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After spending much of the past year caring for elderly patients, physicians have seen a clear demographic change: young and middle-aged adults make up a growing proportion of patients in COVID-19 hospital wards.
This is both a sign of the country’s success in protecting the elderly through vaccination and an urgent reminder that the younger generations will pay a high price if the outbreak is allowed to boil in many communities in the country.
“Now we see people in their 30s, 40s and 50s – young people who are really sick,” said Dr. Vishnu Chundi, an infectious disease doctor and chair of the Chicago Medical Society’s COVID-19 working group. “Most of them succeed, but some don’t. … I just lost a 32-year-old with two kids, so it’s heartbreaking.”
Nationally, adults under the age of 50 now represent the most hospitalized COVID-19 patients in the country – about 35% of all hospital admissions. Those between the ages of 50 and 64 represent the second largest number of hospitalizations, or about 31%. Meanwhile, hospitalizations among adults over 65 have decreased significantly.
Currently, more than 30% of the US population is fully vaccinated, but the majority are over the age of 65, a group that has been identified as a priority in the initial phase of vaccine introduction.
While new infections are gradually declining across the country, some regions have struggled with a resurgence of the virus in recent months – what some have called a “fourth wave” – driven by option B.1.1.7, first identified in the UK, which has been calculated is between 40% and 70% more contagious.
As many countries are abandoning pandemic precautions, this more virulent strain still has ample room to spread among the younger population, which remains highly 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’re in a very different ball game,” said Judith Malmgren, an epidemiologist at the University of Washington.
Rising infections among young adults create a “reservoir of disease” that eventually “spreads to the rest of society” – one that has not yet reached the herd’s immunity – and portends a greater influx in cases, she said.
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 long-term symptoms after the initial infection. People with major illnesses such as obesity and heart disease are also more likely to get seriously ill.
“B.1.1.7 doesn’t make a difference in age, and when it comes to young people, our reports are still too soft,” says Malmgren.
Hospitals full of younger, sicker people
Around the country, the influx of younger patients with COVID-19 has shocked clinicians who describe hospital beds full of patients, many of whom appear to be sicker than what was seen during previous pandemic waves.
“Many of them need intensive treatment,” said Dr. Michelle Barron, head of infection prevention and control at UCHealth, one of Colorado’s major hospital systems, compared to the earlier one during the pandemic.
The average age of patients with COVID-19 in UCHealth hospitals has dropped by more than a decade in the past few weeks, from 59 to about 48, Barron said.
“I think we will continue to see this, especially if there is not much vaccine uptake in these groups,” she said.
While most hospitals are far from the onslaught of diseases seen in the winter, the explosion of cases in Michigan highlights the potential consequences of loosening 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 UK option.
A recent study suggests that option B.1.1.7 does not lead to more severe diseases than previously thought. However, patients infected with the variant appear to be more likely to have more of the virus in their bodies than the previous dominant strain, which may help explain why it spreads more easily.
“We think it can cause more of these hospitalizations in younger people,” said Dr. Rachel Lee of the University of Alabama-Birmingham Hospital.
Lee’s hospital has also seen an increase in younger patients. Like other southern states, Alabama has a low rate of vaccine absorption.
But even in Washington state, where much of the population chooses to receive the vaccine, hospitalizations have been steadily rising 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 Health Chief Dr. Jeff Duchin.
“We still don’t have enough young adults vaccinated to counteract the increased ease with which options are spreading,” Duchin told a recent press briefing.
Nationally, about 32% of people in their 40s are fully vaccinated, compared to 27% of people in their 30s. This share drops to about 18% for 18- to 29-year-olds.
“I hope that the death curve will not rise so fast, but it is burdening the health system,,“ says Dr. Nathaniel Schlicher, 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 admitted with new heart failure caused by COVID-19.
“I’ve seen it up close, and that’s what scares me,” he said.
“I understand that young people feel invincible, but what I would just tell them is, don’t be afraid to die, be afraid of heart failure, lung damage, and you can’t do the things you love to do.”
Will younger adults be vaccinated?
Doctors and public health experts hope that the alarming jump in hospitalizations among younger demographics will be only temporary – one that vaccines will soon counter.
It was not until 19 April that all adults were entitled to the COVID-19 vaccine, although they had been available in some countries much earlier.
But there are some in terms of national surveys that show that a significant proportion of teenagers and adults between the ages of 20 and 30 do not necessarily have vaccination plans.
“We just have to make it super easy – not awkward in any way,” said Malmgren, an epidemiologist in Washington. “We have to put our minds into it and think a little differently.”
She recommends more outreach through social media platforms or even in bars and other places where young people walk. Two bars in New Orleans tested the 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 patients with COVID-19, he usually does not hear that there has been resistance to receiving the vaccine as much as a sense of complacency about doing it 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’ll go get coffee somewhere and it’s there – yes, they’ll get vaccinated.”