NYT, Dec. 16, 2020
Opinion
People Thought Covid-19 Was Relatively Harmless for Younger Adults. They
Were Wrong.
New research shows that July may have been the deadliest month for young
adults in modern American history.
By Jeremy Samuel Faust, Harlan M. Krumholz and Rochelle P. Walensky
Dr. Faust is a doctor at Brigham and Women’s Hospital Department of
Emergency Medicine. Dr. Krumholz is a professor of medicine at Yale. Dr.
Walensky, chief of the division of infectious diseases at Massachusetts
General Hospital, has been nominated by President-elect Biden to be the
director of the C.D.C.
Dec. 16, 2020
The largest burden of Covid-19 has undoubtedly fallen on people older
than 65, accounting for around 80 percent of deaths in the United
States. But if we momentarily eclipse that from our mind’s eye,
something else becomes visible: The corona of this virus.
Young adults are dying at historic rates. In research published on
Wednesday in the Journal of the American Medical Association, we found
that among U.S. adults ages 25 to 44, from March through the end of
July, there were almost 12,000 more deaths than were expected based on
historical norms.
In fact, July appears to have been the deadliest month among this age
group in modern American history. Over the past 20 years, an average of
11,000 young American adults died each July. This year that number
swelled to over 16,000.
The trends continued this fall. Based on prior trends, around 154,000 in
this demographic had been projected to die in 2020. We surpassed that
total in mid-November. Even if death rates suddenly return to normal in
December — and we know they have not — we would anticipate well over
170,000 deaths among U.S. adults in this demographic by the end of 2020.
While detailed data are not yet available for all areas, we know
Covid-19 is the driving force behind these excess deaths. Consider New
York State. In April and May, Covid-19 killed 1,081 adults ages 20 to
49, according to statistics we gathered from the New York State Health
Department. Remarkably, this figure towers over the state’s usual
leading cause of death in that age group — unintentional accidents
including drug overdoses and road accidents — which combined to cause
495 deaths in this demographic during April and May of 2018, the most
recent year for which data are available to the public.
Nor is it an illusion that people of color constitute a disproportionate
fraction of the dead. According to the Centers for Disease Control and
Prevention, among adults 25 to 44, Black and Hispanic people make up not
just a disproportionate number but a majority of Covid-19 deaths through
Sept. 30.
Stay-at-home policies have saved lives, but their benefits have not been
equally distributed. Among essential workers, many of whom are people of
color, sheltering-in-place was never a real option.
Take a step back and compare what we are experiencing to the H.I.V./AIDS
epidemic. Before effective treatments became available, we watched in
horror as a contagious but preventable disease ravaged young adults in
the prime of their lives. It claimed the lives of thousands of
working-age adults every month. While too many still become infected,
and too many die, public health messaging helped ease the epidemic.
Now we must deal with Covid-19. For too long, the message has been
repeated — by us and our colleagues, by government officials and the
public — that Covid-19 is dangerous for the old and that younger people
do well. It’s true that deaths among adults ages 25 to 44 account for
fewer than 3 percent of Covid-19 deaths in the United States, according
to the National Center for Health Statistics.
But what we believed before about the relative harmlessness of Covid-19
among younger adults has simply not been borne out by emerging data. In
the past, it took us too long to respond to the epidemics of opioids and
H.I.V./AIDS when the young started dying in large numbers. Now that we
have similar information about Covid-19, we must immediately address it.
We need to amend our messaging and our policies now. Outreach in the
coming weeks and months is imperative. We know it can help. The use of
lifesaving medications like methadone and buprenorphine increased after
awareness of the devastation of the opioid epidemic became commonly
understood, saving many lives. We need to tell young people that they
are at risk and that they need to wear masks and make safer choices
about social distancing.
This is even more important now that safe and effective vaccines are a
reality. Young, healthy people are low on the priority list for the
vaccine rollout. That means that modifying behavior now can save
thousands of young lives next year.
And that is the crux of it. Our messaging is no longer about merely
flattening the curve to prevent hospitals from overflowing. Now with
vaccines, our policies and our individual choices can together save a
far larger number of lives.
That challenge is ours to confront. The sooner that reality sets in, the
better.
Jeremy Samuel Faust is an attending physician at Brigham and Women’s
Hospital Department of Emergency Medicine in Boston and an instructor at
Harvard Medical School. Harlan M. Krumholz is a professor of medicine at
Yale University. Rochelle P. Walensky, chief of the division of
infectious diseases at Massachusetts General Hospital and a professor at
Harvard Medical School, has been nominated by President-elect Biden to
be the director of the Centers for Disease Control and Prevention.
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