More than ever, COVID-19 is a pandemic of the unvaccinated, the elderly, and those with pre-existing conditions. Yet there’s a disturbing tendency by the administration and the media to generalize and magnify the crisis rather than contextualize it based on well-known data.
From the start of the pandemic it has been clear that COVID-19 is particularly severe for well-defined groups — almost all deaths and most hospitalizations have been among the people over 65 and/or people with underlying medical problems. People ages 65-74, 75-84, and 85 and older comprise 10, 5, and 2 percent of the population respectively. But they account for 22, 27 and 30 percent of the total U.S. COVID-19 deaths. One systematic review of age-specific infection fatality rates found they are very low for children and younger adults (0.002 percent at age 10 and 0.01 percent at age 25) but rise sharply with advancing age to 0.4 percent at age 55, 1.4 percent at age 65, 4.6 percent at age 75, and 15 percent at age 85.
Another review, conducted for the World Health Organization by noted epidemiologist John Ioannidis, found a median infection fatality rate of 0.27 percent but only a median infection fatality rate of 0.05 percent for people younger than 70.
Ninety-five percent of patients hospitalized with COVID-19 had at least one underlying medical condition. The risk of death rose rapidly with the number of conditions. The relative risk of death compared to patients with no medical conditions was 1.53 times as high for patients with one condition, 2.55 for patients with 2-5 conditions, and 3.29 for patients with 5-10 conditions. These conditions become more common with increasing age.
The at-risk groups have not changed during the recent surge with the delta variant which began at around the beginning of July and peaked and started to decline about two months later. The elderly still account for the lions share of COVID-19 deaths during this time.
What has changed since the early days of the pandemic is that now more than 80 percent of the population is vaccinated or has natural immunity resulting from infection and recovery from COVID-19. Roughly two thirds of the population eligible for vaccination (ages 12 and up) have been fully vaccinated. In the vulnerable 65 and older group, 83 percent have been fully vaccinated and another 10 percent have received at least one dose which provides good protection, albeit less than the full two doses.
The good news is that vaccines remain highly protective. COVID-19 vaccines substantially lower the risk of infection, although not as much with the delta variant as with earlier variants. But vaccines continue to provide strong protection against severe COVID-19 illness and death — even after delta became the most common variant, unvaccinated people were 10 times more likely than vaccinated people to be hospitalized or die. And studies indicate that natural immunity is as good or better than vaccine immunity.
COVID-19 remains a serious public health problem, but it is largely a crisis of those who lack vaccine or natural immunity and vulnerable groups. Generalized mandates and mitigation measures — such as masks and social distancing — need to be more narrowly targeted those who are truly at risk.
Joel Zinberg, M.D., J.D., is a senior fellow at the Competitive Enterprise Institute and an associate clinical professor of surgery at the Icahn Mount Sinai School of Medicine in New York.