After spending much of the past year caring for elderly patients, physicians are seeing a clear demographic shift: young and middle-aged adults make up a growing proportion of patients in COVID-19 hospital wards.
It is both a sign of the country’s success in protecting the elderly through vaccination and an urgent reminder that younger generations will pay a high price if the outbreak is allowed to simmer in communities across the country.
“We now see people in their 30s, 40s and 50s – young people who are really sick,” says Dr. Vishnu Chundi, an infectious disease physician and chairman of the Chicago Medical Society’s task force COVID-19. “Most of them do it, but some do not … I just lost a 32-year-old with two kids, so it’s heartbreaking.”
Nationally, adults under 50 account for the majority of hospitalized COVID-19 patients in the country – approx. 35 percent of all hospital admissions. Those aged 50 to 64 account for the second highest number of admissions or about 31 percent. Meanwhile, admissions among adults over the age of 65 have dropped significantly.
More than 30 percent of the U.S. population is now fully vaccinated, but the vast majority are people older than 65 – a group that was prioritized in the initial phase of the vaccine’s rollout.
While new infections are gradually declining nationwide, some regions have struggled with a resurgence of the virus in recent months – what some have called a “fourth wave” – propelled by the B.1.1.7 variant, first identified in the UK, which is estimated to be somewhere between 40 percent and 70 percent more contagious.
As many states avoid pandemic measures, this more virulent strain still has ample room to spread among the younger population, which remains widely susceptible to the disease.
The emergence of more dangerous strains of the virus in the United States – B.1.1.7 as well as other variants first discovered in South Africa and Brazil – has made vaccination efforts even more urgent.
“We are in a completely different ball game,” said Judith Malmgren, an epidemiologist at the University of Washington.
Rising infections among young adults create a “disease reservoir” that eventually “spreads to the rest of society” – one that has not yet reached herd immunity – and shows a broader increase in cases, she says.
Fortunately, the chance of dying from COVID-19 remains very small for people under the age of 50, but this age group can become seriously ill or suffer from prolonged symptoms after the first infection. People with underlying conditions such as obesity and heart disease are also more likely to become seriously ill.
“B.1.1.7 does not discriminate on the basis of age, and when it comes to young people, our messages here are still too soft,” says Malmgren.
Hospitals filled with younger, sicker people
Across the country, the influx of younger patients with COVID-19 has surprised clinicians describing hospital beds filled with patients, many of whom look sicker than what was seen during previous waves of the pandemic.
“Many of them require ICU treatment,” says Dr. Michelle Barron, Head of Infection Prevention and Control at UCHealth, one of Colorado’s largest hospital systems compared to earlier in the pandemic.
The median age of COVID-19 patients at UCHealth hospitals has dropped by more than a decade in the last few weeks, from 59 down to about 48 years, Barron says.
“I think we will continue to see it, especially if there is not much vaccine uptake in these groups,” she says.
While most hospitals are far from disease-stricken in the winter, the explosion of cases in Michigan underscores the potential fallout of solution restrictions when a large proportion of adults have not yet been vaccinated.
There is strong evidence that all three vaccines used in the United States provide good protection against the British variant.
A recent study suggests that the B.1.1.7 variant does not lead to more serious illness as previously thought. However, patients infected with the variant appear to be more likely to have more of the virus in their bodies than those with the previously dominant strain, which may help explain why it spreads more easily.
“We think this may cause more of these hospitalizations in younger people,” says Dr. Rachael Lee at the University of Alabama-Birmingham hospital.
Lee’s hospital has also observed an increase in younger patients. As in other southern states, Alabama has a low vaccine intake.
But even in the state of Washington, where a large portion of the population chooses to get the vaccine, admissions have risen steadily since early March, especially among young people.
In the Seattle area, more people in their 20s are now hospitalized for COVID-19 than people in their 70s, according to Seattle King County Public Health Chief Health Officer Dr. Jeff Duchin.
“We do not yet have enough younger adults vaccinated to counteract the increased ease with which the variants spread,” Duchin said during a recent press briefing.
Nationwide, about 32 percent of the population in their 40s are fully vaccinated compared to 27 percent of the population in their 30s. This share drops to approx. 18 percent for 18- to 29-year-olds.
“I hope that the death toll will not rise so fast, but it puts a strain on the health system.,“ says Dr. Nathaniel Schlicher, an emergency physician and president of the Washington State Medical Association.
Schlicher, also in his late 30s, recalls with horror two of his recent patients – close to his age and previously healthy – who were hospitalized with new heart failure caused by COVID-19.
“I’ve seen it up close and that’s what scares me,” he says.
“I understand young people who feel invincible, but what I just want to tell them is – do not be afraid to die, be afraid of heart failure, lung damage and not be able to do the things you love to do.”
Will younger adults be vaccinated?
Doctors and public health experts hope the alarming rise in hospital admissions among the younger demographic will only be temporary – one that vaccines will soon counteract.
It was only a few weeks ago that all American adults became eligible for a COVID-19 vaccine, even though they were available in some states much faster.
However, there are some regarding national polls that indicate that a significant proportion of teens and adults in their 20s and 30s do not necessarily have plans to be vaccinated.
“We just have to make it super easy – not inconvenient by any means,” says Malmgren, a Washington epidemiologist. “We have to put our minds to it and think a little differently.”
She recommends more outreach via social media platforms or even at bars and other places where younger people hang out. Two bars in New Orleans tried this tactic earlier this month – one even offered a free shot to customers who were vaccinated.
When Chicago doctor Vishnu Chundi talks to the families of his COVID-19 patients, he generally hears no opposition to getting the vaccine as much as a sense of complacency about getting it done quickly.
“You have to be motivated to go to these places, you have to get two vaccines now – it’s a process,” he says. “If it’s available to them, they have to pick up coffee somewhere, and it’s there – yes, they’ll be vaccinated.”
Copyright 2021 NPR. To see more, visit https://www.npr.org.
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