Recent reports from mainstream press such as CNN showcase rises in COVID-19 cases with the overwhelming number of infected and hospitalized patients unvaccinated. Aya C. Elamroussi reports on findings that the Delta variant-driven COVID-19 surge now targets more healthy, young, and unvaccinated people. The press indicates that as compared to the first couple of waves in America where the elderly and highly at-risk populations—such as people with co-morbidities and ethnic minorities—now relatively younger populations, even as low as in the 30s to 40s, end up in the hospital. A review by TrialSite indicates that there is a clear correlation between states with the highest vaccination rates and fewer new Delta-drive COVID-19 cases, and those states with the lowest vaccination rates experience significant surges in daily cases. The overall death rates across the country have been on the wane, and it’s too early in this surge to determine if Delta is simply more transmissible or more deadly. A review in India found it not necessarily to be so but in Russia, perhaps more deadly. The overall COVID-19 death rates are still considerably higher in low-income, Black, and Latino (Hispanic) populations, at least in places like Los Angeles County. TrialSite predicts poor rural white communities will be unvaccinated and more vulnerable. Based on this survey, the unvaccinated face materially more risk for hospitalization and death than the vaccinated, especially if they fall into a lower socio-economic category. TrialSite remains steadfast that vaccination is a wise thing to do but those with particular risks should consult their physician. Vaccination anchors a comprehensive, holistic strategy to protect populations from COVID-19. Given 90% of cases are asymptomatic to mild-to-moderate cases, the health authorities should accelerate efforts to not only continue vaccination education but also authorize potential generic repurposed therapies where and when the data reveals efficacy and safety for such a pandemic. National Institute of Health clinical trials, such as those involving antivirals and prophylactic monoclonal antibodies (AstraZeneca) to the NIH-sponsored ACTIV-6 study and the COVID-OUT study led by the University of Minnesota, center now on ivermectin as a possible early-onset treatment.
Slowing Vaccination Rates
A mass vaccination program, which commenced at the start of the year, has slowed down to a near halt as so-called vaccine hesitancy makes it ever more challenging, although the U.S. White House is doubling down its efforts to fight what it calls misinformation targeting COVID-19.
According to Our World in Data, 49% of the United States population have been fully vaccinated while 56.6% of the population has received at least one dose. With the White House’s recent announcement that it would step up campaigns against misinformation to reduce vaccine hesitancy, TrialSite reviewed some of the numbers and trends, and observes that the poor, ethnic and racial minorities, and definitely the unvaccinated, are bearing the brunt of what appears to be a building, Delta-driven surge. The U.S. has experienced three successive surges, the first one when the pandemic started back in March/April, a second larger one last summer and a much larger wave of illness starting in October and running through February. Since then, the number of cases has waned and that indeed has correlated with vaccination, undoubtedly natural immunity, and perhaps some of the population discovering other off-label options. But with an active July 4th, Americans were out in droves, hanging out in large groups at picnics and beaches, attending ball games, concerts, and the like. The CDC even suggested that those who were vaccinated could lose their masks. Could a fourth surge be growing? It’s too early to tell, but the pressure will be on to vaccinate as much of the remaining population as is practicable.
TrialSite summarizes some of the CNN bullet points:
- In Louisiana, according to Gov. John Bel Edwards, since February, 97% of cases and deaths associated with COVID-19 there involved those not fully vaccinated. Note that 36.1% of this state’s population is fully vaccinated as of this writing based on the CDC.
- CNN reports that in Arkansas, a state with one of the lowest rates of vaccination at 35.3%, reported on rising cases “filling up hospital beds.”
- In Los Angeles County, CNN reports “cases surging” now leading to a reinstatement of “indoor mask requirements.” California’s most populated county issued a press release reporting a four-fold increase in cases since July 4th. And the number of those hospitalized in the county (462) has doubled since June.
- Utah has a surge of cases with data evidencing very low numbers of young people vaccinated.
TrialSite looked at the top ten vaccinated states in the nation as the mainstream press has focused intensively on the lowest vaccinated ones. We include a breakdown of vaccination rates and COVID-19 trends:
Top 10 Vaccinated States
|State||COVID-19 VaccinationRate||June 1 cases 7-day avg.||Latestcases 7-day avg.||% + or –||% white||%minority|
While a majority of the nation’s most vaccinated states (as measured by total percentage fully vaccinated) have seen declines in the new cases as measured by total 7-day average daily case counts, there are some notable trends. Generally from June 1 to the present (July 17 or the last reporting date), there is an increase in COVID-19 infections across a few of the most heavily vaccinated states. In fact, some states such as Massachusetts and New Jersey have seen a 30% rise in 7-day daily average new case counts while New Mexico has seen a 25% increase. Something to note is that the heavily vaccinated states with overall declines share a common demographic—a high proportion white population (e.g. Anglo, Scotch, German, Irish-America, etc.) or put another way, low minority (African American, Hispanic, Asian) populations. There are exceptions to this, such as in New Jersey, Maryland, and New Mexico. In the aggregate, of all the top 10 vaccinated states, they have dropped an average of -14% in daily cases as measured by the 7-day daily new case average, according to NY Times data. Again, the three (3) states with considerable growth in COVID-19 cases in this group have sizable minority populations but TrialSite cannot declare this to be statistically significant. Overall, the top 10 vaccinated states are, in the aggregate, 73.2% white.
Top 10 Unvaccinated States
|State||COVID-19 VaccinationRate||June 1cases 7-day avg.||Latest cases 7-day avg.||% + or –||% white||%Minority|
Note the overwhelming surge in cases across the least vaccinated populations is based on the same duration of June 1, 2021 to the present day. On average, the least vaccinated states saw their 7-day daily average new case counts rise by 168%. A few states have had huge surges occur recently:
- Arkansas 659%
- Louisiana 278%
- Mississippi 224%
- Alabama 164%
- Tennessee 132%
We note that these states have larger African American populations than the national average. Blacks make up about 13.4% of the total U.S. population. Note Arkansas is 15.2% African American while Louisiana is 32.8%; Mississippi has the largest percentage of African Americans in the nation at 38% while Alabama stands at 26.64% and Tennessee at 17.1%.
It’s also apparent that the most unvaccinated states also maintain strong regional affiliation in that many of them are in the American South, although there are exceptions such as Wyoming and Idaho—both located in the Intermountain West region of the nation, although these two states don’t see large increases of new cases. Of note, of course, to CNN and the like is the fact that the least vaccinated states’ populations are majority Republican. This is most definitely the case.
COVID-19 Death Trends
What about COVID-19 death trends? Media sources such as CNN suggest there are significant deaths associated with the latest surge. What do the numbers reveal?
According to New York Times, COVID-19 death data showed that on June 1 the 7-day average for new deaths came in at 601 new deaths across America. By June 15, a couple of weeks later, that number declined to 354 reported average new deaths for the 7-day period. By July 1, that figure dropped even lower to 256 deaths per day based on the running 7-day average. Fast forward to July 17, and the figure has inched back up to 272, more than likely due to surges in a handful of these states. Since June 1, overall death rates are down. Delta may be more transmissible, but it’s not clear if it’s more dangerous yet. Some data in India indicated it wasn’t but in Russia, TrialSite reported on the opposite trend.
What about Los Angeles County?
In the recent CNN report, Los Angeles County was featured as experiencing a growing surge. On June 1, the nation’s most populous county reported its 7-day daily average new case count at 725 new cases per day. That number declined to 172 by June 15 and 329 on July 1, 2021. The number has since jumped to 1,389 based on the 7-day daily new case average—a significant increase.
In Los Angeles County, CNN’s Cheri Mossberg reported on July 14 that the county’s health services director, Dr. Christina Ghaly, told the Board of Supervisors there that:
“To date, we have not had a patient admitted to a [Department of Health Services] hospital who has been fully vaccinated, with either the J&J, Pfizer or Moderna vaccine. Every single patient that we’ve admitted for COVID is not yet fully vaccinated.”
Now Los Angeles County is heavily vaccinated with nearly 60% of the total population vaccinated. The surge has led to a new mask mandate, as reported by KTLA. By Sunday, July 18, there were over 525 people hospitalized across Los Angeles, with four (4) related deaths reported. But what the press isn’t informing the public is the social class and racial/ethnic dynamics associated with the surge.
COVID-19 vaccination and mortality rates aren’t spread evenly across this sprawling 11+ million county, as ethnic minorities in poor eastern, southeastern and southern areas of the county are overwhelmingly hit the hardest. The mortality rate for Latinos is highest—nearly 3 times the rate of whites. Blacks are next, with nearly a rate two times that of whites. Poverty correlates with COVID-19 death in Los Angeles County. The homeless and those in dire poverty have the highest death rate, nearly four times the rate of the white population.
Some General Trends: Brown & Poor People More Vulnerable
While, of course, there are exceptions, the brunt of this latest surge represents the unvaccinated, often minorities (Latino or Black), homeless individuals of all backgrounds as well as those living in the poorest districts within the county.
Generally, vaccination correlates with greater protection, but there are other factors driven by the social determinants of health. For example, in California as a whole, 29% of the vaccinations have gone to Latino (Hispanic) people yet they account for 63% of COVID-19 cases in the Golden State and 48% of all COVID-19-related deaths there—while they represent 40% of the total state population, reports the Kaiser Family Foundation (KFF). Obviously, efforts to vaccinate Latinos in California lag considerably behind whites. Put another way, the POTUS outreach should be most intense in some of the poorest regions of the United States—that’s where the brunt of the worst problems are unfolding, whether that be the Deep South or in some rural areas of the Intermountain West.
Another example is Washington DC, where Black people represent 46% of the population and 43% of the vaccinations. Yet Blacks account for 56% of new recent cases and 71% of all deaths. TrialSite suspects that COVID-19 deaths aren’t spread evenly across the African American population but concentrate in poorer Southeastern districts. As reported last month in New York Magazine, Blacks and Latino New Yorkers face higher risks from the Delta variant.
Generally, whites are vaccinated at higher rates, proportionally, than Blacks of Latinos. But within minority communities, TrialSite suspects the vaccination rate is correlated to economic class. That is, the higher the household income, the higher the vaccination rate.
COVID-19 case data is complex, and it appears that poverty and race/ethnicity are major factors as could be other socio-demographic dynamics in this emerging surge. It would appear Blacks and Latinos may face harsher consequences, particularly among the unvaccinated. But socio-economic levels are a factor, so poor whites may also have greater incidence of new cases. Generally, the Delta variant appears more contagious than previous strains but its potency is yet to be determined in America.
Generally, the other at-risk areas are unvaccinated whites in a handful of regions from the deep South and pockets in Appalachia and the Ozarks to parts of the Plains and Intermountain West states. As indicated by the KFF map, inland California also has substantial numbers of unvaccinated white populations. TrialSite proposes that perhaps the income gap among the vaccinated and unvaccinated may not be as severe as in major urban centers and in heavily vaccinated states but we haven’t studied this in detail yet. As TrialSite has shown, however, states like Wyoming and Idaho, while among the least vaccinated, have small populations and not as of yet significant growth in cases. Of course, that could change.
Call to Action: TrialSite recommends vaccination as a protective measure unless there are specific risk factors that need the attention of a physician. For those individuals that won’t accept a vaccine, they should not be discriminated against but rather offered continued education as well as access to the clinical research-as-a-care option, including expanded studies such as ACTIV-6 and COVID-OUT offering treatments for early-onset SARS-CoV-2 infections. Government-funded programs to shame unvaccinated individuals may backfire. While some Washington DC playbooks may call for 70%+ to be fully vaccinated, health authorities should be flexible, open-minded, and entrepreneurial in their approach to aid populations if that target isn’t reached. The patient-physician relationship shouldn’t be intermediated by a state agency (federal, state, or local). Of course, post-vaccination data should be tracked in a transparent manner.