Update: Tracking COVID-19 Disparities

The Virginia Department of Health continues to track COVID-19 disparities by race and ethnicity for cases, hospitalizations, deaths, and vaccinations. A previous post, Tracking COVID-19 Disparities, describes them from the start of the pandemic through August 2021. This update examines disparities in April 2022 to describe them at present. By continuing to revisit disparities over time, it is possible to get a sense of where they have improved and where improvement is still needed.

As the original post stated, early on in the pandemic Non-white groups had much higher rates of cases, hospitalizations, and deaths relative to White people. These disparities alleviated to varying degrees across all groups by August 2021. Latino and Asian and Pacific Islanders experienced the greatest reduction in relative rates of cases, hospitalizations, and deaths while having increased vaccination.

To date, there has been significant progress towards vaccinating people in Virginia and the effort continues. 81.7% of the Commonwealth has been vaccinated with at least one dose, 73.1% are fully vaccinated, and 2.9 million people have received a booster shot1.  Additionally, a new variant classified as Omicron has become the dominant variant in the country with cases peaking at a 7-day moving average of 14,328 in early 20223. Vaccination remains the safest way to protect against severe symptoms, hospitalization, and death from COVID-19 and its Omicron variant2.

Health Disparity Rate Ratios

Rate ratios are used here to quantify disparities by race and ethnicity for cases, hospitalizations, deaths, and vaccinations. A rate ratio compares the rate of events in different groups to a reference group and expresses it as a simple ratio. A previous blog post, Health Disparity Rate Ratios, goes into greater detail about them. In general, higher rate ratios mean higher rates within one group compared to the reference group. 

One Year Period

The latest rolling one-year average of rate ratios suggests that the trends in COVID-19 observed during the first half of 2021 have continued in the same direction. Vaccination rate ratios for Latino people climbed to 1.4 times that of White people, while relative hospitalization and death rates both fell to around .8.

Black people were vaccinated at about the same rate as White people throughout the last year (with a rate ratio equal to 1). Asian and Pacific Islander people had much higher vaccination rates; 1.5 times higher than White people. Black people continue to have the lowest vaccination rates relative to any other group.

 

Six Month Period

The trends seen in the last six months of data are similar to the trends for this past year, but more pronounced. For the last six months, Latino people have been vaccinated at 1.7 times the rate of White people, which is .3 higher than the one year period. Black people were vaccinated at 1.2 times the rate of White people in the past six months, which is also higher than the one year period, suggesting a positive direction for this group. 

 

 

Overall, Virginia has made important progress in vaccinating people, likely contributing to lower case, hospitalization, and death rates observed among some groups. Latino people have experienced the greatest positive shift over the course of the pandemic towards higher vaccination rates and lower COVID-19 rates.

Improvements are still needed to narrow the disparities experienced by Black people, however. Black people continue to have the lowest relative rates of vaccination. While vaccination rates have recently improved among this group, they remain burdened by the highest cases, hospitalizations and death rates.

The Virginia Department of Health continues to prioritize vaccination across all groups with disparities in mind. To view changes in disparities by race and ethnicity updated monthly, please check the Health Equity dashboard page.

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References

  1. VDH COVID-19 Data-Mart, 25 April 2022
  2. “Omicron Variant: What You Need To Know”. Cdc.Gov, 2022, https://www.cdc.gov/coronavirus/2019-ncov/variants/omicron-variant.html?s_cid=11734:omicron%20vaccine:sem.ga:p:RG:GM:gen:PTN:FY22.
  3. “CDC Museum COVID-19 Timeline”. Cdc.Gov, 2022, https://www.cdc.gov/museum/timeline/covid19.html

Tracking COVID-19 Disparities

The Virginia Department of Health tracks COVID-19 disparities by race and ethnicity for cases, hospitalizations, deaths, and vaccinations. This is important because underlying health and social inequities put some racial and ethnic groups at greater risk than others. By examining disparities over the course of the pandemic, it is possible to get a sense of where they have improved and where improvement is still needed.

Early in the pandemic it became clear disparities were severe across the United States, so the Virginia Department of Health began tracking cases, deaths, and hospitalizations by race, ethnicity, age, and socioeconomic status, to learn how different groups were impacted. Mortality was disproportionately higher for racial and ethnic minority persons than for White persons.This analysis compares three different periods of the pandemic in Virginia to better understand disparities within the Commonwealth and how they have changed so far.

Health Disparity Rate Ratios

Rate ratios are used to quantify disparity. A rate ratio compares the rate of events in different groups to a reference group and expresses it as a simple ratio. A previous blog post, Health Disparity Rate Ratios, goes into greater detail about them. In general, higher rate ratios mean higher rates within one group compared to the reference group. 

March 2020 – September 2020

During the spring and summer of 2020, cases surged across the United States and disparities were more pronounced than at any other point in the pandemic. The 7-day moving average of cases in Virginia hovered around 1,000 during this time. Latino people were most impacted initially; they were more likely to get COVID-19, and subsequently die from it, compared to any other group in Virginia, with case rates consistently at least five times the rate of White people. Black people also had case and death rates that were twice as high as White people. 

Some of the early disparities in cases likely stemmed from outbreaks among front-line and essential workers, particularly those in the meat and poultry industry. Lessons learned from these early outbreaks helped to inform future responses and outreach. For example, one investigation into outbreaks in Chesterfield County and Richmond City identified lack of accessible health information in Spanish, lack of insurance and paid sick leave, and employment in frontline industries as risk factors for COVID-19 in Latino communities. Public health officials and policy-makers responded with strategies to address these disparities.

 

October 2020 – February 2021

In the fall of 2020 and winter of 2020-2021, the number of cases in Virginia reached new highs while racial and ethnic disparities began to decline. The 7-day moving average of cases rose from around 1,000 in October to over 5,000, and remained above 3,000 through February. This was the highest peak in cases during the pandemic so far.

During the peak, Latino people still had a case rate of about four times that of White people, but by January 2021, that number dropped to 2.2.

A similar trend can be seen for Black people, decreasing from 1.9 times that of White people to around 1.4 times. Asian or Pacific Islander people remained near or below the cumulative case rate of White people throughout the pandemic. 

 

March 2021 – August 2021

Disparity in COVID-19 case and death rates changed significantly after March 2021, when 21% of people in Virginia had received at least one dose of vaccine and cases briefly dipped to lower  levels. In June, the 7-day moving average was as low as 145, though it quickly returned to over 3,000. Now, with varying levels of vaccine uptake among racial and ethnic groups, COVID-19 disparities have shifted.

The current COVID-19 vaccines have been proven to be effective at preventing infection, severe illness, and death from COVID-19; they are the most important preventive measure to reduce the impact of the virus on individuals and communities. The extent to which racial and ethnic minorities are vaccinated has likely affected case and death rate disparities in Virginia.

 

 

Asian and Pacific Islander people have a higher overall vaccination rate, around 1.3 times that of White people. Additionally, Latino people are now the second most vaccinated group, while White and Black people are less likely to be vaccinated. 

Monthly rate ratios are better at indicating the direction of disparities, or current trend, than cumulative rate ratios. The following graph of monthly death rate ratios depicts a new trend from March 2021 onward, where case and death rate ratios for Latino people have better parity. Latino people had the highest death rates early in the pandemic.

 

 

Vaccine hesitancy is a significant barrier to decreasing death rates for all groups in Virginia, and is a particular issue among Black communities. Further research is needed to fully understand the impact, but the extent to which different racial and ethnic groups in Virginia are getting vaccinated is likely affecting death rates from COVID-19. Trends in COVID-19 case and death rate disparities are likely to change as more people get vaccinated. The Virginia Department of Health updates rate ratios monthly on its COVID-19 Cases & Testing Dashboards to maintain its commitment to transparently tracking COVID-19 disparities in the Commonwealth. 

 

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* The impact of the Delta variant cannot be fully presented due to the lack of data points since July when it became the major variant.

*American Indian and Alaska Natives were not included in this analysis due to the small size of that population.

References

  1. Webb Hooper M, Nápoles AM, Pérez-Stable EJ. COVID-19 and Racial/Ethnic Disparities. JAMA. 2020;323(24):2466–2467. doi:10.1001/jama.2020.8598

UVA COVID-19 Modeling Weekly Update

Key Takeaways

  • The cadence of COVID-19 modeling projections has been reduced to bi-weekly. This is an abbreviated interim report.
  • Statewide community transmission rates remains “High” with over 100 weekly cases per 100,000 residents.
  • Case rates continue to decline, but this trend appears to be slowing. Four health districts are now experiencing slow growth, six others have recently plateaued, and the statewide Re is slowly climbing.
  • Models continue to forecast a decline in cases. But they also suggest the possibility of another surge if winter weather and travel increase transmission rates to match those of Winter 2020.
  • Stay safe during the holidays by following CDC guidance.

Weekly Modeling Report.

UVA COVID-19 Model Dashboard.

COVID-19 Attack Rates by Vaccination Status and Age

COVID-19 vaccinations are preventing severe illness and deaths among Virginians who have received their shots. At the same time, the highly contagious Delta variant has become the main strain of the virus in Virginia and the United States. Many factors affect the direction the pandemic takes, including new variants that emerge and their effect on vaccine effectiveness, vaccination rates, seasonal changes, and the acceptance and use of other mitigation strategies, like physical distancing and community masking. Some factors reduce the spread of the virus, while others increase it. As these factors interact, trends in how the virus spreads and who is most affected can change as well. 

Most recently, there has been a shift in health outcomes by age group. COVID-19 causes more severe disease in older age groups. Fortunately, high rates of vaccination among Virginians 65 and older means a reduced risk of severe COVID-19 disease. However, hospitalization rates are now increasing in younger age groups that have lower vaccination rates.  83% of those 65+ have been vaccinated, compared to 18% of those under the age of 18.  The upward trend in hospitalizations among younger age groups can be observed in figure 1.1 below:

Figure 1.1 – Monthly Hospitalization Rate Ratios by Age Group

Rate ratios are used in epidemiology to compare the severity of disease across different groups. They take into account differences in the groups’ characteristics, such as age. Rate ratios are calculated as follows:

Rate per age group = (number of monthly hospitalizations / population) * 100,000

Rate ratio per age group =  rate for age group / overall rate

In the beginning of January 2021, the rate ratios for people 19 years and younger were very low. The older the age group, the higher the rate ratio of hospitalizations. Recently, the rate ratio for people ages 0-9 and 10-19 has changed and it is now increasing. Young people are being hospitalized at a higher rate than they were earlier in the pandemic.

Attack rates can also help us understand the degree to which different age groups are protected from the virus. A recent blog post on Vaccine Effectiveness outlines the methodology for this and what attack rates mean.  

In Virginia, COVID-19 attack rates among unvaccinated people are much higher than for vaccinated people. It is also important to note that some breakthrough cases are expected, as no vaccine is one hundred percent effective. Vaccinated people are experiencing COVID-19 attack rates in the low thousands per 100k, while unvaccinated people, and especially people in older age groups, have attack rates of twenty to thirty thousand per 100,000 persons.

                          Figure 1.2 – Attack Rates by Vaccination Status1,2              Figure 1.3 – Attack Rates by Case Vaccination Status Table

Further research is needed to study the impact of COVID-19 on younger age groups. However, recent studies have shown that COVID-19 vaccination prevents severe health outcomes such as hospitalization and death.  Getting vaccinated reduces the risk for everyone and protects children who are not yet eligible for the vaccine.

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  1. The number of unvaccinated people is overestimated due to the exclusion of federal doses and lack of interstate data on vaccine administration.
  2. This data is preliminary and subject to change.
  3. Vaccine effectiveness figures were updated 19/10/2021 due to an error, with no impact on content or analysis.