Read more stories in our What We Learned This Year series here.
When my colleague Will Huntsberry and I sat down to analyze thousands of Covid-related death certificates in San Diego County earlier this year, we were surprised to learn that the virus was wiping out younger people as time went on.
Public health professionals had not expected this to happen after vaccines became widely available. They had assumed the median age of death would hold steady. There was even a possibility it would go up as the virus worked its way into the oldest and most vulnerable populations.
One reason for the shift was lower vaccination rates among younger age groups, but it was by no means the only.
Our analysis found a moderate correlation between changes in Covid-related death rates and vaccination rates. ZIP codes with the highest vaccination rates experienced the greatest decreases in Covid-related deaths and vice versa. But data in the middle was much messier.
As we came to discover during the reporting process, there were other forces at play. A range of factors need to be taken into consideration to fully understand what happened.
Though the total number of deaths went down, disruptions in the healthcare industry during the first year of the pandemic ensured that people who needed it delayed or avoided preventative treatment. This was a particularly important point because Covid doesn’t always act alone. It weakens the body’s defenses by inflaming the insides and exacerbating other diseases.
For example, the proportion of Covid-related heart attack deaths nearly doubled between years one and two of the pandemic, and middle-aged men made up most of those cases. We also found that those under 45 who died in year two were more likely than in year one to have a chronic underlying condition, such as hypertension or obesity.
But changing attitudes and behaviors were also important. As one professor told us, the rollout of vaccines created a perception in people’s minds that the pandemic was over. They stopped masking up. They started hanging out again in groups, indoors.
Combined, all these factors caused the disparities we’d seen in year one of the pandemic to shift dramatically across the region.
Predominantly Latino, working-class neighborhoods with large immigrant populations like San Ysidro had some of the highest casualties of Covid during year one of the pandemic, but the death rate began to fall in the face of targeted public health campaigns. Mobile vaccine units were dispatched to meet people where they were, and advocates trained ambassadors inside hard-hit communities to alleviate any vaccine hesitancy.
The county’s racial death gap narrowed as a result. But for every $6,600 increase in median income in any given ZIP code, the rate of death shrank by 10 percent during year one. That number changed only slightly in year two, even as the total number of deaths fell — suggesting that class remained a powerful undercurrent.
Money doesn’t buy immunity, but it does create the conditions to effectively seal oneself off. Wealthier people often have the luxury of working from behind a computer screen. They’re not necessarily face to face with the public throughout the workday. They’re much more likely to eat better, have health insurance and a primary care physician.
But while death rates were dropping in South Bay — and virtually everywhere else — the virus was becoming more deadly in several smaller communities, primarily on the eastern edge of the metro. The most dramatic increase was in Lakeside, an unincorporated community home to about 21,000 residents.
Lakeside was not on our radar when we started this project. It had the 62nd highest death rate in year one, but ended year two at the top of the list. Ramona, Santee and a ZIP code south of Mission Trails weren’t far behind.
Those areas have higher concentrations of White people and some of the lowest vaccination rates in the region. But when we surveyed Lakeside residents for their thoughts, we were met with a lot of shrugs and skepticism. The vaccines, they said, are the real danger.
If true, Lakeside would have had one of the lowest death rates in year two rather than the highest.
Plenty of the people we spoke to argued that Covid was being blown out of proportion for political reasons. But the fact remains: it makes no difference to a virus what you believe and who you voted for.
Will Huntsberry contributed to this report.