U.S. Covid fatalities reach highest level in a year as omicron cases subside

Employees of a funeral home and staff from Bucharest University Hospital morgue, all wearing personal protective equipment, prepare a COVID-19 victim for transport to a cemetery, in Bucharest, Romania, October 29, 2021.

Inquam Photos | Reuters

The ChristianaCare health system in Wilmington, Delaware, implemented “crisis standards of care” for the first time in its 130-year history last month as a fresh wave of Covid-19 infections ripped through the Northeastern U.S.

That gives the organization’s three hospitals, which have more than 1,200 beds, flexibility to treat more than one patient in private rooms and reschedule critical procedures to meet the onslaught of Covid cases.

“There’s nothing mild about what’s going on in our hospital and in our ICUs, particularly if you are unvaccinated or unboosted,” said Dr. Ken Silverstein, the chief physician executive of ChristianaCare. Silverstein was alluding to reports that the highly contagious omicron variant produces milder infections than previous strains.

A shortage of monoclonal antibodies, which were standard care for Covid patients before they proved little use against omicron, has also forced ChristianaCare to make “clinical prioritization decisions about who’s most eligible,” Silverstein said. “Not who’s eligible, who’s most eligible.”

Covid deaths rise

The daily death toll from Covid rose to an average of more than 2,400 fatalities over the previous seven days as of Monday, up 39% over the past two weeks and the highest level in about a year, according to data compiled by Johns Hopkins University. 

Jennifer Nuzzo, head of epidemiology at Johns Hopkins Covid Resource Center, said Covid deaths may rise even more because states with lower vaccination rates got hit later by omicron and haven’t experienced the full brunt of the variant yet. She said it’s a tragedy that people are still dying when vaccines are available that protect against severe illness.

“Any time we have deaths after the development of a vaccine — that largely takes off the table the possibility of death — is a tragedy,” Nuzzo said. “There’s no way around that this is a bad development for the pandemic.”

Vaccines

Milder omicron

Dr. Shereef Elnahal, CEO of Newark, New Jersey-based University Hospital, said it’s not yet clear if his facility is fully over the hump in Covid-related deaths in this wave. After an increase in deaths over the past couple of weeks, the hospital has seen a plateau in ICU patients and fatalities.

About half as many patients who come in with Covid end up needing intensive care in this wave as compared with previous surges, Elnahal said. “It’s just so transmissible that the absolute numbers of people needing ventilators looked similar to previous waves,” he said.

Some parts of the country are seeing encouraging signs, and cases and hospitalizations are easing nationwide. Hopkins data shows that U.S. cases surged to a pandemic high of close to 1 million new infections a day in mid-January. The country is now reporting a seven-day average of about 450,000 new cases per day, down 36% over the past two weeks.

Hospitalizations fall

The roughly 140,000 patients currently in U.S. hospitals with Covid is also down from the recent peak of 159,400 on Jan. 20, according to a seven-day average of Department of Health and Human Services data.

This easing is most evident in the Northeast, where cases were already on the rise when the omicron variant spread earlier than in other parts of the country. Cases and hospitalizations are falling more sharply in that region than others, but it’s now feeling the effects of getting hit first by omicron, with population-adjusted daily deaths higher than anywhere else.

The number of ChristianaCare patients has declined by 33% in recent weeks, but its hospitals were still operating at 99% capacity as of late last week. That includes patients who came to the hospital because of Covid as well as those who were admitted for something else and then tested positive. All patients who test positive for Covid, regardless of why they were admitted, need extra care and resources to isolate them from other patients and staff, which is taxing on the system, Silverstein said. 

“There are a lot of sick people, with Covid and because of Covid,” he said.

Mortality rates

The mortality rates, the percentage of people with Covid who ultimately succumb to the virus, are lower in the Northeast during this wave than previous surges. But other parts of the country that have lower vaccination rates may not be as lucky, doctors say.

“When you look at the delta period and last winter, as cases increased, hospitalizations and deaths increased in a similar pattern,” Centers for Disease Control and Prevention Director Dr. Rochelle Walensky told reporters last week. “Strikingly, when we compare the past month when omicron was the predominant variant, we see a clear separation between cases, hospital admissions, and deaths.” She attributed the lower death rates to the vaccines, which have proven to provide good protection against dying from Covid.

Cases are currently five times higher than they were during the delta wave, Walensky said, but hospitalizations and deaths haven’t increased at the same rate. Nuzzo said the current wave of infection, hospitalization and death would have been much worse without the vaccines.

Immunity

“Part of why omicron looks more mild is because it is finding societies that have already amassed a fair amount of immunity from prior infection or vaccination,” Nuzzo said.

In the New York and New Jersey area, “many of the cases did not become fatal, and/or extremely serious because of the high vaccination rates,” said Perry N. Halkitis, dean of the Rutgers School of Public Health. “But in the rest of the country, that may not be the case.”

That’s both because of lower vaccination rates and because of less-robust hospital health care in other parts of the country, he said, which could even mean a peak in total deaths in those areas surpassing those from last winter’s surge.

The unvaccinated

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