COVID’s unthinkable toll

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Once thought impossible, the United States now has recorded more than 1 million COVID-19 deaths since the beginning of the pandemic. That figure, which likely understates the number of fatalities due to the virus, some experts say, is roughly equivalent to the population of San Jose, Calif., Austin, Texas—or the entire Rochester metro region. 

In Monroe County, the death toll has crossed 1,550, at least 50 percent more than the total fatalities from the 1918 flu pandemic. Cholera epidemics in the 1830s caused hundreds of deaths in Rochester.

The fatality numbers do not speak well of the nation’s response to the coronavirus crisis. According to Johns Hopkins University, the U.S. has had 303.37 COVID deaths per 100,000 population; among major countries, only Brazil has a higher rate, 312.86. (Peru has the highest rate overall: 646.05.) The U.S. rate is far higher than Germany (165.34), Canada (105.29), or Japan (23.72). If the U.S. had Germany’s per-capita rate, its death toll to date would be 549,590; if it had Canada’s rate, deaths would be only 349,984. 

Monroe County has recorded some 214 COVID deaths per 100,000—better than the U.S. rate. Compared with other nations’ rates, it lands between Uruguay (207.64) and Liechtenstein (220.26).

Unpacking more than two years of data also reveals disproportionate amounts of suffering among various populations. The elderly and people of color have been affected at a greater rate since the pandemic began. 

Still, there are hopeful signs—in particular, recent spikes in positive cases have not resulted in the same devastation seen in 2020 and people appear to be regaining optimism about the future.

Deadly waves

When the pandemic began in 2020, it took seven months for Monroe County to register 3,000 positive COVID tests. But starting in November 2020, positive tests skyrocketed, bringing the total to more than 20,000. The number of deaths also rose sharply.

On Dec. 21, 2020, 30 people died from COVID, a number that remains Monroe County’s highest reported daily fatality count to date. For New York as a whole, the deadliest day was April 18, 2020, with 1,677 deaths, driven by the early outbreak in the New York City area.

Those deaths were and continue to be disproportionately skewed toward older people. In New York, three out of four deaths due to COVID have been people 65 years and older. Older adults are more likely to have underlying medical conditions or be taking medication that weakens their immune system; as a result, if they contract COVID they also are more likely to require hospitalization, intensive care, or a ventilator to help them breathe.

While COVID deaths on a county level are not available by age group, they likely follow state trends. 

Compared with the start of the pandemic, reported COVID cases now are more evenly distributed across age groups.

For example, Monroe County data for the week of May 5, 2022, shows that people ages 0 to 19 made up 23 percent of positive cases; 20 to 44 made up 28 percent; 45 to 64 made up 27 percent, and 65 and older made up 22 percent of all positive COVID cases. This is much more evenly distributed than the week of April 6, 2020, when those in the 65-and-older category made up more than half of all COVID cases.

Unequal impact

Like the elderly, people of color have been disproportionately affected by COVID. In Monroe County, where more than 120,000 African Americans live, the mortality rate for COVID was 258.1 adjusted per 100,000 people. That is more than two times higher than the mortality rate for white people in the county, which was 93.6 per 100,000.

Hispanics, who number 69,000 in Monroe County, also have a high mortality rate, 180.6 per 100,000 people. Asians living in the county have a COVID mortality rate of only 81.9 per 100,000 people.

Systemic inequalities that already put racial and ethnic minority groups at risk were further exacerbated by the pandemic. Discrimination in health care, housing, education, criminal justice and finance can shape social and economic factors that make it more likely for people to get sick.

In addition, people of color are more likely to be employed in essential-worker settings such as health care facilities, farms, factories, grocery stores, and public transportation. One study, conducted by the Agency for Healthcare Research and Quality, found that non-Hispanic Black adults were 60 percent more likely than non-Hispanic white adults to live in households with health care workers. The study also found that fewer than half of non-Hispanic white adults—46.6 percent—live in households with at least one worker who was unable to work from home, compared with 56.5 percent for non-Hispanic Black adults and 64.5 percent for Hispanic adults.

Geographically, the COVID burden has been uneven as well. During the peak COVID months in Monroe County (the winter season of 2020-2021 and 2021-2022), the ZIP codes that experienced the most hospitalizations included the Maplewood neighborhood (14613), the 19th Ward (14608 and 14611), and the North Clinton neighborhood (14621 and 14605). According to census data, each of those neighborhoods is at least 70 percent Black or Hispanic and has a 33 percent average rate of families living in poverty.

Erie County, which includes Buffalo, had higher mortality rates for all race/ethnicity categories except Hispanics. In addition, all racial categories’ rates in Monroe County were lower than the average mortality rates statewide (excluding New York City). This suggests that, while mortality rates here were disproportionate for people of color, the county’s COVID response was better than many others.

The influence of vaccines

Vaccination efforts were a key part of the county’s response. (And they can still be signed up for.) However, vaccine shots began to plateau in January 2022, roughly a year after they became available to the public. In Monroe County, about 23 percent of the population remains unvaccinated.

Among the more than three out of four people in Monroe County who have received COVID shots, well over half have completed the series of vaccinations, meaning two from Pfzier or Moderna or one from Johnson & Johnson. In addition, gains made with the COVID booster were remarkable, leaping to well past 100,000 total when it was made available. As of May 16, close to 44 percent of all county residents had been boosted.

While research suggests that COVID vaccines are less effective against the latest COVID variants, according to the Mayo Clinic, they remain effective at preventing severe illness. 

A comparison of the case and death rates since the beginning of the pandemic show the impact of COVID vaccines as well as mutations that have reduced the virus’ virulence. January saw a huge spike in positive test results with nearly 19,000 reported in one week that month. However, an equivalent increase in deaths like the dramatic rise in the 2020-2021 winter season was not seen. People in Monroe County are still catching the disease, but few are dying from it.

These improvements could be reflected in Americans’ current cautious optimism toward COVID. According to a recent Gallup poll, over 60 percent of respondents thought that things were improving a lot or improving a little. This is a dramatic shift from a poll conducted in January, when the Omicron variant raged and only 20 percent of respondents believed things were improving.

Still more to unravel

Much remains unknown, however. In particular, while much data related to COVID is available, experts agree the long-term health effects of the disease require more study. 

Most sufferers of long COVID, called “long haulers,” can be diagnosed with this about four weeks after infection and can be young or elderly.

The wide-ranging symptoms of long COVID include general tiredness or fatigue, respiratory, digestive, and heart problems, and negative neurological effects, according to the CDC. Long haulers report issues that last as long as days or months. Some still are wrestling with the after-effects of the disease two years later. Experts have observed that anywhere from 7 percent to 61 percent of those infected with COVID, even mild forms, later experience long COVID. Johns Hopkins University is currently surveying people who are battling symptoms of long COVID.

Estimates for the number of Americans with long COVID range between 8 million and 23 million. Meanwhile, the nationwide death toll has not stopped at 1 million. Clearly, the pandemic’s impact will continue to be felt for a long time.

Jacob Schermerhorn is a Rochester Beacon contributing writer. The Beacon welcomes comments from readers who adhere to our comment policy including use of their full, real name.

All Rochester Beacon coronavirus articles are collected here.

One thought on “COVID’s unthinkable toll

  1. As I read your article I could not help but think back to the start of this tragic pandemic and how the powers that be anticipated that the virus would just disappear or at most 200,000 souls would succumb to this new and novel virus. As we enter the third year of this tragic calamity the true and total ramifications of virus has still not been felt or even accurately delineated.
    As you and the readers are aware the numbers are woefully inaccurate and do not even touch upon the collateral damage done by this virus and how we handled this global threat.
    As a physician I believe the loss of preventive care services and routine care will soon be felt.
    Delayed and missed care due to the pandemic has not yet been felt. Long haul disease will require significant health care resources. Potential future viral reactivation of those infected is a distinct possibility as we have a number of viruses which cause havoc decades after the initial infection.
    An ounce of prevention is worth a pound of cure. In our office the number of positive at home tests far out paces COVID vaccinations. Get vaccinated and boosted as recommended. Use common sense and mask up when sharing the air in crowded places. Protect yourself and at the same time those at high risk and unable to get vaccinated . This virus is not done with us yet as it is estimated that a potential fall surge of 100 million infected may be in our future. Stay healthy because you can not afford to get sick. Take it from one who knows. Better yet trust me.
    I’m a doctor.

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