The country’s months-long decline in coronavirus cases, deaths and hospitalizations bottomed out in late June. The U.S. case rate, or seven-day average of new confirmed cases per 100,000 residents, was lower than at any point in the past 14 months.
But the spread of variants has pushed rates back up, especially in states with low vaccination rates. For example, Missouri’s overall case rate was below the country’s until it recently climbed above the U.S. average.
Almost half the U.S. population is fully vaccinated, however — and mostly protected from infection. In Missouri, if we remove vaccinated people from the population used to determine the case rate, the numbers paint a better picture of Missouri’s cases among unvaccinated people.
The result is startling: Missouri’s case rate among unvaccinated people is as high as its overall case rate in mid-January, near the state’s peak of coronavirus infections.
The country’s summer of freedom from covid-19 is turning savage for the half of the nation that is still not fully vaccinated.
Coronavirus cases are increasing almost exclusively in the unprotected population. So The Washington Post adjusted its case, death and hospitalization rates to account for that — and found that in many places, the virus continues to rage among those who have not received a shot.
As summer approached, the Centers for Disease Control and Prevention loosened mask recommendations and President Biden advised people to take off their masks and smile. Case numbers were dropping and millions of people were being vaccinated each day, suggesting a reduction in covid worries and a possible end to the pandemic.
But The Post’s adjustments for vaccinations reveal the rate among susceptible, unvaccinated people is 91 percent higher than the unadjusted case rates reported on coronavirus websites and state tracking systems.
With that adjustment, the national case rate for unvaccinated people is roughly the same as the unadjusted case rate was more than two months ago — and is rising. The national adjusted hospitalization rate has climbed to a point last seen in April, and the death rate is comparable to May’s unadjusted figures.
Unvaccinated people are being hit hardest where the more contagious, more powerful delta variant is dominating.
“With the arrival of delta, we will have two very different epidemics — one a mild cold in vaccinated individuals, and then we continue to have deadly infections in unvaccinated individuals,” said William Powderly, an infectious-disease specialist and director of the Institute for Public Health at Washington University in St. Louis.
“The people who need to come to hospital, who end up in the intensive care unit, and the people who die are almost exclusively unvaccinated individuals,” he said, noting that his hospital has three times the covid-19 patients it had in late June.
States with high rates among unvaccinated people
The adjusted rates in several states show the pandemic is spreading as fast among the unvaccinated as it did during the winter surge. Florida, Arkansas, Missouri, Nevada and Louisiana all have coronavirus case spikes among the unvaccinated, with adjusted rates double or triple the adjusted national rate. The adjusted rates of Utah, Kansas, Alabama and Alaska are slightly lower than those states.
Maryland, Virginia and the District of Columbia have adjusted rates below the national average. In the region, however, lower vaccination rates in the Black community have concentrated cases there to an extraordinary degree. Before vaccines, Black people represented about one-third of new coronavirus cases in Maryland and half in D.C. In the latest data, Black people represent just under half of the new cases in Maryland and more than 80 percent in D.C.
Average new daily cases per 100,000 residents
“We are on an exponential curve,” said Mark Williams, dean of the Fay W. Boozman College of Public Health at the University of Arkansas for Medical Sciences. “The delta variant is a different animal than the wild [original] variant. It is far more infectious and far more virulent.”
Williams expects the case rate among unvaccinated people to push higher than the winter surge. “I don’t see at the minute how we can avoid it,” he said.
People more likely to end up in the hospital
Like deaths, hospitalizations from covid-19 are almost entirely limited to unvaccinated patients. When current hospital utilization is spread across only the unvaccinated population, Nevada, Missouri, Arkansas and Florida have rates between double and triple the adjusted national rate.
“Ninety-eight percent of hospitalized individuals with covid in Arkansas are unvaccinated,” Williams said.
Even though treatments are better than they were originally, a larger share of patients are ending up in intensive care, and the fatality rate for those patients remains high, experts said.
“That’s just indicative of the more virulent quality of the delta variant,” Williams said. “It will make people sick, even people that are young and would not have felt any consequence from the original wild variant.”
Frighteningly, he said, far more children are being hospitalized, which was very rare until recently. As of mid-July, a dozen children were in Arkansas Children’s Hospital, he said, and two were on ventilators.
Virginia’s adjusted hospitalization is below the national average. Adjusted D.C. and Maryland rates are close to the national adjusted rate.
Average hospitalizations per 100,000 residents
The share of unvaccinated people among Maryland’s hospitalized covid patients has climbed from 89 percent in May and early June to 93 percent, according to a state analysis duplicating the findings announced across the country.
States with high death rates
The delta variant is driving death rates back up, even though deaths tend to lag more than a month behind surges in cases.
Covid-19 is killing almost exclusively unvaccinated people, according to Rochelle Walensky, director of the CDC.
Average new daily deaths per 1 million residents
Montana, New Mexico, Missouri, Arkansas, Florida, Arizona and Nevada all have adjusted death rates double the national adjusted rate or higher.
D.C., Maryland and Virginia have adjusted rates below the national average.
Experts repeatedly expressed frustration that people who think the pandemic is over are falling victim.
“We have the tool now to control this disease,” said Bart Hammig, a public health professor at the University of Arkansas. “We have a way to prevent the disease, to virtually eliminate all hospitalizations and deaths. Vaccinate. Vaccinate. Vaccinate.”
Rather than marking the end of the pandemic, the delta summer may be previewing the uptick experts are expecting in the fall in states such as Arkansas that have banned mask and vaccine mandates while pushing schools and colleges to open.
“That’s kind of like a viruses playground,” Williams said. “There will be a lot of transmission going on.”