,” Singer DeLoye said. “The human toll is missing.”
Adalja said he doesn’t expect this surge to let up before the holidays accelerate it.
“There’s a lot of transmission going on, and there are just so many vulnerable people getting hit with infections, that I think it’s just going to be a continual surge that we face until we get to a point where enough people are vaccinated,” he said. The earliest that could be, he added, is January.
Carlozo said she had planned to take time off around Christmas but has now decided against it.
“I don’t want to not be there for my nurses and my patients and my staff,” she said.
She’s trying not to think about the further death her hospital might see in the weeks ahead.
“I can’t live in the would’ve, could’ve, should’ve,” she said. “I just can’t watch the news anymore. I can’t hear it. I can’t hear the deniers. I went through my period of anger back in, you know, October and November, and I’m done. I’m done. I just need to take care of what’s in front of me.”
California has activated its “mass fatality” program as novel coronavirus cases and deaths continue to soar, NPR reported.
It comes as Gov. Gavin Newsom announced an average of more than 160 deaths per day over the last week, and ordered 5,000 additional body bags to distribute to counties experiencing record deaths, KRON-TV reported.
The California Office of Emergency Services said the mass fatality program is implemented when there are more deaths during a period of time than the local coroner or medical emergency personnel can handle. The program coordinates aid between several governmental agencies.
Mark Pazin, the state’s OES chief, told KCRA the mass facility program is meant to ensure that local agencies aren’t overwhelmed with the death toll.
“I know it sounds morbid, but it’s got to be said, that we have the body bags, that we have the proper refrigeration units, that the capacity has not outstripped the local morgue or funeral home,” Pazin said.
California, on Thursday, reported 52,281 new daily confirmed COVID-19 cases and 379 new deaths.
The Los Angeles Times reported that in Southern California, which spans more than 56,000 square miles and has a population of nearly 24 million people, there is no ICU bed capacity left, meaning patients would likely be placed in other locations within hospitals.
As of Wednesday, the Times also reported the hospitalizations have broken records for 18 days in a row. On Tuesday, 14,939 people were hospitalized with COVID-19 across the state.
Nearly twice as many people in the United States were hospitalized with COVID-19 on Monday compared to the first surge of the the virus in April, with more than 300,000 Americans now dead from the disease.
According to The Covid Tracking Project, at least 110,549 people are currently in the hospital with the novel coronavirus. During the two previous big waves of infection, in April and July, less than 60,000 people were hospitalized.
Arizona and Nevada lead the nation in hospitalizations, with 505 people and 657 people per million, respectively, currently receiving medical care.
By contrast, Hawaii and Vermont are doing the best; neither state currently has more than 100 people per million in the hospital with the coronavirus.
The news comes amid another grim milestone: this week, the US surpassed 300,000 deaths from COVID-19, by far the highest recorded number in the world, per a count from by Johns Hopkins University. Brazil, the next closest country, has seen more than 181,000 deaths over the course of the pandemic.
By early next, as many as 362,000 Americans will be dead from the coronavirus, according to the latest forecasts analyzed by the US Centers for Disease Control and Prevention.
“In January, we will pass 400,000 deaths,” Dr. Ashish Jha, dead of public health at Brown University, said on Sunday. “Those deaths will come from infections that have already happened or will this week.”
“Vaccines will help,” he added. “But we can, must do more.”