‘Sicker and younger’: Unvaccinated people are driving a new hospitalization trend in Alaska’s COVID-19 wave

Alaska’s latest and still growing COVID-19 wave involves a jarring new trend: younger hospital patients, at times sicker than the older people who needed medical care last year.

Last winter, as the peak of the coronavirus pandemic ripped through the state, the infected patients seen by Dr. Nick Papacostas in his Anchorage emergency room tended to be older, in their 70s and 80s.

Now the highly contagious delta variant of COVID-19 is driving up case counts around the country and in Alaska, where as of Friday barely 44% of the total population was fully vaccinated.

And now Papacostas is seeing people in their 40s, 50s and 60s with more serious respiratory problems, who need additional oxygen or even mechanical ventilation, he said. None are vaccinated.

“They’re sicker and younger than we were seeing last year, requiring either hospital admission or ICU admission,” said Papacostas, Alaska chapter president of the American College of Emergency Physicians. “They’re really more intensive to care for, because they’re more ill.”

The state reported two new deaths in people with COVID-19 on Friday, both Anchorage residents. One was a woman in her 50s. One was a man in his 40s.

A spike in patients under 50

COVID-19 patients between 35 and 50 are showing up at the ER in greater numbers, getting admitted, and needing more complicated care, hospital and health officials say. Even those who aren’t staying for long run the risk of complications like prolonged breathing difficulties or heart problems.

“What we are seeing is hospitalizations are increasing in younger people, not only in Alaska but nationally,” state epidemiologist Dr. Joe McLaughlin said at a Thursday media briefing. “This probably has a lot to do with the fact that younger people in general tend to be less vaccinated.”

In July, 36% of people hospitalized in Alaska with COVID-19 are under 50, compared to 23% in November, according to the Alaska Department of Health and Social Services. People under 40 make up a quarter of patients, compared to 14% last year.

During last November’s statewide surge in cases, the average age of someone hospitalized was 63, according to Dr. Anne Zink, the state’s chief medical officer. Now it’s 56.

Zink offered one theory about the hospital trend at a science briefing Wednesday: a young person with more stamina may wait longer before seeking medical care. By then, their case is more advanced. She also wondered if such patients are aware of monoclonal antibody treatments that can minimize hospitalizations.

“Overall, our older population is more vaccinated than our younger population,” Zink said. “Younger bodies can usually fight longer.”

Most new cases in Alaskans under 60

State data shows Alaskans in their 20s and 30s continue to hold the top spot in terms of new cases. That corresponds with vaccination trends, health officials say: people who choose to get vaccinated tend to be older and more medically vulnerable, while younger residents are holding off.

Nearly 72% of Alaskans 65 and older are fully vaccinated. Since the pandemic started, people 60 and up make up 84% of the state’s 382 deaths in residents reported as of Friday.

Based on a seven-day average of daily new cases, people under 60 accounted for about three-quarters of the new infections, state data shows. Just over 30% were people between 20 and 39 and 21% were 40 to 59.

Cases in children are also rising, partly because there’s more testing in that age group but also because vaccination isn’t yet available for people under 12, according to state health officials. There have been just 17 children hospitalized with COVID-19 since March 2020, though some were sick enough to require intubation.

‘Flat-lined’ rates

Overall, vaccination rates in Alaska have stalled even with the rising case counts.

State data shows just under 1,000 daily doses per day in June and July, with “little blips” on weekends when more people have time to get shots, according to Matt Bobo, state immunization program director.

“That trend is pretty much flat-lined now,” Bobo said at a briefing this week.

Some communities are seeing local increases, however, like Sitka where there’s a large COVID-19 outbreak that started after the Fourth of July. At the start of the week, half of the 18 patients at the 25-bed Mt. Edgecumbe Medical Center had COVID-19, hospital officials said at a recent press conference.

Three quarters of the new cases in Sitka over a two-week period involved people under 50.

“Cases in the community, and in the hospital, are a younger demographic than it was last fall,” said Dr. Elliot Bruhl, chief medical officer for Southeast Alaska Regional Health Consortium. “Maybe that follows from the fact this is the group that’s the least vaccinated in the country.”

Delta’s role

It’s possible the delta variant is one reason medical providers are seeing sicker patients, they say, but it’s too early to know for sure.

Internal research from the Centers for Disease Control obtained by news organizations this week indicates the variant causes more severe illness and spreads as easily as chickenpox.

The delta variant brings another new wrinkle: infected vaccinated people may transmit the virus as readily as those who aren’t immunized. Those findings helped prompt a new CDC recommendation this week that all people, included vaccinated ones, mask up in indoor public spaces in parts of the country with high COVID-19 transmission levels. That includes all of Alaska, though some individual communities have lower spread.

[State encourages vaccinated Alaskans in places with high rates of COVID-19 transmission to mask up again]

Papacostas, with the American College of Emergency Physicians, wonders if the delta variant may be the cause of the more dangerous infections in patients he’s seeing, though that’s just speculation at this point.

“It seems like it’s more efficient at making more copies of itself,” he said. “Maybe their viral load makes more severe illness? I feel like that’s the only way to explain it.”

‘Devastating’

Vaccinated people can spread the virus, growing indications are showing. Two recent outbreaks in Juneau and the Yukon-Kuskokwim Delta region included cases in vaccinated people, a third and a quarter of the total, respectively. In both places, vaccinated people reported milder symptoms.

But vaccinated people rarely require critical care in hospitals, doctors say, so they’re not adding pressure to a health-care system operating at or near capacity, especially in Southcentral.

To date in Alaska, unvaccinated people account for 94% of all COVID-19 cases, 94% of all hospitalizations, and 97% of all deaths, according to a weekly state update.

Hospital administrators are urging broader vaccination amid what they say is a pending health-care capacity crisis exacerbated by rising COVID-19 numbers.

Hospitals are busy with the usual summer rush of Alaskans injured outside, visitors back in the state after the pandemic delayed travel plans -- and “for sure” COVID-19 cases, Dr. Lisa Rabinowitz, a staff physician with the state health department who worked some ER shifts last week, said during a briefing.

“It’s devastating as a provider to watch patients come in the emergency department when we know we have vaccines available,” Rabinowitz said.

Correction: An earlier version of this story used the wrong first name for Dr. Nick Papacostas.