The year 2020 will go on record as the deadliest year in our nation’s history. With the rapid spread of the Delta variant, 2021 is poised to take second place if not enough people are vaccinated.
Everyone felt the impact of COVID-19 last year, even those who remained infection-free or were asymptomatic. Whether it was jobs lost, shelter-in-place orders and restricted social interactions with family and friends, the pandemic’s burden hit heavy and hard.
When thinking of COVID-19 deaths, many envision people on ventilators in intensive care units (ICU) but this does not provide a full picture of what transpired.
Looking at deaths during the nine-month period from March through November 2020 (prior to when the Food and Drug Administration, FDA, granted emergency use authorization for COVID-19 vaccines ), close to 40 percent of the excess deaths in the United States were not attributed to COVID-19. This means that around 175,000 excess deaths did not list COVID-19 on their death certificates.
Why is this important?
Every COVID-19 societal response may have directly saved lives due to COVID-19 for some demographics while leading to unpredictable deaths for other demographics from other causes.
During the nine-month time period in 2020, there were around 500 COVID-19 deaths reported for young adults 15 to 24 years old, or 1.8 percent of their all-cause deaths. However, this group had around 4,300 additional all-cause deaths, an increase of 18 percent, compared to the average number of deaths between 2015 and 2019. This means that these young adults were exposed to risks that significantly elevated their odds of dying. Given the 30 percent increase in drug overdose deaths in 2020 compared to 2019, this could explain some of these additional deaths and the increased odds of dying.
In contrast, during the same time period in 2020, there were around 60 COVID-19 deaths reported for children 4 years old and younger, or 0.35 percent of their all-cause deaths. However, this group had around 2,400 fewer all-cause deaths, a decrease of 12 percent, compared to the average number of deaths between 2015 and 2019. This means that these children had a much lower risk of dying than they had over the previous five years.
This does not mean that these children benefited from COVID-19. They did benefit from an “invisible hand” created by the societal response to COVID-19. No one has yet explained this phenomenon. Perhaps lockdowns spared them from accidental deaths or parents/guardians were more attentive to their whereabouts.
Societal responses have consequences, frequently unpredictable, impacting different demographics in different ways, which may be worse or better than the issue that they were designed to address. Indeed, lockdowns may have saved the lives of older Americans and children, but they also appear to have cost the lives of some young adults in ways that are not yet fully studied or understood.
To avoid such consequences in the future requires virus transmission to be mitigated, ideally completely suppressed, effectively reducing the likelihood of new mutations leading to new variants. With the Delta variant now dominant in the United States, vaccination-induced immunity provides the most reliable method to protect society today and in the future.
The 15-to-24-year-old group would appear to be a key demographic in which to suppress virus transmission. They represent 13 percent of the United States population and many of them have already been infected and recovered. COVID-19 poses a minimal direct personal health risk to them, yet without them reliably immunized against the virus and its variants, the virus will continue to mutate and spread, inviting societal responses that may be more dangerous to these young adults than the virus itself.
Myocarditis has surfaced as a rare vaccination risk to those under 40 years old, particularly males. With around 500 such cases in total reported out of over 43 million of them fully vaccinated through mid-June, close monitoring serves to substantially reduce this risk, while preserving the societal benefits afforded by the vaccines.
Safe and effective vaccines are enabling the light at the end of the COVID-19 tunnel to grow. To realize the full benefit of these vaccines demands widespread uptake, particularly in the 15-to-24-year-old group. Without such acceptance, the Delta variant and future new variants could present conditions necessitating societal responses akin to what occurred over the past 18 months. Is this a risk we want to take?
Sheldon H. Jacobson, Ph.D., is a professor of Computer Science at the University of Illinois at Urbana-Champaign. He applies his expertise in data-driven risk-based decision-making to evaluate and inform public health policy.
Janet Jokela, MD, MPH, is the acting regional dean of the University of Illinois College of Medicine at Urbana-Champaign. She is an infectious disease and public health physician.