Why is US mortality so bad in the "fourth wave"?

So just read this article. The premise of which is that while mortality rates between the US and other western countries, were very similar for previous waves, for the current “fourth wave” they are much higher in the US. The rest of the (vaccinated) world matches what you’d expect, given so many vulnerable people have now been fully vaccinated, with Covid rates going up but mortality not rising any where near as much (between 90-75% less.) The US: not so much, mortality is rising at least 50% of the rate of previous waves (and given the delay between Covid rates and deaths, possibly at the same rate!)

So what does the dope think about this? To me the “occam’s razor” explanation is testing rates must be lower. I guess people who get sick after being vaccinated are not getting tested as they would in previous waves? And then maybe the difference is that people in the US (given our dumpster fire of a health system) don’t want to do anything that can land them a hefty bill, so just aren’t getting the test?

If you’re using Occam’s razor, you say that the US is worse than more vaccinated countries because it’s less vaccinated. Unvaccinated people mean the covid rates increase faster and death rates are much higher.

That’s the only logical conclusion I can think of. Canada is now sitting at about 68% of vaccine eligible, fully vaccinated and even at that our rates of transmission has increased dramatically in the last few weeks. However, with 81% of the vaccine eligible now done, that leaves me hope that Canada could get closer to “herd immunity” later in the year.

Most of the points are brought up, albeit briefly at times, in the interview itself.

There’s a fair amount of ‘clumpiness’ at play (heterogeneity is what they call it in the interview). The interview mentions that, while not perfect, there’s a fair correlation between how vaccinated a region is and the caseloads and deaths it’s seeing. Heterogeneity is big. Florida vs Massachusetts, for example. It really is a few regions that are driving the overall numbers in the US. I suppose there’s time for it to change, but we’re not seeing the same increase in the death rate in say Vermont that we’re seeing elsewhere.

LA County is not looking great, though it is more vaccinated than Florida as mentioned in the interview, but it’s not evenly distributed. Seniors are about 90% vaccinated while younger people are not. African Americans are the least vaccinated, on average. And so on. So, saying it has a 70% overall vaccination rate is somewhat misleading.

And while there may be some heterogeneity in vaccination status in other highly vaccinated countries, I’d wager it’s not as extreme as the state to state variations we have in the US or even within a city/state the extremes we’re seeing in different demographic groups.

It was sort of touched on, but it is also almost certainly related to the high correlation between states with low vaccination rates and a cessation of nearly all other prophylactic measures, such as public masking and limits on public gatherings. And again, there’s a high correlation between states that not only stopped those measures earlier but also enacted bans on instating them in the future, either at the state or local levels. Even with the exception of the UK (which did this much later than most of the US), most other highly vaccinated countries still have some level of universally required prophylactic measures in place (vaccine requirements for restaurant dining, masking, etc).

Test rates are lower now than earlier this year. We know this, but it doesn’t appear to be the entire answer either.

Yes, it’s entirely unsurprising that a country with a lower overall vaccination rate, which is particularly low in some areas, is seeing more deaths than places with higher vaccination rates.

This is a point we’ve been trying to make for months now, but which the anti-vaxxers just can’t seem to get: Even in cases where vaccination doesn’t prevent a new infection, those who are vaccinated suffer far less severe symptoms, and almost never die. With a new, more infectious strain making the rounds, it’s no surprise that we’re seeing new cases, but almost all deaths due to these cases will be among the unvaccinated, and the US just has lots more of those people than Canada, or other places with higher rates of vaccination.

It’s a cliche, but sometimes it’s also true: Darwinism in action. If they can’t be arsed to take even the simplest actions needed to protect themselves, then they’re more likely to get sick and die.

At this point, though, I have no idea how to get that across to them. If a year and half of pandemic with over 600,000 deaths in the US hasn’t opened their eyes, I can’t imagine anything anyone might say to them to make a difference.

But only by a few percent (49-57%) that seems a small amount to explain such a big difference (though I guess there are plenty of mechanisms that could mean the difference in mortality is not linearly related to vaccination rate)

But how would that account for a difference in mortality? That would increase the Covid rate, but wouldn’t change the number of people dying for every 1000 people that caught covid.

But this is same in other countries. So how would this account for the difference?

From what I remember from before delta, there was reason to believe that the likelihood of severe disease increases with higher viral loads. Masking and other measures may result in them getting less of the virus.

This seems like it could explain some of the difference. We have places like Louisiana where you have 5 million people with a vaccination rate of only %37. There is no comparable chunk of other western countries like that.

I guess I’d revise my initial thoughts into saying its probably due to:

  • Lack of testing
  • Lower vaccination rate
  • “heterogeneity” where regions with millions of people in them have much lower rates than the (already low) average.

Delta. Delta. Fucking Delta. It has a higher level of transmission and tends to have a much higher viral load. We have known since early days that viral a higher load is correlated with adverse outcomes, which is why healthcare workers, basically swimming in SARS-Cov2 have high fatality rates, even ignoring age and co morbidities.

This lack of testing point I find really confusing. It’s true that highly vaccinated countries are performing fewer tests, and may be undercounting 4th wave covid cases due to higher numbers of asymptomatic or weakly symptomatic cases. But what does that have to do with mortality rates? I find it very hard to believe that people dying of covid in the UK or wherever aren’t being tested. So how is decreased testing elsewhere supposed to explain how the US has a higher covid mortality rate in this wave?

The simplest explanation for a mortality gap in this wave is vaccination. Not only are rates higher in other countries, but fairly uniformly the most vulnerable (that is, the oldest) populations in highly vaccinated countries are vaccinated at extremely high rates. In Saskatchewan, which is dead last amongst Canadian provinces for vaccination rates, the 70+ demographic is over 90% at least one dose and over 85% fully vaccinated, and 80+ is slightly higher still. I believe the same is not true in the low-vaxx areas in the US.

Obviously the 1 person out of 100 (or whatever it is) who dies is going to be tested, along with the 5 or whatever that get hospitalized (to choose some numbers at random). But whether the other 94 people do or not is going to directly effect the mortality rate.

If 90 of the remaining people get tested (then it looks like you have 96 people with covid). They you have an apparent mortality rate of 1%. If only 45 get tested then the it looks like you have 51 people with Covid and the mortality rate looks like 2%.

Post vaccination when people are getting more colds anyway (in my experience at least) its particularly likely that someone who has mild covid because they are vaccinated may not bother getting tested (and the fact no one wants nasty medical bill in the US, means it will be more like in the US)

I think this is it. In fact, the vaccination rate is so steeply divided in the US by income and education level, as well as other markers of social privilege, that we may, paradoxically, have ended up with the highest vaccination rates among the lowest-risk people. It’s still a good thing overall, but vaccinating a bunch of youngish professionals with good health insurance and few preexisting conditions isn’t going to cause a significant drop in the mortality rates; the overwhelming majority of those people wouldn’t die of COVID if they were unvaccinated.

Oh I’m sorry, I had been reading you as suggesting that the explanation for higher US mortality than other countries was due to lower testing in those other countries because they have higher vaxx rates. But in fact you’re positing the opposite in terms of testing rates, which would indeed help to explain a disparity in mortality rates.

That does at least seem possible, though I expect the difference is more likely to be that old GOPers are unvaccinated at much higher rates than old Tories. Vaccination is much, much less politicized outside the US.

Is it really? While there appears to be age related or ethnicity related spread in other countries, it does not appear to be as extreme as the US.

In the UK, it appears that a majority of people in each eligible adult age group has at least one one dose. That’s not true for large parts of the US - Mississippi, for example, has barely half (~51%) their 18+ population even partially vaccinated while Vermont has almost all (~87%) their 18+ population partially vaccinated. Likewise, the UK are also reporting ethnic differences in uptake but not the extreme variations we’re seeing in the US.

They have mentioned some regional differences, but I haven’t found anything to suggest regional differences like we’re seeing in Mississippi vs Vermont. And, not surprisingly, the former is near the epicenter of the current wave of infections and deaths and the latter is not.

Likewise Canada. There’s some province to province variations but they’re all more or less within a few percent of each other within each age group, at least compared with the US, and all at least 60%. Unfortunately, Canadian provinces don’t publish ethnicity breakdowns for immunizations, but the overall numbers are still pointing to less obvious disparities from location to location.

Demographically, our immunization statistics show remarkable heterogeneity compared to other countries. And not coincidentally, the areas showing the biggest divergences from the national average in either direction are doing relatively the best/worst compared to other states.

But you were specifically talking about demographic differences not regional ones. Yeah, there are regional differences that are much more extreme than in the US than elsewhere (as I mention above there is nowhere comparable to say Lousiana where you have 5 million people with an average vaccination rate of %37 percent). But the demographic differences are absolutely the same elsewhere, can’t speak for Israel but the UK absolutely has the problem of lower income groups being disproportionately affected by covid, and having lower vaccination rates.

Yes, but to the same extent?

Hard to get up to date statistics, but while Black UK citizens are among the least likely to be vaccinated, at least 60% of the population 50 or over has had two shots.

Not exactly the same but for the US here’s a nifty graphic showing ethnic breakdowns of vaccination by state, and it’s striking. There are wild variations across states. Some states show similar behavior as the UK or other countries and some states absolutely don’t.

It’s a point that’s been made by several physicians and scientists - this is primarily a surge among the unvaccinated. And we’re not going to have a good story to explain a single national level statistic when there are these types of differences both regionally and even demographically between those regions. We’ve hit the point in several states where we are getting additional deaths because hospitals and staff are overwhelmed. The statistics get skewed at that point. We get “extra” deaths from that alone.

As to the OP, yeah, this may be due to reduced testing in those very states. But, again, it’s hard to pry that part of it out of the overall numbers because the states that have people not testing are bad at other aspects of the pandemic as well.

I think that’s a big difference. Especially if the patially-vaxxed numbers are significantly higher than 47%.

As you all already mentioned, there are pockets of very low vax rates and very risky behaviors. The virus is burning through these like kindling.

I tend to think that the unvaccinated population is far more infected than we realize, and that maybe the mortality rate isn’t necessarily higher, but rather a trailing indicator of the magnitude of the infection rate in the unvaccinated population.

In other words, we’re mistaking the number of deaths that are occurring for a higher mortality rate, when in fact it’s probably indicative of a dramatically higher infection rate that we can’t really see.