Donald McAvoy was hospitalised with the Delta Covid variant in June. Photo / Donald McAvoy via The New York Times
Recently, a 28-year-old patient died of Covid-19 at CoxHealth Medical Center in Springfield, Missouri. Last week, a 21-year-old college student was admitted to intensive care.
Many of the patients with Covid-19 now arriving at the hospital are not just unvaccinated — they are much younger than 50, a stark departure from the frail, older patients seen when the pandemic first surged last year.
In Baton Rouge, Louisiana, young adults with none of the usual risk factors for severe forms of the disease — such as obesity or diabetes — are also arriving in ERs, desperately ill. It isn't clear why they are so sick.
Physicians working in Covid hot spots across the nation say that the patients in their hospitals are not like the patients they saw last year. Almost always unvaccinated, the new arrivals tend to be younger, many in their 20s or 30s. And they seem sicker than younger patients were last year, deteriorating more rapidly.
Doctors have coined a new phrase to describe them: "younger, sicker, quicker". Many physicians treating them suspect that the Delta variant of the coronavirus, which now accounts for more than 80 per cent of new infections in the United States, is playing a role.
Studies done in a handful of other countries suggest that the variant may cause more severe disease, but there is no definitive data showing that the new variant is somehow worse for young adults.
Some experts believe the shift in patient demographics is strictly a result of lower vaccination rates in this group.
As of Sunday, more than 80 per cent of Americans aged 65 to 74 were fully vaccinated, compared with fewer than half of those aged 18 to 39, according to figures from the Centers for Disease Control and Prevention.
The vaccines are powerfully effective against severe illness and death after infection with any variant of the virus, including Delta. A vast majority of hospitalised patients in the US — roughly 97 per cent — are unvaccinated.
"I don't think there's good evidence yet about whether it causes more severe disease," Dr Adam Ratner, associate professor of pediatrics and microbiology at the New York University Grossman School of Medicine, said of the Delta variant.
"This may be behavioural — a combination of the fact that we're opening things up, and in some places they're wide open and there are no masks, which is different from a year or 15, 16 months ago," he added.
But recently the Delta variant has offered up a series of unpleasant surprises to scientists, and questions about the variant's virulence and capacity to cause more severe disease are taking on new urgency.
An internal CDC document obtained last week by The New York Times described the Delta variant as being as contagious as chickenpox and said it "may cause more severe disease than Alpha or ancestral strains".
People aged 65 and over represented half of all hospitalised patients in the US at the end of January, while adults under 50 represented 22 per cent, according to the CDC.
Now, older people make up just over a quarter of hospitalised patients, while those aged 18 to 49 account for 41 per cent.
"Something about this virus is different in this age group," said Dr Catherine O'Neal, chief medical officer at Our Lady of the Lake Regional Medical Center in Baton Rouge.
"We always saw some people who we just said, 'Why the heck did this get them?' But that was rare. Now we're seeing it more commonly."
"I think it is a new Covid," she added.
Dr Cam Patterson, chancellor of the University of Arkansas for Medical Sciences, said the average age of patients admitted to UAMS Medical Center during the winter was 60; now, it's 40.
"Our sense is that younger, healthier people are more susceptible to the Delta variant than those that were circulating earlier," Patterson said.
The first Delta variant case was detected at the university hospital on May 1, and by June 17 almost all of the infections were caused by the variant.
"The transition we saw toward younger patients and toward people getting sick more quickly coincided almost precisely with the emergence of Delta here in Arkansas," Patterson said. "This to us feels like an entirely different disease."
Donald McAvoy, 33, a bodybuilder known as Frue who manages a gym in Jacksonville, Florida, didn't bother to get the Covid vaccine because he thought the virus affected only older people with health problems.
But toward the end of June, he had a runny nose, which he thought was a cold or allergies. His girlfriend insisted he get a coronavirus test. It was positive, and he was sent home with a small device called a pulse oximeter to monitor his blood oxygen levels.
Within days, his condition deteriorated, and he collapsed on the floor of the bedroom. His blood oxygen levels were at rock bottom: 56. A normal reading is 95 or higher.
At Baptist Medical Center Beaches, he was put on oxygen and admitted to the intensive care unit, where he spent 11 days, an ordeal that he described as "the scariest thing I ever went through, not only physically but mentally". His doctor told McAvoy that he had been infected with the Delta variant.
He was discharged July 8, tethered to an oxygen tank. He has lost 25 pounds (11kg), and has been warned it will take four to six weeks of rest and respiratory therapy before he can return to work. He fears it may be longer.
"This is much more of an equal-opportunity virus now," said Dr Angie Honsberg, director of the intensive care unit at University Medical Center in Las Vegas.
Earlier in the pandemic, patients would come into the hospital after spending a week or two at home with symptoms. Often they were treated on a regular floor for some time before needing intubation or intensive care.
Like McAvoy, her younger patients are getting sick much more quickly, Honsberg said. "My suspicion is that the Delta variant probably does behave somewhat differently," she said.
In Springfield, Dr Terrence Coulter, director of critical care at CoxHealth, a 500-bed hospital, said Covid-19 patients at the hospital were younger and sicker than they were in the previous wave.
"They thought in the first round that young patients and kids would get it and not even know they had it, or have mild disease," Coulter said. "With the Delta variant, it's not like that. It's much more severe, without a doubt, than the original variant."
Many patients being hospitalised have underlying health conditions like diabetes, obesity or high blood pressure that are risk factors for severe disease, he said. But some younger patients have none of those risk factors.
"That's what really frightens me," he said. "It's hitting younger healthy people that you wouldn't think would have such a bad response to the disease."
They often face prolonged recoveries, Coulter added, and some will have lasting lung damage.
In the United States, the Delta variant is a relatively new arrival, and evidence on whether and how it behaves differently is still accumulating. It is more contagious, experts agree. People who are infected may carry the variant in high amounts in their airways, a few studies have found.
The variant may also cause more severe disease, some researchers have suggested. A study in Scotland, which was published in The Lancet, examined Covid cases in the spring, when Delta became the dominant strain in that country.
Patients infected with the variant were at nearly twice the risk of being hospitalised, compared with those infected with the earlier Alpha variant. The patients also were younger, presumably because they were last in line to be vaccinated, the authors said.
In a preliminary study posted online and not yet peer-reviewed, Canadian researchers found the risk of being admitted to intensive care was nearly four times as high in patients with the Delta variant, compared with patients infected with other variants.
Patients with the Delta variant were at twice the risk of hospitalisation or death.
Research in Singapore, which is to be published in The Lancet, concluded that patients with the Delta variant faced higher odds of requiring oxygen, needing intensive care, or dying.
And a study in India, which was also posted online and not yet peer-reviewed, found that in the second wave of infection, when the Delta variant was dominant, patients faced a greater risk of dying, especially those under the age of 45.
But what appears to be greater virulence may be simply the result of the Delta variant's greater contagiousness, some experts say. As more people are infected, the sheer number of severely ill is bound to increase, even if the variant itself does not cause more severe disease than previous versions of the virus.
"I haven't seen evidence that Delta selectively is targeting kids and adolescents and young adults," said Dr Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine.
"My impression has been that this virus is so highly transmissible that anyone who is unvaccinated is getting swept up in this, and that includes young people."
Written by: Roni Caryn Rabin
Photographs by: Desiree Rios, Donad McAvoy
© 2021 THE NEW YORK TIMES
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