Since Jan. 20, 2020, when health officials reported the first local fatality from COVID-19 – involving a man who had just come back from Wuhan, China – the still-mysterious and evolving disease has gone on to kill more than 7,700 people in Orange County, making it the most lethal health event of the past century.
But according to three years of local health data, COVID-19 has been something else as well – an unequal-opportunity killer.
In the first two years of the pandemic (numbers for 2022 aren’t complete), COVID-19 was the third-leading cause of all deaths in the county, according to data from the Orange County Health Agency. For older residents, ages 65 and up, it was the third-leading cause of death, ahead of Alzheimer’s among others. And for local Latinos COVID-19 was the No. 1 cause of death.
But those inequities only hint at the random way the worst outcome of the disease has played out in different parts of Orange County.
Consider: In Irvine, a city of 309,031 people, roughly one out of every 1,652 residents has died of COVID-19 since the start of 2020, according to county numbers through Dec. 30, 2022. But in Santa Ana, a neighboring city with almost exactly the same-sized population (309,441), the death rate has been about six times higher, roughly one out of every 271 residents.
Such discrepancies are common in a county with 34 cities and nearly as many distinct economic, social and demographic realities.
Laguna Woods and Seal Beach – two communities defined or shaped by the age of their residents – have suffered COVID-19 death rates nearly 10 times higher than the city that’s suffered the lowest death rate, Laguna Beach. But cities without age-centric populations show similar differences. The death rate in La Habra, for example, has been roughly three times higher than in Tustin, even though both cities are similar in median age, population size and household income.
Such gaps are only partly about biology. Instead, public health experts say three years of COVID-19 mortality has simply exposed the sharp social and economic inequalities that existed in the county long before the pandemic.
“The characteristics of people living in different places influence both the likelihood that they are tested for COVID-19 and their risk of severe disease if they are infected with the virus,” said epidemiologist Dan Parker, an assistant professor of population health and disease prevention at UC Irvine who co-authored a 2021 study that looked at different COVID-19 death rates in Orange County during the early months of the pandemic.
“It isn’t that the virus was different,” he added, via email. “It’s the demography, biology, and socio-economic conditions of the population that are different.”
Age, housing, insurance and death
The factors that drive the worst outcome of COVID-19 in a particular community, Parker and others say, are still coming into focus.
By many accounts, roughly 90% of people in Orange County have had COVID-19, with roughly half of those cases not officially tracked by health officials. Though positive cases initially were thought to be centered in some cities more than others, that changed over the past three years as testing became more widely available and the disease reached every neighborhood in the county.
Now, nearly three years after the county’s first pandemic death – and about two years since the arrival of vaccines – most people and political leaders (if not all health experts) have come to view COVID-19 as a routine fact of life rather than a moment-to-moment health emergency. That’s held true over the past year or so, even as new strains have prompted small waves of positive tests and moderate spikes (though smaller than 2020 levels) in deaths.
The upshot is that, today, mask-wearing isn’t required in almost any setting and is far less common than it was during the peak of the pandemic. Social distancing is no longer routine. Schools, churches and other public gathering spots now work a lot like they did before the pandemic.
This collective return to normal has, in some ways, made it easier to identify some of the factors that drive COVID-19 death rates up or down in one city versus another.
Public health experts point to a few specific community characteristics – median age, population density and access to insurance – as part of a constellation of reasons why death rates are so uneven in Orange County.
“In all communities, it’s disproportionately older people who die of COVID,” said Andrew Noymer, an associate professor at UC Irvine who teaches about population health and disease prevention.
“Obviously, anybody can die of the disease. And many factors are part of this. But age is the real risk factor.”
That’s certainly true in isolated places, such as nursing homes, where COVID-19 deaths are much higher than other parts of the population. And it’s been true for individuals as well, as numerous studies have found that COVID-19 death rates jump considerably with each decade of life.
But it’s not at all clear that age, on its own, is the biggest reason why COVID-19 deaths have been higher in some Orange County cities than in others. Census data shows the ages in cities that suffered more COVID-19 deaths, and those that suffered fewer, were roughly the same.
Another factor driving COVID-19 deaths, on a city-by-city basis, is population density, at least when “density” reflects the number of people living under the same roof. People packed together, indoors, boosts the spread of most communicable diseases, including COVID-19.
“Multi-generational living is a huge factor in this,” said Noymer. “It’s another key to the puzzle that definitely dovetails with (COVID-19) mortality.”
That’s backed up by the numbers. Census data shows that in the 19 cities with lower-than-average death rates, the number of people per household is 2.75, or about 10% less dense than the 2.99 people per household in the 15 other cities where COVID-19 deaths have been higher than average.
Another factor is access to health care.
Though viral testing and, later, vaccines have been free to the public through federal or state agencies over the past three years, community health in some Orange County communities was compromised long before the arrival of COVID-19. And given that COVID-19 is far more likely to be lethal when a person suffers from other health problems – everything from diabetes and heart disease to obesity have been linked to higher COVID-19 death rates – experts believe a community’s pre-pandemic access to health care played a powerful role in differing death rates.
That, too, is supported by the numbers. Census data shows O.C. cities that fared better than the county average had a median uninsured rate (for people under 65) of 5.284%, far less than the median uninsured rate of 8.946% in cities that fared worse than average.
Still, experts suggest none of those factors, on their own, explain why COVID-19 deaths in Rancho Santa Margarita were about one-sixth what they were in Anaheim over the past three years. Instead, they say, all of those factors, collectively, contribute to the higher or lower death rates.
“Santa Ana is a very different place from Irvine or Huntington Beach or Newport Coast, and the differences are more than just economic,” said UC Irvine epidemiologist Parker.
But the differences are somewhat economic. Census data shows money is a big difference between cities where COVID-19 is a big or little killer. The average annual household income in the 19 O.C. cities that fared better than average, coronavirus-wise, was about $120,000, versus $85,600 in the cities that fared worse.
Now what
The difference between pandemic, when a disease is spreading rapidly, and endemic, when a disease is simply part of the biological landscape, might be academic when it comes to COVID-19.
Three seemingly unrelated news stories or trends have been identified in recent months that point to the disease sticking with us for the foreseeable future.
One is the overnight relaxation of coronavirus restrictions in China. Health experts said that as the disease works through China’s population of 1.4 billion – and as people in that country are allowed to travel domestically and internationally – COVID-19 numbers worldwide could be driven up.
Another is the arrival of the so-called “Kraken” strain of the virus, which is the name given to the “XBB.1.5” subvariant of omicron identified in recent weeks in New York state. Health experts said this week that the version spreads as quickly or faster than any previous version of COVID-19. But they added that it isn’t yet clear if it poses a greater health risk than other strains, in part because it is arriving in a post-vaccine world.
To date, about 5.51 billion people worldwide have received at least one vaccination dose, nearly 72% of the population, according to statistics from the World Health Organization. In Orange County, about 75% of all residents are fully vaccinated (though not yet boosted) according to county health data.
And that touches on a third trend that suggests COVID-19 – and, with it, the chance of death from it – isn’t going away entirely. Several signs indicate partisan politics is likely to shape the disease going forward.
Last month, a study from Kaiser Family Foundation found sharp differences in vaccine acceptance between Republicans and Democrats. The study noted that Republicans increasingly are wary of many vaccines, such as the measles shots required for children to attend school, and that they’re less likely than Democrats to be interested in getting a COVID-19 booster shot anytime in the future.
This came on the heels of a study from researchers at Yale University that found over the past two years – since vaccines have been available – people registered as Republicans were more likely to die of COVID-19 than people registered as Democrats. The reason was that Republicans have been less likely to get vaccinated. Though the study was concentrated in two states, Ohio and Florida, it tracked more than 600,000 individuals, and was based on voter registration and health data, not on polling.
Vaccine resistance is a political and information issue, not a health issue. Numerous studies – by the Centers for Disease Control and other health experts – show that vaccines reduce the odds of suffering severe COVID-19 outcomes or death, and that vaccines aren’t particularly risky.
But vaccine resistance means at least some segment of the population will remain unvaccinated. As such, they’ll be more vulnerable to disease and death than others. It’s partly why public health experts who trust vaccines say they are only part of how COVID-19 should be fought going forward.
“As with most public health issues, a multi-pronged and nimble approach would be good,” wrote UC Irvine’s Parker.
“I don’t believe we’re doing this right at this moment. We’ve essentially dropped almost all precautions because we now have a vaccine. But vaccine and booster coverage isn’t sufficient in all demographic groups and vaccines aren’t 100% effective.
“This is not the same as saying that we should stay indoors and away from others, or even wear masks, forever,” he added. “But there are times when we should exercise much more caution than what is currently happening.”
Source: Orange County Register
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