‘These deaths could have been averted’: Doctors lament that too many residents went without life-saving vaccines upon Mass. exceeding 20,000 COVID deaths

Massachusetts surpassed 20,000 confirmed coronavirus deaths on Wednesday, a grim milestone reached days after the state entered the third calendar year of the pandemic.

With 54 new COVID-19-related fatalities reported, a total of 20,008 people have died since March 2020, when an 87-year-old Winthrop man became the state’s first confirmed death, according to the Department of Public Health. The state also reported 27,612 confirmed COVID-19 cases Wednesday.

The somber mark came as the Broad Institute of MIT and Harvard told the Globe that the fast-spreading Omicron variant now accounts for 95 percent of all COVID cases in the state, virtually supplanting the less transmissible Delta variant.

Omicron has driven a surge of new cases and hospitalizations in the state, which some experts warn may only intensify in coming weeks. Coronavirus readings in Boston-area wastewater, an early indicator of climbing case rates, have skyrocketed, breaking previous records. Because Omicron appears to cause less severe disease than previous variants, it’s unclear how many of the new cases will result in hospitalizations and deaths.

More than 60 percent of the deaths, or 12,359, occurred in 2020. Most came in the first wave of cases in the spring, when doctors and nurses at overwhelmed hospitals struggled to figure out the best treatment for people in severe respiratory distress.

Health experts say most of the more than 7,600 fatalities in the past 12 months could have been prevented if the victims had received any of three COVID vaccines developed in record time and bought by the US government. Messenger RNA vaccines from Pfizer-BioNTech and Cambridge-based Moderna became available in December 2020. Johnson & Johnson’s viral vector vaccine became available in March 2021.

“Once the vaccines came on the market, these deaths could have been averted,” said Dr. Philip J. Landrigan, director of the global public health program at Boston College. “The overwhelming majority of these deaths have occurred in people who never got a single dose of the COVID vaccines.”

Although the three vaccines cleared by the Food and Drug Administration have varying rates of protection from infection, all are remarkably effective at preventing severe illness and death, Landrigan said. That message has helped spur more than 80 percent of the roughly 7 million residents of Massachusetts to get at least one vaccine dose, among the highest rates in the country.

“But turning that around, that means that 1.4 million of the 7 million people who live in the Commonwealth haven’t gotten at least one shot,” said Landrigan, a pediatrician and epidemiologist who spent 15 years with the Centers for Disease Control and Prevention. “Sadly, I fear that the great majority of any future deaths are going to occur in unvaccinated people as Omicron continues to gain momentum.”

An average of 21 people died from COVID in Massachusetts each day in the past year, according to the state data. That would appear to make the coronavirus one of the leading causes of death in the state. On average, 35 people died of cancer and 33 died of heart disease each day in 2017, according to the most recent available daily mortality data from the health department.

Carlene Pavlos, executive director of the Massachusetts Public Health Association, a nonprofit advocacy group, said she was “heartbroken” by the milestone of 20,000 deaths. She renewed calls for Governor Charlie Baker to reimpose a mask mandate that his administration lifted in May when many thought the end of the pandemic was in sight. As Omicron-fueled cases have surged in recent weeks, some cities and towns have imposed their own mandates, but Pavlos said a hodgepodge approach is ineffective.

“We’ve said this over and over again: the virus doesn’t stop at municipal borders,” Pavlos said.

The Baker administration referred to its standing guidance on masks. In December, the governor said he had “no interest” in imposing a mask mandate, but noted that the state had advised residents to wear face coverings in public indoor spaces. In addition, masks are mandated in certain settings, including health care facilities, public transportation, and prisons.

Overall, Baker has said that Massachusetts is in a better position to combat the virus than a year ago because of high vaccination rates, availability of boosters, and the decision by some communities to issue their own mask requirements.

The pandemic has taken an outsize toll on communities of color, which tend to be more densely populated, making it easier for the virus to spread. In addition, Pavlos said, many lower-income residents with limited Internet access have struggled to set up vaccination appointments online. Others have had difficulty arranging transportation to vaccination sites and juggling work and day care for children to get shots.

“It’s layer upon layer upon layer of inequities,” Pavlos said.

The three counties with the highest rates of death were Hampden, with 380 per 100,000 residents; Bristol, with 365 per 100,000; and Essex, with 344, per 100,000.

Alan Charles Geller, a researcher with the Harvard T.H. Chan School of Public Health, noted that those counties had higher COVID caseloads in their main cities and lower rates of vaccination and booster shots. As of Dec. 23, for example, only about 68 percent of eligible residents in Fall River, in Bristol County, had received one dose of a vaccine, and only 37 percent of eligible residents had received a booster dose.

The counties also have a number of nursing homes that were hit hard early in the pandemic, including the Holyoke Soldiers’ Home in Hampden, where at least 76 veterans died from COVID.

“But I’d bet my house that it’s the lower vaccination rates more so than age [of residents in the counties] that’s driving it,” Geller said.

The highest daily total of COVID-related deaths in Massachusetts occurred on April 24, 2020, when there were 198. Daily fatalities declined in the spring and summer but then surged in the fall and winter, reaching a peak of 94 on Jan. 26, 2021. Death totals fell again through the first half of 2021 and on July 6, the state reported there wasn’t a single fatality associated with the virus.

But they again climbed as the Delta variant took hold later in 2021, and then rose further after Omicron supplanted that viral strain starting after Thanksgiving. But the number of people dying now is nowhere near the rates early in the pandemic.

Cities in the Northeast, particularly New York, were the focus of the first surge of cases in the spring of 2020, according to Spencer Fox, associate director of the University of Texas COVID-19 Modeling Consortium. The virus ravaged many other parts of the country later.

“In most of the country, the majority of mortality has come in 2021 compared to 2020,” he said.

While vaccines have prevented coronavirus deaths in Massachusetts, the medical community has also gotten better at treating infected patients at hospitals, according to health experts.

Dr. Daniel Kuritzkes, chief of the infectious diseases division at Brigham and Women’s Hospital, said the FDA emergency authorization of Gilead’s antiviral drug remdesivir, the use of cheap, readily available steroids such as dexamethasone, and the availability of other anti-inflammatory drugs have prevented many hospitalized patients from dying.

In addition, the medical community has learned valuable lessons. In particular, doctors are more wary about putting patients having trouble breathing on ventilators, which were initially considered life-saving mechanical devices. A growing body of evidence indicated that ventilators, which blow air into the airways and lungs, can cause traumatic injury.

“It’s always better not to have somebody on a ventilator if you can avoid it,” Kuritzkes said.

As a result, patients hospitalized with COVID usually don’t get as sick as they did early in the pandemic. On Wednesday, Brigham was treating some 85 COVID patients on regular medical floors and only 16 in the intensive care unit, Kuritzkes said. In April 2020, he said, the hospital was treating 80 to 100 patients on regular medical floors and 80 patients in the intensive care unit.

Although Omicron appears to be milder than those that came before it, it has caused a surge of infections nationwide that shows no signs of abating, according to Fox, of the University of Texas. His consortium forecasts case numbers three weeks into the future, and he said, “There are no signs right now in the data we’re looking at of a slowdown.” Nonetheless, he expected case counts would peak in the next month.

“These things are inherently uncertain and fickle, and I wouldn’t bet my money,” he said. “I think COVID has humbled us as forecasters in a lot of ways.”

Martin Finucane and Kay Lazar of the Globe staff contributed to this report.

Jonathan Saltzman can be reached at jonathan.saltzman@globe.com.