A year ago, young families of color in Massachusetts were suffering a heavy toll from COVID-19, with Black and Latino people in the prime of their lives dying at rates up to three times higher than white people.
Now, the pendulum appears to be swinging the other way.
Since the end of the first Omicron wave last March, death disparities have reversed, with white people in Massachusetts more likely to die from COVID than Black or Hispanic people, although there is some variation across age groups, according to a new analysis conducted for the Globe by researchers at Boston University’s School of Public Health.
“Clearly, something shifted after the initial Omicron wave,” said Dr. Jonathan Levy, who chairs the department of environmental health at BU’s School of Public Health.
Levy and Jacob Bor, an associate professor in global health and epidemiology at BU, analyzed state data — more than 60,000 death certificates obtained by the Globe through a public records request. Their analysis found that 55 percent of the roughly 4,100 COVID deaths in Massachusetts during 2022 occurred in just the first two months, amid the first Omicron surge.
During that stretch, Hispanic people were one-and-a-half times more likely to die than white people, while Black people were 1.3 times more likely to die.
But since last March, that ratio has dramatically turned. Now, the COVID death rate among Hispanic people is about three-quarters that of white people, and the rate among Black people is roughly two-thirds.
Yet the death rate ratio for Asian people throughout the pandemic has remained consistently lower than for all other racial and ethnic groups, the researchers found.
“Are we seeing lower exposure risks [among Asian people] based on occupation, or mask-wearing patterns, or something else, perhaps different vaccination rates?” Levy said. ”There are clues, if we can figure them out, that may tell us what are the vulnerability factors and what protections do we need.”
State death certificates, which were used in this analysis, do not indicate whether someone was vaccinated or boosted, nor whether the person used a mask. The BU analysis does not factor in potentially different levels of immunity from vaccination or past infection, nor people’s access to care, and how these factors may have changed during the pandemic.
Dr. Yonatan Grad, an associate professor of Immunology and Infectious Diseases at Harvard T.H. Chan School of Public Health, reviewed the BU analysis and said a combination of factors over time may be driving the apparent drop in COVID death rates for Black and Hispanic people. He said better access to vaccines in communities of color in 2022 could, in part, explain the lower death rates in the latter months. So, too, could improved access to care, which would reduce the likelihood of dying from COVID.
Grad said changing infection rates over time may also help explain the apparent shift. Proportionately more Black and Hispanic people were infected and died earlier in the pandemic while working frontline jobs. As masking and other social protections eased last year, and more people headed back to office sites, more white people were exposed.
A phenomenon called mortality displacement, also known as “harvesting,” may be playing a role, Grad said.
That’s when a catastrophic event, such as an infectious disease outbreak, temporarily increases death rates in a population and is followed by a period of lower mortality rates. Such events usually pose the greatest risk to the most vulnerable members of the population, which included large swaths of Black and Hispanic communities working frontline jobs as others were working at home.
Bill Hanage, co-director of Harvard’s Center for Communicable Disease Dynamics, suspects mortality displacement, as well as hybrid immunity — more robust protection among those infected after vaccination, may be fueling the shift in COVID death rates.
“The single most important thing that will determine our pandemic future (other than any new unexpected variant with nasty properties), is how well that hybrid immunity stands up against severe illness, and for how long,” Hanage said. “Because we’re not putting the efforts into the alternative sources of immunity — vaccinating people.”
As the country looks ahead to the lifting of the public health emergency in May, COVID deaths are at their lowest winter rates since the pandemic started. Yet the wily virus continues to cast a long shadow, claiming more than 400 lives a day nationally, and more than 100 last week in Massachusetts.
State data continue to show that older adults are most at risk of dying from COVID. Additionally, those with pre-existing health conditions are among the most vulnerable to severe complications.
But recent research highlights the toll long COVID may also play in pandemic deaths, underscoring how much is still not known about the virus we once called novel.
Indira Canario dreamed of becoming a family physician and was studying to be a nurse when she died in October. The 31-year-old Methuen woman’s death certificate is one of just a handful last year in Massachusetts that listed long COVID as a significant condition contributing to the cause of death.
Federal researchers recently analyzed death certificates nationwide and concluded that long COVID can be deadly, accounting for more than 3,500 deaths from January 2020 through the end of June 2022. But researchers said the still little-understood condition represented less than one percent of the more than 1 million deaths in the United States for which COVID-19 was the underlying or contributing cause of death during that stretch.
They also found that adults older than 65 accounted for the highest percentage of long COVID deaths. State records show all the deaths attributed to long COVID were in people age 70 and older, except for Canario.
Odris Chege said her baby sister’s death stumped doctors. Canario had high blood pressure but was otherwise healthy, and had been vaccinated in early 2022, Chege said.
Canario got COVID last July and suddenly had trouble breathing. She was treated and recovered quickly but had odd side effects that lingered, Chege said. Her blood pressure and eczema medications suddenly didn’t work well, she was often fatigued, and she started retaining large amounts of water. Even her gums swelled.
“She started feeling sick and couldn’t stop throwing up,” Chege said. By the time Canario went to a hospital in late September, doctors told the family she needed a liver transplant and that her kidneys were barely working.
“They still don’t know why her liver and kidney went bad,” Chege said. “They tested her in the hospital in July when she had COVID and they found no other problems other than COVID.”
Underlying health conditions
Bernhard “Berni” Leidner, 39, a University of Massachusetts Amherst social psychology professor, was internationally known for his work on intergroup conflict, morality, and social justice on a large scale. Yet it was his devotion to students and extraordinary energy, despite his limited mobility, that his friends and colleagues marvel about. Leidner, who died in November, had muscular dystrophy since childhood.
“The guy was incredibly inspirational and brilliant,” said Linda Isbell, a UMass psychology professor, who was Leidner’s friend and colleague.
Leidner, who used a wheelchair, had lost the use of all but one hand and a few fingers by the time he got COVID, but relished game nights — Settlers of Catan was one of his favorites — and high-octane adventures. Paragliding was on his itinerary during a 2021 trip to Greece before bad weather interfered.
Throughout the pandemic, people with serious health conditions, such as Leidner, who were infected have been among the most vulnerable to serious illness and death. Despite many advances in treatments, that has not changed.
As Omicron variants over the past year shape-shifted the virus, a succession of monoclonal antibodies that helped prevent severe complications in high-risk people lost their effectiveness. A number of antiviral treatments to help prevent hospitalization remain: Paxlovid, molnupiravir, or remdesivir, which can be given to hospitalized patients.
Leidner, who was vaccinated, was infected last fall. Isbell does not know what COVID treatments he may have received before he was hospitalized.
“He had been exposed to COVID many times and did not get it,” Isbell said. “COVID may have hastened his death, but sadly, Berni’s health was declining for quite some time.”
From the get-go, COVID has been a relentless stalker of older adults. They are more prone to health conditions, making them vulnerable to severe disease and death from the infection, and also their immune system has waned with age.
State data show the average age for COVID deaths was about 80 in late 2020, but dropped in spring 2021 to as low as 69 after most older adults received their first COVID vaccines.
But the average age for COVID deaths has climbed back to near 80 again, as only about 60 percent of adults age 75 and older have received a second booster, state data show. Also, the number of younger people who have been infected, conferring them additional immunity, has grown.
“The proportion of younger people who have had COVID is incredibly high now, so it pushes the ages [of COVID deaths] higher and higher,” said Dr. Paul Sax, clinical director of the division of infectious diseases, at Brigham and Women’s Hospital.
For 83 Massachusetts centenarians, several of whom survived the world’s deadly 1918 flu pandemic, COVID was the killer: their death certificates listed the infection as the cause, or a significant contributor, state records show.
Clara Catoe, 109, was the oldest centenarian to succumb to COVID in 2022. She died in December, nine days before her 110th birthday. The Springfield great-great-grandmother lived on her own on the top floor of a three-family home, passionately gardening and cooking until she was 103. That’s when she moved into a local nursing home after a serious fall.
“She liked reading her Bible and was thrilled when we gifted her a large-print Bible” as her eyesight failed, said her granddaughter, Veronica Catoe. “Her favorite saying was “Do your best and let God do the rest.”
Veronica said her grandmother adored her family and the simple things in life.
She never drank coffee or tea, instead choosing hot water in the morning with a dash of ginger in it.
“She bought lottery tickets,” Veronica said. “That was the one little thing she loved to do.”
Catoe religiously mailed her family holiday cookies and pound cake up until she was nearly 100, and still handled her own finances after that.
Veronica said her grandmother had no serious, chronic health problems at the time of her death. Her death certificate lists acute kidney injury as the cause of death, with COVID and “advanced age” playing a significant role.
As Massachusetts and the country face a fourth year with COVID, Levy, the BU researcher, said public attention to COVID deaths has dissipated, and one of the most powerful tools to protect against serious disease and death is still woefully underused.
“The majority of people aren’t up to date on boosters, and there is not a lot of concern about that,” Levy said. “Most people have let it go.”