Almost All US COVID-19 Deaths Now in the Unvaccinated

Damian McNamara

June 29, 2021

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If you, a friend, or a loved one remain unvaccinated against COVID-19 at this point — for whatever reason — you are at higher risk of dying if you become infected.

Dr Vino K. Palli

That's the conclusion of a new report released by the Associated Press looking at COVID-19 deaths during May 2021.

Of more than 18,000 people who died from COVID-19, for example, only about 150 were fully vaccinated. That's less than 1%.

"Recently, I was working in the emergency room [and] I saw a 21-year-old African American who came in with shortness of breath," said Vino K. Palli, MD, MPH, a physician specializing in emergency medicine, internal medicine, and urgent care.

The patient rapidly deteriorated and required intubation and ventilation. She was transferred to a specialized hospital for possible extracorporeal membrane oxygenation (ECMO) treatment.

"This patient was unvaccinated along with her entire family. This would have been easily preventable," added Palli, who is also founder and CEO of MiDoctor Urgent Care in New York City.

"Vaccine misinformation, compounded with vaccine inertia and vaccine access, have contributed to this," he added. "Even though we have a surplus amount of vaccines at this time we are only seeing 50% to 55% of completely vaccinated patients."

Dr Hugh Cassiere

Authors of the Associated Press report also acknowledge that some people who are fully vaccinated can get a breakthrough infection. These occurred in fewer than 1200 of more than 853,000 people hospitalized for COVID-19 in May, or about 0.1%.

The Associated Press came up with these numbers using data from the Centers for Disease Control and Prevention (CDC). CDC tracks the numbers of cases, hospitalizations, and deaths, but does not breakdown rates by vaccination status.  

Stronger Argument for Vaccination?

"The fact that only 0.8% of COVID-19 deaths are in the fully vaccinated should persuade those people still hesitant about vaccination," said Hugh Cassiere, MD, medical director of Respiratory Therapy Services at North Shore University Hospital in Manhasset, New York.

Dr Stuart C. Ray

Stuart C. Ray, MD, professor of medicine and oncology in the Division of Infectious Diseases at Johns Hopkins University School of Medicine in Baltimore, Maryland, agreed. "It seems compelling, even for skeptics, that unvaccinated people represent 99% of those now dying from COVID-19 when they represent less than 50% of the adult population in the USA."

The findings from the study could be more persuasive than previous arguments made in favor of immunization, Ray said. "These recent findings of striking reductions in risk of death in the vaccinated are more directly attributable and harder to ignore or dismiss."

Brian Labus, PhD, MPH, of the University of Nevada Las Vegas (UNLV) is less convinced. "While this might change some peoples' minds, it probably won't make a major difference. People have many different reasons for not getting vaccinated, and this is only one of the things they consider."

The study adds information that was not available before, said Labus, assistant professor in the Department of Epidemiology and Biostatistics at the UNLV School of Public Health. "We study the vaccine under tightly controlled, ideal conditions. This is the evidence that it works as well in the real world as it did in the trials, and that is what is most important in implementing a vaccination program," added Labus.

Dr Brian Labus

"The scientific data has honed in on one thing: vaccines are effective in preventing hospitalizations, ICU admissions, ventilations, and deaths," agreed Palli.

"We now know that almost all deaths occurred in patients who were not vaccinated. We also know that all vaccines are effective against various strains that are in circulation right now, including the Delta variant, which is rapidly spreading," Palli said.

Cassiere pointed out that the unvaccinated are not only at higher risk of developing COVID-19, but also of spreading, being hospitalized for, and dying from the infection. Avoiding "long hauler" symptoms is another argument in favor of immunization, he added.

As of June 28, the CDC reports that 63% of Americans 12 years and older have received at least one dose of a COVID-19 vaccine, and 54% are fully vaccinated.

Worldwide Worry?

Although overall rates of US COVID-19 hospitalizations and deaths are down, the outlook may not remain as encouraging. "I hope I'm wrong about this, but I anticipate that the coming fall and winter will bring increasingly localized versions of similar findings — severe disease and death due to SARS-CoV-2 infection in regions or groups with lower vaccination rates," Ray said.

There could be a silver lining, he added: "If this unfortunate surge occurs, the health and economic consequences seem likely to erode much of the remaining hesitancy regarding vaccination."

The rise of more infectious SARS-CoV-2 variants, such as the Delta variant, could also throw a wrench in controlling COVID-19. "This isn't just a domestic issue," Ray said. "We have learned that the world is a small place in pandemic times."

The Associated Press investigators state that their findings support the high efficacy of the vaccine. Also, given the current widespread availability of COVID-19 vaccines in the United States, they believe many of the COVID-19 deaths now occurring are preventable.

Public health measures should have continued longer to protect unvaccinated individuals, especially Black Americans, Hispanics, and other minorities, Palli said. "Only time will tell if re-opening and abandoning all public health measures by the CDC was premature."

Damian McNamara is a staff journalist based in Miami. He covers a wide range of medical specialties, including infectious diseases, gastroenterology, and critical care. Follow Damian on Twitter: @MedReporter.

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