- Fully vaccinated people have a low risk of severe COVID-19, but surges in coronavirus cases could still impact their health in other ways.
- Experts say that throughout the pandemic, coronavirus surges disrupted routine screenings and outpatient care.
- Nearly all COVID-19 deaths in the United States are now among the unvaccinated, according to an Associated Press analysis.
With the rapid spread of the delta variant in the United States, coronavirus cases are spiking in parts of the country, especially in areas with low COVID-19 vaccination rates.
This has led to surges in COVID-19 hospitalizations and deaths, largely among people who are not fully vaccinated.
In fact, nearly all COVID-19 deaths in the United States are now among the unvaccinated, according to an analysis by the Associated Press.
At a White House briefing on June 22, Director Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention (CDC), said most of these deaths were “entirely preventable.”
Although fully vaccinated people have a much lower risk of severe illness, their health could still be impacted as COVID-19 surges send ripples throughout the healthcare system, something we’ve seen throughout the pandemic.
In addition, children under 12 years old are not yet eligible for vaccination, which leaves them at risk — albeit a smaller risk than adults — of illness, hospitalization, and other complications of coronavirus infection.
Increased hospitalizations in some parts of the United States are driven by the fast-spreading delta variant and low vaccination rates in those areas.
Overall, 53.8 percent of all people in the United States have received at least one dose of a COVID-19 vaccine, according to the CDC.
But in some states in the South and West, the one-dose rates are below 40 percent. The situation is even more dire in certain counties in these areas.
Missouri leads in hospitalizations, with intensive care beds filling up with mostly unvaccinated COVID-19 patients. Many of them are “surprisingly young.”
Arizona, also lagging behind in vaccinations, has seen a recent spike in coronavirus infections and deaths.
Other states with high numbers of hospitalized COVID-19 patients may follow Missouri’s footsteps unless their vaccination efforts pick up.
Vaccination remains the best protection against severe illness from COVID-19 and hospitalization spikes that can affect non-COVID care.
Dr. Rishi K. Wadhera, a cardiologist at Beth Israel Deaconess Medical Center in Boston, says coronavirus surges disrupted routine screenings, outpatient care, and prescription services throughout the pandemic.
“In addition, elective procedures and surgeries were canceled during the height of the pandemic,” he said.
Some of these disruptions were due to limited resources.
Medical staff was reassigned to take care of COVID-19 patients. Surgical suites were converted to intensive care units. And shortages of personal protective equipment (PPE), ventilators, and other equipment led to non-urgent procedures being postponed.
In addition, people shifted their behavior in response to the coronavirus.
“We know that some patients with urgent or emergent conditions — like a heart attack — avoided coming to the hospital because they feared contracting the virus,” said Wadhera, “which may have contributed to higher death rates.”
Some cancer treatments and screenings were also postponed during the pandemic, putting people’s lives at risk.
“Cancer didn’t stop just because COVID started,” said Dr. Vivian Bea, an assistant professor of surgery at Weill Cornell Medicine in Brooklyn, New York. “Unfortunately, there was disruption in the care of breast cancer patients [during the pandemic].”
This included shifting the order of cancer treatments.
When cancer surgeries were postponed during the pandemic, some patients were given chemotherapy or endocrine therapy instead, which before the pandemic may not have been the first-line treatment.
In addition, Bea says many women were not able to get their annual breast cancer screening, or mammogram, because breast imaging departments were shut down during the surges.
Delayed screenings increase the risk that a cancer will be detected at a later stage, when it is more difficult to treat.
Other factors also contributed to the decline in screening during the pandemic, says Bea, such as women no longer having health insurance coverage because they lost their job or focused on taking care of their family and just getting through the pandemic.
Wadhera says disruptions of non-COVID care likely had a larger impact on Black and Hispanic populations due to their higher burden of chronic medical conditions.
In a recent study published in the journal Circulation, Wadhera and his colleagues found that this and other factors contributed to a greater jump in cardiovascular deaths in Black and Hispanic populations during the early months of the pandemic.
Among Black and Hispanic populations, heart disease deaths increased about 20 percent in March through August 2020, compared to the same period in the previous year. For stroke-related deaths, it was around a 13 percent increase.
In contrast, heart disease deaths among whites increased only 2 percent, and stroke-related deaths only 4 percent.
“Black and Hispanic communities have not only borne the burden of COVID-19 due to long-standing structural and systemic inequities,” said Wadhera, “but these communities have also shouldered the indirect effects of the pandemic.”
“This has contributed to an increase in deaths [among these groups] due to other — non-COVID-19 — conditions,” he added.
Some health systems tried to minimize care disruptions during the pandemic by using telemedicine to connect with patients.
However, not everyone has the right technology or stable internet access to be able to do telemedicine, or they may not be internet or phone savvy enough to connect with their doctor that way.
“For some patients, [telemedicine] actually worked,” said Bea. “But for others, there was a digital divide, which meant decreased [medical] access for them during the COVID surge.”
With the decrease in coronavirus cases since the peaks of the pandemic, delivery of healthcare services has essentially returned to normal, says Wadhera.
However, some health experts expect low vaccination rates and the delta variant — or other faster-spreading variants — to continue to fuel surges in parts of the country.
“It is possible that, in spite of our vaccination efforts, we’re going to go through another wave, driven by this new variant,” said Dr. Federico Laham, medical director for Orlando Health Arnold Palmer Hospital for Children Infectious Diseases in Florida.
This could once again impact non-COVID care.
“It’s possible that healthcare disruptions will occur again if we see a resurgence of COVID-19 cases, particularly as novel variants emerge,” said Wadhera. “Regions of the U.S. with low vaccination rates will be most vulnerable.”
Currently, COVID-19 vaccines are approved only in the United States for people 12 years and older.
Like vaccinated adults, children and teens fully vaccinated are well-protected against the coronavirus, including the delta variant.
However, their medical care could be disrupted if there are spikes in hospitalizations in their area. This is more likely to happen in parts of the country with lower vaccination rates and higher levels of the delta variant.
While children and teens have a lower risk than adults of severe illness from COVID-19, they can still get sick or need to be hospitalized.
They are also at risk of a serious complication called
Some children and teens also experience
While the delta variant appears to spread more easily among unvaccinated children and teens, it doesn’t appear to cause more serious diseases in them than earlier strains of the virus.
Laham says the United Kingdom — where the delta variant now accounts for almost all of the
“That’s very encouraging,” he said. “So it’s pretty safe to say that [the U.S.] should not brace for an increasing number of sick kids,” he said.
However, spikes in coronavirus cases among children could still disrupt schools, camps, sports and other activities, which would impact their mental health.
The more children and adults who are fully vaccinated, the easier it will be for the country to fully reopen, including healthcare systems.
“I still strongly recommend that you immunize your child as soon as you can,” said Laham, “because you need two doses of the mRNA approved vaccine to confer the level of protection that you want.”
Some parents may be concerned about the possible side effects of the COVID-19 vaccines in their children.
Most of the side effects are mild, such as soreness at the site of injection or short-term fever or fatigue.
This week, though, the CDC found a “likely association” between the Pfizer-BioNTech and Moderna-NIAID COVID-19 vaccines and a higher risk of heart inflammation in adolescents and young adults.
Laham notes that those side effects are extremely rare and have been mild in almost all of the cases.
“The benefits of vaccination still completely outweigh the risk of one of these very rare side effects,” he said.
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