UAB medical experts on Wednesday offered a mixed bag of COVID-19 news: There are fewer patients in ICUs statewide and fewer people getting sick with COVID-19, but younger people are faring worse and dying.
On Oct. 6, UAB Hospital was treating 34 COVID-19 patients in its ICU, 30 of whom were not vaccinated against the disease. Of this number, 22 patients are on mechanical ventilators.
Nationally, the numbers of hospitalizations, total cases and deaths are slowly trending downward. Dr. Rachael Lee is among UAB doctors who are troubled by the increase in younger patients battling COVID-19 in the ICU.
At the height of UAB Hospital’s COVID-19 surge in September, Lee was disheartened as she cared for the young, very ill people who ended up in ICU and required ventilation treatment. The average age of UAB patients fighting the current wave – the delta variant – is about 10 years younger than people who were treated during the 2020 holiday wave of COVID-19.
“They were on a ventilator, and they were incredibly sick,” said Lee, UAB Medicine health care epidemiologist. “It’s heartbreaking to see patients who are younger than yourself, who have no co-morbidities, struggling to breathe and ultimately dying from something that is now preventable.
“We are seeing a large amount of people who are not vaccinated, about 85-90% or so,” Lee said. “Those who are vaccinated are actually much older, a median age of about 68 years compared to 50 years (for those) who are unvaccinated. That’s a large difference. About half of those fully vaccinated individuals are immunocompromised – they have multiple co-morbidities, whereas the younger, unvaccinated population typically do not.”
About 75% of the state’s population 65 and older are vaccinated. Lee is concerned about the numbers of younger, unvaccinated people ending up in the ICU.
“Younger people are dying – that’s what’s scary to us,” Lee said. “As a health care worker, it’s devastating to see someone so young dying.”
While many things may drive this scenario, about 2.9 million people in the state remain unvaccinated. Russell Griffin, associate professor in UAB’s School of Public Health, is not surprised the hospital is seeing a younger population in ICU. About half of the older, vaccinated patients coming into ICU have immunocompromised conditions.
According to the Alabama Department of Public Health, 14,562 residents have died of COVID-19. More than 2 million Alabamians are fully vaccinated against COVID-19.
The delta wave of the pandemic in the U.S. has been ongoing for nearly three months. Griffin noted that seasonality – the start of the “cold and flu season,” for example – doesn’t seem to be behind the COVID-19 surges. Cases may be waning, potentially, because people are changing their behaviors and there may be more natural immunity.
“With the flu, there’s a legit seasonality,” Griffin said. “We see it between October to March or April every single year. We can kind of predict what’s going to happen with the flu and get the vaccinations correct based on what’s happening in the Southern Hemisphere, because they also have their flu season while we’re having our summer season. It doesn’t seem this is going this way with COVID.”
Griffin said that people often ask about the outcomes for COVID-19. Surviving the illness is just the tip of the iceberg.
“We have these patients that are in the ICU on mechanical ventilation for two, three, four weeks, and even if they survive, it’s not a short recovery,” he said. “To recover from being in the ICU for so long, for being on invasive ventilation, to be intubated for weeks at a time, that’s kind of the part that’s not discussed too, too much.”
How to prevent a holiday surge
Recent news reports indicate that the mu variant of COVID-19 has been effectively eradicated in the U.S. Delta is currently the variant of concern to the Centers for Disease Control and Prevention as well as the World Health Organization. Whether there is a holiday surge of COVID-19 depends on whether another variant occurs to which people are susceptible, and on people’s natural immunity to SARS COVID-2, the virus that causes COVID-19.
“A good, educated prediction is we may see a surge but not of the magnitude of the current delta wave,” Griffin said.
The U.S. Food and Drug Administration has announced three meetings in October of its Vaccines and Related Biological Products Advisory Committee to discuss new data about COVID-19 vaccines. From Sept. 26 to Oct. 1, UAB gave more than 2,500 vaccines – actions that can help prevent another variant from forming, Lee said.
The longer the time in which variants are allowed to form, the longer the pandemic will continue. For Alabamians who are seeing the decrease in COVID-19 cases and haven’t yet been vaccinated, now is the time for getting a vaccination. People who have already had COVID-19 should also get vaccinated, Lee said.
“We really don’t know the level that our antibodies need to be to protect us from further infection or breakthrough infection,” Lee said. “But what I can tell you is that if you’ve had COVID and you get vaccinated, the amount of antibodies that you produce is sky-high – it’s almost three times higher compared to a person that hasn’t had COVID and gets vaccinated. If you really want to protect yourself further and not have to deal with that infection again, go ahead and get vaccinated.”
Everyone has a part to play in preventing a surge at Thanksgiving and Christmas, Lee said.
“That is through masking, that is through vaccination and that is staying at home when you’re sick – all those things that we do as a community is what’s going to help us have a safer and happier holiday,” she said. “We all have to do our part to have a safe holiday and not have a surge.”