Why are so many Americans still dying of COVID? For one thing, says data guru jburnmurdoch, small differences in vaccination rates can make a big difference. He spoke with dwallacewells
A vigil outside the White House on January 13 for nurses who have died during the pandemic. Photo: Allison Bailey/NurPhoto/Shutterstock Why are so many Americans still dying of COVID? The seven-day average is now 2,500 a day, higher than at any point in the last two years outside last January — before vaccines, at the height of the most devastating phase of the pandemic. Yesterday, the total reported dead was 3,600.
Let’s start with the headline observation of your piece, which is just how much worse the U.S. experience has been. You suggest that if the U.S. was as well-vaccinated as most western European countries, only half as many Americans would’ve ended up in the hospital. Now, I do think there are obviously some wrinkles here. Something that I think some people miss is if they look at a place like New York, and they say, Oh, hospitalizations have gone as high as they did last winter, they’re missing the fact that in a place like New York, the winter of 2021 was much less bad than the spring of 2020. But that being said, on the national level, we have seen hospitalizations and ICU admissions — and in parts of the U.S.
All of these things were happening at the same time. But I think part of this is that it’s human nature that stories around things like this are formed not necessarily based purely on a rational, logical approach but just on a more emotional side. And I think the fact that India’s Delta wave was so bad, it led everyone to think of Delta as very, very bad, but then you saw it really well mitigated by the success of the vaccination campaign in the U.K.
With Omicron, some of the best research on the specific question of intrinsic severity was the stuff done by Imperial College. Their best effort gets you to a reduction of intrinsic severity somewhere in the region of 30 to 50 percent.Yes.
If you take a thousand Omicron cases and a thousand Delta cases, the Omnicon cases will just be more heavily skewed toward people with some immune protection. And therefore, even if there were no change in its intrinsic severity, that would still mean it would look less severe. But the U.S. did certainly start vaccinating ahead of pretty much every other country in the world other than Israel.With the Delta wave in the U.S., you had this perfect storm. Number one, relatively low vaccination rates in places like Florida–
And I think what that means is that what looked like smaller gaps in vaccine coverage among the vulnerable between the U.S. and the U.K. ended up being bigger heading into the Delta wave, certainly in parts of the U.S.And then the southern states were also those that had been hit less hard the previous spring. And so these were places that had both less immunity acquired by vaccination and less immunity acquired by infection.
Because a place that’s got 90 percent coverage and a place that has 85 percent coverage — those numbers sound similar, but actually one has 50 percent more vulnerable people, which is a huge gap. Absolutely, absolutely. And I’d be the first to say, in terms of the analysis that we did, that’s the biggest limitation with the data that we used. One percent versus 2 percent is a huge difference. It could also just be an error. It could also be a rounding error. There could actually be no difference. So these things are very sensitive to measurement
Yeah. But look, all I’m doing here is saying things that to me could reasonably explain the data you sent. And I do think that some of this comes to prior immunity. New York had one really bad outbreak, in spring 2020. The U.K., consistently from April 2020 until November 2021, was probably having more severe disease than New York. Second, boosters could be playing a role there.
And if a 95-year-old is 15 times more likely to die than a 65-year-old and hundreds of times more likely to die than a young adult, small variations in the demographic mix or in the vaccination coverage among the very old can make a very big difference overall. That’s where prior infection and boosters were doing a lot of work in England. England had this slow-burning Delta wave in which a lot of people were getting infected, particularly younger people, and that was just adding a huge amount of immunity. And then the English booster rollout was pretty rapid once it got going — pretty fast and pretty steep.
And then there was a study that came out relatively soon after that looking at two-dose efficacy against Delta in Canada and in the U.S. And that also seemed to be showing much faster waning of efficacy in the U.S. than Canada, with dosing interval one of the likely keys there. Let’s talk a bit more about boosters. The headline of this piece was “Pandemic of the Unboosted,” and I think there’s a growing view among American epidemiologists that part of the story of America’s poor performance is that while we may be relatively close in terms of overall vaccine coverage and probably a little farther in terms of our elderly coverage with two doses, the gaps are really, really large at the moment in the booster uptake. Between the U.S.
But I do think there’s also an important caveat there looking at the risk of hospitalization. We don’t have very good estimates yet for protection against death with Omicron. And it may be that the difference between two and three doses when it comes to death is smaller than the difference between zero and two doses. Whereas for hospitalization, the two differences might be similar.
Yeah. I think some of the issue may be with the difference between hospitalization and death data for Omicron. The reason we used hospitalizations rather than death for this story is that we don’t have as good estimates of vaccine efficacy against death yet.
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