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Younger and unvaccinated: The new face of COVID-19 hospitalizations in Massachusetts

As the Delta variant rips through the state, those without the shot bear the brunt of the illness.

Medical workers conferred through a glass door while working in the Medical Intensive Care Unit at Tufts Medical Center. As the number of hospitalized COVID-19 patients climbs, Tufts critical care physician Dr. Kari Roberts expressed concern. "I don't know how we keep doing this again and again," she said.Erin Clark/Globe Staff

Doctors, nurses, and their army of colleagues in Massachusetts hospitals are worried and exhausted. The trickle of COVID-19 patients arriving at their doors a month ago has grown to a steadier stream — up 78 percent over the last three weeks.

The faces of those infected are changing, too. No longer is the typical patient a gray-haired 70-year-old with multiple health conditions, they say. Instead, they are seeing many 40- and 50-year-olds, some even younger, who had been healthy before becoming infected. Many are people of color.

And 80 percent of them are not fully vaccinated.

As the ferociously contagious Delta strain of the virus seeds infections at a frightening clip, hospital leaders are anxious about what may be just around the corner. And they are frustrated about the number of unvaccinated COVID patients who are winding up in hospital beds now — a situation they describe as largely preventable if more people would get their shots.

“It’s more sadness than anything else,” said Dr. Armando Paez, director of the infectious disease program at Baystate Medical Center in Springfield. “Looking at somebody gasping for air, and you know it could have been prevented by getting vaccinated.”


As of Thursday, Massachusetts was reporting 197 people hospitalized with COVID, up from 80 the week of July 4, when the state’s seven-day average hit its pandemic low. The spike at hospitals tracks closely with the rise in people testing positive for COVID that began after the 4th of July holiday.

The numbers are still far below last year’s high, when more than 3,000 people were hospitalized on many days during April and May. But the trend is worrisome, and there are indications at some of the state’s biggest hospitals that the hospitalization rate is starting to accelerate.

Mass General Brigham, the state’s largest health care system, said the number of its COVID-19 hospitalized patients more than tripled this month, from 12 on July 1 to 38 on Wednesday. At UMass Memorial Medical Center in Worcester, cases have also more than tripled, from 10 earlier this month, to 33 as of Wednesday. Baystate Medical Center in Springfield was reporting 17 midweek, up from a handful of COVID patients a week earlier. And Beth Israel Lahey Health said its COVID-19 patients increased from 19 on July 1 to 27 Thursday.


Doctors Basel Humos (left) and Benjamin Schwartz work behind the desk in the medical intensive care unit at Tufts Medical Center on Thursday.Erin Clark/Globe Staff

“It’s disconcerting,” said Dr. Richard Ellison, an infectious disease specialist at UMass. “None of our staff wants to go through what we went through last year or last winter.”

Dr. Tom Sequist, a primary care doctor who helped lead Mass General Brigham’s COVID-19 response, said he and his colleagues are seeing an increase in the number of COVID-hospitalized patients across their system.

“I’m worried about how long this current wave is going to last, and how high will the wave be,” he said.

Governor Charlie Baker has pointed out that that the state’s second-highest-in-the-nation vaccination rate — 69 percent of residents have received at least one dose — has afforded Massachusetts residents extraordinary protection against the virus. Massachusetts still had the nation’s third-lowest COVID hospitalization rate as of Friday, behind Vermont and New Hampshire, according to The New York Times COVID tracker.

“Massachusetts is in a much better position than the vast majority of the states in this country with respect to how we deal with and how we’re prepared to deal with COVID,” Baker said Wednesday after the Centers for Disease Control and Prevention recommended a return to indoor mask-wearing for many counties nationwide, including five in Eastern Massachusetts, because of rising infections and hospitalizations.


Of course, vaccinations don’t provide complete protection against COVID, as the July outbreak in Provincetown demonstrates. Nearly three quarters of the 882 people who had tested positive by Thursday were vaccinated, prompting the Centers for Disease Control to reassess how easily the Delta variant spreads among vaccinated people. The agency reported Friday that the rate of spread is extraordinary, and that those who had been vaccinated appeared to carry the same level of virus as the unvaccinated did — findings that were “pivotal” in prompting the CDC’s updated guidance.

But just seven of the infected people in Provincetown have been sick enough to be hospitalized, according to Town Manager Alex Morse, and at least four of those had been vaccinated, according to the CDC. In addition, there has been at least one reported death of a vaccinated person on Cape Cod, 98-year-old Anna Silvi, who lived in a West Yarmouth nursing home.

This year, roughly 97 percent of people hospitalized with COVID-19 in Massachusetts were not fully vaccinated, a figure that mirrors the trend nationally, in part because far fewer people were vaccinated earlier this year. But starting in July, that dropped to 80 percent in Massachusetts, a Globe analysis of state data shows. That’s likely due to the rise of the new Delta strain and exceptionally high vaccination rates in the state, which mean fewer unvaccinated people to contract the virus.


Over the past month, the analysis shows that the risk of hospitalization from COVID was roughly eight times greater for those who were not fully vaccinated compared with the vaccinated, a number that has dropped as more people get the shot, but remains significant.

The Baker administration has not included vaccination rates among patients hospitalized with COVID in its regular public postings, but an administration spokeswoman said it is working with hospitals on that data and that it will be reported soon.

A Globe survey of Massachusetts hospitals shows that officials are most concerned about the unvaccinated, both because there are so many of them and because their illnesses are so preventable.

More than 99 percent of COVID patients admitted to Tufts Medical Center since January have been unvaccinated, according to hospital records. More than 98 percent of current COVID patients at Southcoast Health had not received their shots, said Dr. Dani Hackner, chief clinical officer of the system, which owns hospitals in Fall River, New Bedford, and Wareham.

“We are seeing COVID patients admitted with few risk factors and it’s tragic,” Hackner said. “We have had [COVID patients] ask for vaccine after admission,” when it’s too late to help them.

Dr. Simone Wildes, an infectious disease physician at South Shore Health, said almost every day she is encountering patients without COVID in the hospital who are not yet vaccinated and could easily gain that protection. Most of those holding out, she said, are in their 20s, 30s, and early 40s.


Wildes said she offers a shot right there, on the spot. Still, many decline.

“You would think, being in the hospital, that would get their interest piqued a bit,” she said. “But they are still not wanting to get the vaccine. They are still waiting to see how it’s affecting others.”

Dr. Kari Roberts, who works in the medical intensive care unit at Tufts Medical Center, says she’s witnessed people in their 20s and 30s die of COVID throughout the pandemic.Erin Clark/Globe Staff

Dr. Kari Roberts, critical care physician at Tufts Medical Center, said nearly every COVID-19 patient she has seen has been unvaccinated. She said those without shots are largely in their 40s and 50s. But she’s witnessed people in their 20s and 30s die of COVID throughout the pandemic, with and without other underlying health problems.

“These are not 70-year-old diabetics with hypertension who smoke,” she said. “These are 30-year-olds with jobs, college educations, or high school educations, with families or dogs or plants.”

The rising cases, she said, make it harder to believe that the pandemic will ever completely subside.

“I don’t know how we keep doing this again and again,” she said. “We just will, I suppose. But I don’t feel like any of us have had a chance to take a breath.”

As the virus resurges, health and social justice advocates say it’s vital that the state publicly report not only the vaccination status of patients, but also demographic data on COVID-19 hospitalizations, something it ceased doing July 1.

They said inequities during the pandemic, including the inability to work remotely and a heavy reliance on public transportation, have fueled higher infection rates in low income neighborhoods and communities of color. The demographic data, before its release was halted, showed the consequences of those inequities: significantly higher COVID hospitalization rates in Black and brown communities, even after vaccines became more widely available.

“In order to address inequities, we must be able to measure them,” said a coalition of more than a dozen advocacy groups, called Vaccine Equity Now!, in a July 28 letter to the Baker administration urging officials to resume tracking and reporting.

A Baker administration spokeswoman said the demographic data had been reported to the state by hospitals and tended to be incomplete or underreported. It said the state decided to remove all of the data because it lacks complete numbers on the race and ethnicity of hospitalized COVID patients.

Hospital leaders not part of the coalition also spoke of the state’s need to better address racial disparities and the severe consequences of more COVID hospitalizations and deaths if such risk factors are left unaddressed.

“If we don’t take care of really vulnerable people, and if we don’t do things right from an equity standpoint, it’s not just those vulnerable people that are going to suffer,” said Dr. Alister Martin, emergency room doctor at Mass. General Hospital. “It’s all of us.”

Tufts Medical Center nurse Katey Ring used a pair of binoculars to peer in through the glass walls of a patient's room while working in the medical intensive care unit. To limit exposure to COVID-19 and to preserve PPE, the binoculars have been used during the pandemic to assess the pumps and vent settings of the patients on the floor. Erin Clark/Globe Staff

Kay Lazar can be reached at kay.lazar@globe.com Follow her on Twitter @GlobeKayLazar. Ivy Scott can be reached at ivy.scott@globe.com. Follow her on Twitter @itsivyscott.