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This story is part of our reporting series, “Covid Year Two: After the Vaccine.” See the full series here.
It’s not exactly surprising: The number of deaths related to Covid-19 dropped by almost half during the second year of the pandemic in San Diego County, after vaccines became widely available to the general public.
The virus was either an immediate cause or a contributing factor in 4,264 deaths between March 2020 and March 2021. During the pandemic’s second year, 2,204 people died from Covid-related causes, according to death certificates compiled and analyzed by Voice of San Diego over the last two years.
Vaccines are “absolutely” the primary reason deaths went down, said Rebecca Fielding-Miller, who specializes in public health at UC San Diego, in an email.
“I would describe it as miraculous and a testament to what we can do when there is sufficient political will and resources to move science forward,” she wrote. “The political will and resources to create those vaccines, combined with the political will and resources to get vaccines to the people who needed them most, saved thousands of lives.”
Not all of the death certificates logged by Voice list Covid-19 as an immediate cause of death. Seven percent of death certificates listed covid as a contributing cause of death during the first year. During the second year, it was a contributing cause in 17 percent of cases. Even in cases where COVID is listed among the immediate causes, Covid-19 wasn’t always the sole cause of a person’s death.
People who oppose vaccines often latch onto this fact to downplay the virus’s threat. Some, or even many, deaths were not actually caused by the virus, they say. Indeed, Covid-19 alone did not kill every single person who had the virus at the time they died.
But as medical professionals point out, the virus acts as a trigger that sets off a chain of complications leading people to die of something else, like kidney failure, that would not have killed them if it hadn’t been for the virus.
The medical field applied that same logic throughout the first two years of the pandemic, and the fact remains: All Covid-related deaths of any kind went down by half once the vaccine became widely available.
The new data reveals several interesting findings that Voice will publish in the coming days and weeks.
The median age of death, for instance, dropped from 76 to 73 years old in year two — meaning the virus killed a younger proportion of San Diegans as time went on.
The raw number of deaths decreased among all age groups. But how deaths were distributed across age groups changed significantly.
People over 65 still made up the greatest number of Covid-19 deaths, but their share of the total went down by 10 percent. The share of middle-aged people who died with the virus went up 21 percent. And those under 45 who died with the virus spiked by 144 percent.
The finding is especially startling because Covid-19 is so much more likely to be deadly for older people. Public health professionals think the shift may have happened, in part, because younger people across the state are less likely to get vaccinated than those over 65.
“I wish he would have,” Patti Campbell said of her son, who died on Sept. 26, 2021, at 40 years old.
Dale Campbell was the floor manager at an Albertsons in Oceanside. His mother and sisters remembered him as big-hearted and well-liked, the kind of guy who would pick up shifts for others even when it inconvenienced him. He was required to wear a mask on the job.
Try as they might, though, the Campbell family couldn’t convince Dale to take the next step. They’d all gotten the vaccine. But Dale’s refusal to get the shot stemmed from things he’d heard on TV and read on Facebook.
“He listened to too much of that political stuff — ‘the government is after us, they’re putting stuff in us that we shouldn’t have,’” Patti recalled.
As soon as he got sick, he avoided the rest of the family out of concern for their safety. He texted his mother one day to say he couldn’t breathe and then called 911.
Dale spent more than a month at an Encinitas hospital, hooked up to a ventilator, as his loved ones watched helplessly from afar. He apologized for missing his niece’s birthday party.
“I just couldn’t be there for him, and that’s what makes me mad,” Patti said.
The official cause of death was refractory hypoxemic respiratory failure, triggered by Covid-19 pneumonia.
To this day, Patti isn’t sure where Dale contracted covid. “He could have gotten it anywhere,” she said. “He liked to socialize.”
Lower vaccination rates among younger people was likely not the only reason for increasing their share of deaths.
“The vaccine was essentially a game changer,” said Arturo Bustamante, professor of health policy and management at UCLA. “But at the same time, other things also changed.”
Like people’s behavior, for starters. Masks became less common, even though the county didn’t officially lift its mandate until near the end of year two. Large indoor gatherings resumed and more places of work, including schools and offices, opened back up.
On its face at least, society reopening should not have necessarily affected young people more than old people, though. Changing attitudes may have also led people to take fewer precautions.
“The pandemic, it’s not on people’s radar anymore and that contributes to the perception it’s over,” said Tyan Parker Dominguez, a professor at the USC Suzanne Dworak-Peck School of Social Work.
Four of the people who died in year two were students. One was still in high school — just 15 years old. She was the youngest person to die of the virus in San Diego County during the entire first two years of the pandemic. She contracted covid, was hospitalized at Rady Children’s Hospital, and ultimately died of acute respiratory failure in February 2022.
One of the earliest indications that the virus was killing younger and younger populations came in summer 2021, when the Delta variant hit. The region began to see a shift in who was being hospitalized.
“It was higher for 50-to-64 year olds than 65 and above, which it hadn’t been in 2020,” said Shane Crotty, a professor at the La Jolla Institute of Immunology. “While the oldest individuals are absolutely at the highest risk of death, by a lot, I think that got compressed down by vaccination rates.”
Younger people who died in year two were more likely than younger people in year one to have a chronic underlying condition, such as hypertension or obesity, which impaired their ability to fight the virus.
“A lot of people who were really careful in year one ended up getting COVID for the first time in year two. And the people who were really careful in year one are more likely to have had underlying conditions that increased their morbidity and mortality during a COVID infection,” said Laura Crotty Alexander, a UC San Diego professor and section chief of Pulmonary Critical Care at the VA, in an email.
Public health specialists have also identified insurance, or a lack thereof, as a potential factor. Older folks are more likely to be insured thanks to Medicare and other government programs, and therefore more likely to have a primary care physician.
Significant numbers of Americans — more than 40 percent — avoided or delayed treatment for routine or even emergency care in the first few months of the pandemic, according to the CDC. Other research shows that 11 percent of nonelderly adults with chronic conditions were still avoiding or forgoing care by spring 2021.
Another unexpected finding in the data shows the share of people who experienced Covid-related heart attacks almost doubled during year two.
For years, heart attacks have been the leading cause of death worldwide but were on the decline locally. Yet a recent study out of Los Angeles found a link between heart attack deaths and Covid-19 infections that affected all age groups in the United States. Researchers suspected that was the case because the virus causes inflammation in the body and inflammation has long been tied to an increased risk of heart attack.
Year two data reveals the share of Covid-related heart attack deaths went up 80 percent. Men made up nearly all those cases, and about half were White. The biggest increase in the share of heart attacks was for middle-aged San Diegans — a group that could have benefited from more preventative care.
Maya Srikrishnan, Jakob McWhinney, Catherine Allen, Gabriel Schneider and Jennifer Aguilar contributed to this report.
This series is supported by the Data-Driven Reporting Project. To request access to our data for research or reporting purposes email firstname.lastname@example.org or email@example.com.