Metrics tell story of second year with virus
Vaccine rollout longer than expected
Maryland was supposed to put the coronavirus pandemic behind it last year.
The turn of the calendar to 2021 brought hope. Vaccines, the first doses having been administered to health care workers at the end of 2020, were to be made available promptly to the rest of the public.
Soon enough, they were. However, the vaccine rollout took longer than many hoped. And even when the inoculations were widely offered, some residents were hesitant to get theirs. By year’s end, approximately 70% of the state’s population had completed a two-dose vaccine course or received the singleshot inoculation.
As the virus evolved into more contagious variants, scientists realized another dose was necessary to fully protect against serious illness, hospitalization and death. A smaller proportion of Maryland’s population, about 26%, had received a booster dose by the end of 2021.
Even with the protection of vaccines and more effective ways to treat those who fall ill with COVID-19, Maryland found itself closing out 2021 much as it did 2020: setting records for cases and hospitalizations and looking ahead to what’s projected to be a winter marred by a virus surging at an unprecedented level.
“The big picture is that we’re better at treating this disease; we have more tools,” said Dr. Chris Beyrer, a public health researcher at the Johns Hopkins Bloomberg School of Public Health. “But unfortunately, what we’re seeing is that first of all is that the virus is changing … delta and omicron both were not circulating January of last year.”
Here’s a look at some of the statistics from 2021, and what they show about the second year of the pandemic in Maryland.
Cases and deaths
There were nearly twice as many coronavirus cases in Maryland in 2021 than 2020, according to health department data.
Yet preliminary data from the health department suggests a few hundred fewer Marylanders died of COVID-19 during 2021 than during 2020, when, according to the most recent data available, about 6,100 perished.
At the end of 2020, there was
about one reported death for every 50 reported cases. For deaths and cases reported during 2021, it was about one for every 80.
Beyrer and Neil Sehgal, an assistant professor at the University of Maryland School of Public Health, say that is because the vaccines are doing their jobs.
“What we’ve seen in 2021 is a decoupling of cases from hospitalization and death — but only at the population level,” Sehgal said. “If you are unvaccinated, your risk for serious illness, hospitalization and death hasn’t markedly changed.”
Still, enough people died of COVID-19 in 2021 to make it the third-leading cause of death in the state once again — behind only heart disease and cancer, when compared with historical data.
According to the U.S. Centers for Disease Control and Prevention, there were 4,200 excess deaths in Maryland in 2021 through mid-November, before the damaging COVID-19 surge that killed hundreds as the year drew to a close. In 2020, there were 7,400 excess deaths — the difference between observed death numbers and expected death numbers, calculated based on historical averages.
Just as in 2020, the majority of Marylanders whose COVID-19 deaths were reported in 2021 were older adults. As of Dec. 4, when the data was last updated, those 70 and older made up 62% of all deaths from coronavirus in the state.
January was by far the year’s deadliest month, with more than 1,000 COVID-19-related deaths reported. That month, one Marylander was dying from COVID-19 roughly every 36 minutes. By comparison, in July, 82 people died from COVID-19. But the number of deaths caused by the virus rose again in the fall and winter, and more than 500 people died from the virus in December.
Hospitalizations
Maryland began 2021 amid a then-record-setting surge of coronavirus hospitalizations that began December 2020.
Health department data shows hospitalizations decreased from a peak of approximately 1,950 patients in mid-January to about 765 the second week of March. April saw hospitalizations climb back up to over 1,000 patients before dropping off significantly over the summer.
Come Thanksgiving, hospitalizations were on the rise again. By Christmas, the data shows, they’d tripled.
Between Christmas and New Year’s, more hospital beds were occupied than ever before during the pandemic, eclipsing 2,000 COVID-19 patients for the first time. Approximately 75% of COVID-19 patients were not vaccinated, according to the state.
By then, hospitals knew better how to treat COVID19 patients. But Maryland hospitals are facing a new challenge during this surge: The health care industry experienced an exodus of doctors, nurses and other staff after last winter’s pandemic peaks, leaving fewer professionals to care for Maryland’s ill.
“The average hospitalized person’s prognosis is much better today than it was in 2020 because clinicians have a better understanding for how to treat a person with COVID-19 and there are more therapeutics available to them,” Sehgal said. “Unfortunately, it gets challenging to adequately care for any patient as our hospitals fill.”
Surges happened around holidays, during winter
Cases, hospitalizations and deaths began trending upward in 2020 and 2021 as the weather got colder and spiked after the winter holidays brought people together indoors.
“This is so much an indoor virus, and outdoor activities are so much safer,” Beyrer said. “But when people are indoors, places where they’re not with family, they’re not with people whose vaccine status they know, they should definitely be masked.”
If there are any key differences between 2021-22 s winter surge and the one a year prior, it’s that the coronavirus is spreading far faster this time around with omicron.
“Twenty-nine years I’ve been doing infectious disease epidemiology, I’ve never seen an infection curve like that,” Beyrer said of the omicron-fueled surge. “I said to people when I saw it, ‘It looks like a rocket trajectory, not an infection curve.’ ”
Sehgal said the omicron “tidal wave” has been exacerbated by the fact that the state has gone for a sickness mitigation, promoting vaccines, rather than transmission prevention strategy, like mandating masks indoors and distancing. Absent a statewide policy, some jurisdictions including Baltimore City and Anne Arundel, Baltimore, Howard, Montgomery and Prince George’s counties opted to reinstate or maintain indoor mask mandates.
Geography
Rural counties logged the highest death rates per capita in 2020 and 2021.
Allegany, Garrett and Kent counties, among the state’s least populous, had the most deaths per 10,000 residents in 2020.
Dorchester County, which is on the Eastern Shore, logged the highest death rate per capita in 2021 with 19.7 per 10,000 residents. Allegany and Washington counties, both in Western Maryland, were not far behind with 17.8 and 17.2 deaths per 10,000 residents, respectively.
As of Dec. 31, Allegany had the fourth smallest percentage of its population fully vaccinated — either by completing a two-dose inoculation course or getting Johnson & Johnson’s single-shot vaccine — at 53.4%. Dorchester and Washington counties were not far ahead, both with about 55% of their populations fully vaccinated.
Demographics
At the outset, nonwhite communities were hit hardest by the pandemic, making up shares of cases and deaths greater than their proportions of the population.
People of color are more likely to work essential jobs, those where one can’t telecommute, and to live in multigenerational households, according Beyrer and Sehgal, placing them at higher risk of contracting the virus, and perhaps spreading it to an older relative.
“Privilege is highly protective in the middle of a pandemic,” Sehgal said.
In 2020, Hispanic Marylanders had the highest case rate per 100,000 people, and in 2021 Black Marylanders did. At 8,652 cases per 100,000 people, they were far more likely to get infected than any other racial group.
In 2020, Black Marylanders had the highest death rate from COVID-19 of any racial group, but in 2021, white Marylanders had the worst outcomes, with 102 deaths per 100,000 people.
After the first four months of vaccinations, when only older adults, essential workers, those with certain health vulnerabilities and people living in congregate settings were eligible, over a third of white residents had been fully vaccinated compared with about one in five Black residents and about one in nine Hispanic Marylanders, based on 2020 Census population counts.
Over the next month, when shots opened up to all Marylanders 16 or older, mass vaccination sites were in full swing, and the state ramped up its equity strategy, the pace of shots increased for everyone. Uptake for Black residents and especially for Hispanic residents, though, accelerated faster than that for white residents.
By year’s end, the gap had narrowed moderately for Black residents and more substantially for Hispanic residents. On Dec. 31, almost three quarters of white residents were fully vaccinated while the rates for Black residents and Hispanic residents were each below 60%.
Much of the early gap for Maryland’s Hispanic population, and some that remains, can be attributed to the fact that it skews younger than other groups. According to 2020 Census Bureau estimates, almost a quarter of Hispanic residents are under the age of 12, none of who were eligible to be vaccinated until shots opened up to 12- to 15-year-olds in mid-May.
What was once racial and ethnic disparity has turned political, Beyrer said. A December NPR study found that people living in counties that voted heavily for Republican President Donald Trump during the last presidential election were about three times more likely to die from COVID-19 as people living in areas that broke for Democratic President Joe Biden. Those counties had lower vaccination rates.
There’s no question that the politicization of COVID, the politicization of the COVID vaccines, particularly among subgroups like white evangelical Christians, have really exposed that community to lower vaccine coverage and higher rates of COVID,” Beyrer said. “And with the infectivity of omicron and delta, those communities remain highly vulnerable.”