EVANSVILLE — Lacey Poag didn't just shake her head in sadness at a recent Courier & Press report that a 33-year-old Vanderburgh County man had died of COVID-19.
It broke her heart just a little bit more.
Poag knows the pain of having a loved one wrenched out of her life too soon by the virus. Her little brother, Cody Whobrey, was the same age when he died unexpectedly of the coronavirus early in the pandemic. Whobrey, a Warrick County resident, left behind a 7-year-old son.
"As much as I miss Cody and ache for my own loss and my family's, my mother — we're still struggling terribly every single day," she said.
It's been 17 months since her brother died after complaining of fatigue and lying down to take a nap, Poag said, and people in the prime of their lives are still dying of this thing. Still dying, even though Indiana residents over 30 — Cody's age group — became eligible for vaccination nearly six months ago.
Younger coronavirus victims have been getting sicker than other patients too and spending more time in the hospital, local doctors say. It's the nature of the Delta variant.
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"Last week I had six patients on my rounding list who were all under age 50, all very sick with COVID," said Dr. Jessica Mendel, an Evansville-based M.D. "We usually round on about 20 patients each, and it used to be rare to have more than one or two who were under 60.
"Definitely, much younger people are dying or leaving the hospitals with disabling lung disease and other issues after long stays, 14-plus days."
Those younger hospital patients who die of COVID-19 typically take longer to do it, Mendel said.
"They have more reserves. Stronger. But not strong enough in the long run," she said. "The only time that is not the case is when they have massive stroke or blood clot in the lungs. Then they die sooner."
People under 60 are a much bigger proportion of recent coronavirus deaths in Vanderburgh County and Henderson County, Kentucky, than they were in COVID-19's first iteration. Since Delta emerged in Vanderburgh County in June, the county has lost residents who were 33, 40 and 46 and five who were in their 50s. A 37-year-old Henderson County resident has died along with four people in their 50s.
There is a suggestion in weekly case data that the August surge might be starting to wane, as Vanderburgh County reported about 150 fewer cases in September's first week than it did the week before. It was still more than 1,000 cases.
Deaconess Health System reported on Sept. 1 it had 179 COVID-positive hospitalized patients. The number was 159 as of Monday.
There is no guarantee these nascent trends will continue, and some reason to believe the surge is doing as much damage as ever. The Vanderburgh County Board of Health put out a "call to action" Monday pleading for help corralling the coronavirus and stating that overall "local hospitalization numbers for COVID patients are the highest they have ever been."
Several things happened at once as the nexus of the battle against COVID-19 shifted from older to younger patients. The more contagious Delta variant, its mutations and vaccine hesitancy among younger residents are at the heart of it all.
Vaccines changed the complexion of the area's COVID problem
In a Thursday Facebook post that has been shared 339 times, Evansville critical care Dr. Jessica Jeffries lamented the reliance of some individuals on iffy medications and vitamins in lieu of vaccination. Those people became patients, Jeffries wrote, using capital letters to pound home her point.
"And they’re here. Dying. Young otherwise healthy people in the 20s (TWENTIES!!!) 30s (THIRTIES!!!) and 40s (FORTIES!!!), that should have their whole lives ahead of them," she wrote.
"And EVERY ONE OF THESE YOUNG PEOPLE IS UNVACCINATED."
The Vanderburgh County Board of Health's Monday call to action included a raft of statistics putting the vaccination rates of local adolescents 12 and older and people in their 20s at no higher than 5.5%.
To fully understand how differing conceptions about vulnerability and vaccines led this community to this point, you have to go back to the first week of December.
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It was the first week Vanderburgh County registered more than 1,000 coronavirus cases. The county was in the midst of a two-month run of coronavirus-related deaths that would see 176 residents die — 91% of them 60 or older. That first week, that age group accounted for 21% of the county's coronavirus cases and 88% of its deaths.
But vaccines became available to elderly residents in stages throughout January and February — and Vanderburgh County's total of cases dropped each week save for a modest resurgence in March and April.
By the time the Delta-fueled COVID-19 surge roared like a wildfire through the country in July and August, close to 80% of Vanderburgh County residents 60 and older had been vaccinated. Their share of local cases was several percentage points lower than it was in the dark, pre-vaccination days of winter.
COVID-19 deaths among older residents have dropped so far by now that the eight Vanderburgh County and five Henderson County residents under 60 who died since Delta appeared are nearly one-third and nearly two-thirds of the totals, respectively.
Delta preys on the groups that are left to prey on, health expert says
Correlations between vaccine hesitancy, youth and the nature of the Delta variant help explain what's happening, said Dr. Payal Patel-Dovlatabadi, an associate professor of public health at the University of Evansville.
With most elderly local residents vaccinated, Patel-Dovlatabadi said, the virus preys on the groups that are left to prey on — people with other health issues and the unvaccinated. Local hospitals say almost every COVID-19 patient in their ICUs and on ventilators is unvaccinated.
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And that correlates with younger age groups. Even with the nearly 80% of older Vanderburgh County residents who have been vaccinated, the county's overall rate of vaccination is still just 57% of those eligible.
"(Delta is) just really going more straight to the lungs. Symptoms are a little different. It's just the way that virus has mutated," Patel-Dovlatabadi said. "It’s just going after those under 60 and those who may have other comorbidities."
While some of the area's unvaccinated residents may have evaded the virus in its earlier incarnations, Delta's greater infectiousness and transmissibility have proven too much.
"Some data suggest the Delta variant might cause more severe illness than previous variants in unvaccinated people," the CDC said in a recent statement. "In two different studies from Canada and Scotland, patients infected with the Delta variant were more likely to be hospitalized than patients infected with Alpha or the original virus that causes COVID-19.
"Even so, the vast majority of hospitalization and death caused by COVID-19 are in unvaccinated people."
For weeks Deaconess has been publicizing internal data that makes that point with penetrating clarity.
As of Monday, the local health system reported on Facebook that it has 159 COVID-positive hospitalized patients – 87% of whom are "not vaccinated." There were 50 infected patients in the ICU, Deaconess reported. All but three were unvaccinated.
Thirty-six coronavirus patients were on ventilators, the local health system reported — 33 of them unvaccinated.
The numbers include all Deaconess hospitals and The Women's Hospital. Ascension St. Vincent Evansville hasn't released patient vaccination data, but it said Friday that anecdotally it knows the data would show the same trend.
On Monday, the Vanderburgh County Board of Health produced a statistic meant to be comprehensive: Of 1,288 total hospital admissions between August 1 and August 22, 98.6% of patients were not vaccinated.
'Those who got that sick were so scared and shocked'
Mendel estimates she has treated about 100 COVID-19 patients since December, almost all of whom pleaded to be vaccinated before they left the hospital.
"Those who got that sick were so scared and shocked. A lot of them were basically healthy. No definite reason for serious illness from COVID," she said. "Some day we might know why they got that sick, but we don't know who will and who won't."
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Since the death of her brother, Lacey Poag has become an evangelist for masks and vaccination. She's talked to lots of people who thought they or their loved ones were too young and healthy to be seriously affected by COVID-19.
One conversation stopped her in her tracks, making her realize how much more she still has to do.
"Someone last week, somebody that hadn't seen me in years, asked me, 'What did your brother pass from?'" she said. "I told them and they said, 'Oh, I didn't think that was a real thing.'"