Covid-19 cases, deaths and hospitalizations have been declining in the United States. On May 26, 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 11 months.
But in some parts of the country, that rosy picture hides the strength of the pandemic among unvaccinated people. For example, Washington state’s overall case rate is close to the U.S. average when cases are measured across the state’s entire population.
Half the U.S. population is vaccinated, however — and they are mostly protected from infection. In Washington, if we remove vaccinated people from the population used to determine the case rate, the numbers paint a more realistic picture of Washington’s cases among unvaccinated people.
These adjusted numbers paint a far less optimistic picture: Washington’s case rate among unvaccinated people is as high as it was in late January, near the peak of Covid infections.
The unseen covid-19 risk for unvaccinated people
The country’s declining covid-19 case rates present an unrealistically optimistic perspective for half of the nation — the half that is still not vaccinated.
As more people receive vaccines, covid-19 cases are occurring mostly in the increasingly narrow slice of the unprotected population. So The Washington Post adjusted its case, death and hospitalization rates to account for that — and found that in some places, the virus continues to rage among those who haven’t received a shot.
The rosy national figures showing declining case numbers led the Centers for Disease Control and Prevention to loosen mask recommendations two weeks ago and President Biden to advise people to take off their masks and smile.
But adjustments for vaccinations show the rate among susceptible, unvaccinated people is 73 percent higher than the standard figures being publicized. With that adjustment, the national death rate is roughly the same as it was two months ago and is barely inching down. The adjusted hospitalization rate is as high as it was three months ago. The case rate is still declining after the adjustment.
Unvaccinated people are getting the wrong message, experts said.
“They think it’s safe to take off the mask. It’s not,” said Lynn Goldman, dean of the Milken Institute School of Public Health at George Washington University. “It looks like fewer numbers, looks like it’s getting better, but it’s not necessarily better for those who aren’t vaccinated.”
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. Maine, Colorado, Rhode Island and Washington state all have covid-19 case spikes among the unvaccinated, with adjusted rates about double the adjusted national rate. The adjusted rates of Wyoming, West Virginia, Oregon, Florida, Michigan and Pennsylvania are slightly lower than the highest 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 were about one third of new covid-19 patients in Maryland and half in D.C.. In the latest data, Black people are just under half of the new cases in Maryland and more than 80 percent in DC.
Average new daily cases per 100,000 residents
Oregon’s current surge is driven in part by a covid-19 variant known as B.1.1.7, which is 50 percent more contagious, said Tom Jeanne, a deputy state epidemiologist and a senior health adviser, in an interview.
It is characterized by outbreaks traced to social gatherings with unvaccinated people and no masks.
“They’re at very high risk for infection,” Jeanne said.
Washington state officials say they are caught between applauding the optimism that comes with vaccination and warning everyone who isn’t vaccinated that it’s still dangerous.
“Things are getting safer for those who are vaccinated,” the state’s secretary of health, Umair A. Shah, told The Post. “For those who are unvaccinated, they remain at risk. We have to make sure that nuanced message is getting to our community.”
States with high death rates
In addition to cases, several states still have relatively high death rates.
Coronavirus vaccines are virtually perfect in preventing deaths, so the decline in deaths nationally hides the steady covid death rate among unvaccinated people.
Average new daily deaths per 1 million residents
Michigan, Pennsylvania, New Jersey, Maine, Florida and Illinois all have adjusted death rates about 50 percent higher than the national adjusted rate.
Maryland’s adjusted death rate is above the national average. D.C. and Virginia are just about at the national average.
Looking at the death rate is not a good measure of the current spread of the pandemic, experts said, because it is a “lagging indicator” — people dying are usually infected at least a month earlier, which means deaths don’t reflect current community spread of the disease. The steady adjusted death rate, however, shows that unvaccinated people are not yet getting safer.
People more likely to end up in the hospital
Experts often point to hospitalization rates as a critical measure of the pandemic, because they reflect people getting very sick and aren’t dependent on how much coronavirus testing a community is doing. When current hospitalizations are spread across only the unvaccinated population, D.C. and Michigan have rates about twice as high as the adjusted national rate. Pennsylvania, Maryland, Florida and Rhode Island have rates about 50 percent higher than the adjusted national hospitalization rate. Virginia’s adjusted rate is below the national average. A D.C. spokesperson said the rate could be affected by out-of-state residents in local hospitals.
Average hospitalizations per 100,000 residents
Unvaccinated young adults in Maryland have the same infection rate as they had in the January surge, according to a state analysis. Even worse, the risk of hospitalization among the infected has more than doubled, possibly because of widespread coronavirus variants, said Ted Delbridge, executive director of the Maryland Institute for Emergency Medical Services Systems.
Washington state has been publicizing the extreme threat of hospitalization for unvaccinated people. It said unvaccinated seniors are 11 times as likely to get hospitalized than seniors who got the shot. For unvaccinated people age 45 to 64, the chance of covid-19 hospitalization is 18 times higher.
Shah, the state secretary of health, worries people are being left behind while others feel the pandemic is past.
“I hope this does not become a tale of two societies,” he said. “The people who are vaccinated and are protected can resume their lives, taking off their masks.
“The people who are not vaccinated are the ones who are not wearing a mask or washing their hands. Those are the very people who often times will socialize and be around similar like-minded people. You’re going to have the pandemic continue in those clusters.”