COVID still kills, but the demographics of its victims are changing

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As California enters a third year of the pandemic, covid-19 continues to pose a serious threat of death. But the number of people who die, and the demographics of the victims, has changed markedly since the first two years.

Given the herd immunity people have gained through a combination of mass vaccinations and protections built from previous infections, Californians in general were far less likely to die from covid in 2022, when the omicron variant dominated, which during the first two years of the pandemic, when other variants were largely at play, amplifying a national trend.

Still, each week, the virus is killing hundreds of Californians, hitting hardest among the unvaccinated. The virus remained among the state’s leading causes of death in July, behind heart disease, cancer, stroke and Alzheimer’s disease, but ahead of diabetes, accidental death and a number of of other debilitating diseases. In the first seven months of the year, about 13,500 California residents died of covid, according to preliminary death certificate data from the state Department of Public Health. By comparison, the virus killed about 31,400 people in 2020 and nearly 44,000 in 2021.

From April 2020 to December 2021, covid killed an average of 3,600 people per month, making it the third leading cause of death cumulatively in the state during that time period, behind the diseases of the heart and cancer. From December 2020 to February 2021, it briefly surpassed heart disease as the leading cause of death, claiming the lives of more than 38,300 Californians in just three months. During its most recent peak, in January 2022, covid claimed about 5,900 lives.

Covid fell out of the top 10 causes of death for a brief period in the spring only to re-enter this summer as the omicron variant continued to mutate. In July, even with more than 70 percent of Californians fully vaccinated, covid was the fifth leading cause of death, cutting more than 1,000 lives short, state data show.

Clearly the vaccinations made a difference. Covid death rates fell in recent months as covid infections and prior infections offered much of the population significant protection against serious illness, said Dr Timothy Brewer, professor of medicine and epidemiology from UCLA. Brewer said the omicron variant, while more transmissible than previous strains, appears to be a milder version of the virus. Research on this issue is ongoing, but preliminary data suggest that omicrons are less likely to cause serious illness and death, according to the Centers for Disease Control and Prevention, which also notes that the severity of symptoms can be affected by vaccination status, age and other health conditions.

The decline in deaths was particularly striking among California’s Latino population.

In 2020 and 2021, Latino residents accounted for 47% of covid deaths in California (about 35,400 deaths), even though they make up 40% of the state’s population. By comparison, Latinos accounted for 34 percent of covid deaths between January and July 2022, according to state data. This translates into about 4,600 deaths.

By contrast, the proportion of covid deaths involving white residents increased from 32% in the first two years of the pandemic to 44% in the first seven months of 2022. This equates to 24,400 deaths of white residents in 2020-21 and some 6,000 deaths in 2020-21. the first seven months of 2022. Whites make up about 35% of the state’s population.

Researchers point to several factors in the change. During the first two years of the pandemic, a large number of essential workers, who continued to report in person to jobs, were Latino, while white residents were more likely to be in occupations that allowed work from home usa Census Bureau surveys show.

“They’ve been exposed more,” said Dr. George Rutherford, a professor of epidemiology and biostatistics at the University of California-San Francisco. “They do essential jobs and had to leave the house and go to work.”

An imbalance in remote work remains, census data show, but today the vast majority of Latino and white workers in California report to work in person.

Seciah Aquino, deputy director of the Latino Coalition for a Healthy California, said efforts to make sure testing, treatment and vaccines were available to underserved communities of color also had an impact. And because Latino communities were hit hard during the pandemic, he said, many Latinos in California still wear masks. “They’re still making sure they stay home if they’re sick,” he said. “They’re still following these policies even though the overall narrative is changing.”

Age is also a key factor in demographic changes, Brewer said.

Californians 75 and older accounted for 53% of covid deaths through July 2022, compared to 46% in 2020 and 2021. Only 6% of state residents are 75 or older . And white Californians age 75 and older outnumber Latinos in that age group by 3 to 1 years.

In the initial vaccination rollout, California prioritized seniors, first responders and other essential workers, and for several months in 2021 older residents were significantly more likely to be vaccinated than younger Californians.

“Now, vaccination rates have caught up with pretty much everyone except children, people under the age of 18,” Brewer said. “You’re seeing it go back to what we saw before, which is that age is still the most important risk factor for death.”

More than 86% of Californians age 65 and older have completed their primary series of covid shots. But the protection afforded by vaccines wanes over time, and because many older people received their vaccinations early, enough time passed between their second shot and the omicron wave of early 2022 to leave – the vulnerable. About a third of Californians age 65 and older had not received a booster by early 2022, when the omicron wave peaked, and about a quarter have not yet received a booster.

Throughout the pandemic there have been geographic shifts in the prevalence of covid: outbreaks affect one area while another is spared, and then another community serves as the epicenter a few months later.

Residents of the San Francisco-Oakland metro area accounted for 7.8 percent of the state’s deaths in 2022, through early September, compared with 5.4 percent in 2020-21. The area is home to around 12% of the state’s residents. The Sacramento metro area also accounted for a higher share of covid deaths this year: 6% in 2022 compared to 4.5% in 2020-21.

At the same time, residents of the Los Angeles-Long Beach-Anaheim metro accounted for 42% of covid deaths in 2022, down slightly from 43% in 2020-21. The area is home to around 33% of the state’s residents. A similar drop happened in the nearby Riverside-San Bernardino metro area.

Again, age could be a factor in geographic shifts. Census data show that a higher proportion of residents in San Francisco and Sacramento are 75 and older than in Los Angeles and Riverside.

It is unclear whether this change will last. As the Los Angeles Times reported, deaths from covid grew at a faster rate in July in LA County than in the Bay Area.

The data also shows that vaccination remains one of the strongest deterrents to death from covid. From January to July, unvaccinated Californians died about five times more than vaccinated Californians. But the gap has narrowed. From April to December 2021, unvaccinated California residents died, on average, at about 10 times the rate of vaccinated Californians.

Brewer said the gap has narrowed because the omicron variant was more likely than earlier variants to “penetrate” and cause infection in vaccinated Californians. The omicron variant, while less deadly, also infected many more people than previous variants.

This trend may also be short-lived: The next generation of covid booster shots are being rolled out across the state.

Phillip Reese is a data reporting specialist and assistant professor of journalism at California State University-Sacramento.

This story was produced by KHN, which publishes California Healthline, an independent editorial service of the California Health Care Foundation.

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