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COVID Still Kills, but Demographics of Its Victims Are Shifting

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Editor’s note: Visit Medscape’s Coronavirus Resource Center for the latest COVID-19 news and guidance.

As California braces itself for a third year of the pandemic, Covid-19 continues to pose a serious threat of death. But the number of people dying — and the demographics of victims — has changed markedly since the first two years.

Given the collective immunity people have gained through a combination of mass vaccination and protections from previous infections, Californians were far less likely overall to die from Covid in 2022, when the Omicron variant was dominant than in the first two Years of the pandemic, as people were dying in California, other variants were largely at play, reinforcing a national trend.

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Still, the virus kills hundreds of Californians every week, hitting the unvaccinated hardest. The virus remained among the state’s leading causes of death in July, behind heart disease, cancer, stroke and Alzheimer’s, but surpassed diabetes, accidental death and a host of other debilitating diseases. About 13,500 California residents died of Covid in the first seven months of the year, according to preliminary death certificate data from the state Department of Public Health. For comparison, the virus killed about 31,400 people in 2020 and almost 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 in the state cumulatively for the period behind heart disease and cancer. From December 2020 to February 2021, it briefly overtook 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 the lives of around 5,900 people.

Covid dropped out of the top 10 causes of death for a brief period in the spring, only to reappear this summer as the Omicron variant continued to mutate. In July, despite more than 70% of Californians being fully vaccinated, Covid was the fifth leading cause of death and claimed more than 1,000 lives, state data shows.

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Obviously vaccinations have made a difference. Death rates from Covid have been falling in recent months as Covid vaccinations and previous infections have offered significant protection against serious illnesses for much of the population, said Dr. Timothy Brewer, professor of medicine and epidemiology at UCLA. Brewer said the Omicron variant, while more transmissible than previous strains, appears to be a milder version of the virus. Research into this question is ongoing, but preliminary data suggests Omicron is less likely to cause serious illness and death, according to the Centers for Disease Control and Prevention, which also notes that symptom severity is affected by vaccination status, age and immunization can become other health conditions.

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

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In 2020 and 2021, Latinos accounted for 47% of California’s Covid deaths — about 35,400 deaths — despite making up 40% of the state’s population. For comparison, from January to July 2022, Latinos accounted for 34% of Covid deaths, according to government data. That equates to about 4,600 deaths.

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Conversely, the proportion of Covid deaths involving white residents rose from 32% in the first two years of the pandemic to 44% in the first seven months of 2022. That equates to 24,400 deaths involving white residents in 2020- 21 and about 6,000 deaths in the first seven months of 2022. White people make up about 35% of the state’s population.

Researchers point to several factors in the shift. During the first two years of the pandemic, many of the workers deemed essential who continued to report in person to job sites were Latinos, while white residents were more likely to be employed in occupations that allowed them to work from home, US surveys by the Census Bureau show.

“They just got more exposed,” said Dr. George Rutherford, Professor of Epidemiology and Biostatistics at the University of California-San Francisco. “They’re doing important jobs and they’ve had to leave the house and go to work.”

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Census data continues to show an imbalance in remote work, but today the vast majority of Hispanic and white workers in California are reporting to work in person.

Seciah Aquino, associate director of the Latino Coalition for a Healthy California, said efforts to ensure testing, treatment and vaccinations were available for underserved communities of color had also made an impact. And because Latino communities have been hit so hard during the pandemic, many California Latinos are still wearing masks. “They still make sure they stay home if they’re sick,” she said. “They still adhere to those guidelines even as the larger narrative changes.”

Age is also a key factor in changing demographics, Brewer said.

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Californians ages 75 and older accounted for 53% of Covid deaths through July 2022, up from 46% in 2020 and 2021. Only about 6% of the state’s residents are 75 and older. And white Californians aged 75 and older outnumber Latinos in that age group by about 3 to 1.

When vaccination was first rolled out, California prioritized seniors, first responders and other essential workers, and for several months in 2021, older residents were much more likely to be vaccinated than younger Californians.

“Now vaccination rates have caught up with pretty much everyone except children, people under 18,” Brewer said. “You see it returns to what we saw before, which is that age remains the most important risk factor for death.”

More than 86% of Californians age 65 and older have completed their primary Covid shot series. But the protection vaccines offer wears off over time, and because many seniors got their shots early, there was enough time between their second shot and the Omicron wave in early 2022 to make them 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 still have not received a booster.

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Geographic shifts in Covid prevalence have occurred throughout the pandemic: outbreaks hit one area while another was spared, and a few months later another community served as the epicenter.

Residents of the greater San Francisco-Oakland area accounted for 7.8% of the state’s deaths in 2022 through early September, up from 5.4% in 2020-21. The area is home to approximately 12% of the state’s residents. Greater Sacramento was also responsible for a higher proportion of Covid deaths this year: 6% in 2022 versus 4.5% in 2020-21.

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

Again, age could be a factor in geographic shifts. Census data shows 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 shift is permanent. As reported by the Los Angeles Times, July Covid deaths rose faster in LA County than in the Bay Area.

The data also show that vaccination remains one of the strongest deterrents to death from Covid. From January through July, unvaccinated Californians died about five times as often as vaccinated Californians. But the gap has narrowed. From April to December 2021, unvaccinated Californians died, on average, about 10 times as likely as vaccinated Californians.

Brewer said the gap narrowed because the Omicron variant was more likely than previous variants to “break through” and cause infection in vaccinated Californians. While the Omicron variant was less deadly, it also infected many more people than previous variants.

That trend, too, could prove short-lived as the next generation of Covid booster shots roll 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 editorially independent service of the California Health Care Foundation.

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