December 15, 2022 — More than 3,500 Americans died from long-term COVID in the early years of the pandemic, a new CDC report reveals. Men, people over 75, and Native American/Alaskan Indian populations were at the highest risk of death.
The CDC study is “certainly very sobering,” says William Schaffner, MD, professor of medicine in the Department of Infectious Diseases at Vanderbilt University School of Medicine in Nashville.
The new information shows long COVID is more serious than many people previously thought, he says. “We know that long COVID is very common and causes a lot of distress to many patients. Fortunately, many of these patients improve over time.”
However, “we now see from the CDC report that actually some people are going to die,” says Schaffner, who is also medical director of the National Foundation for Infectious Diseases.
Researchers at the CDC’s Center for Health Statistics examined death certificates that mentioned long-term COVID (or chronic COVID, long-range COVID, post-COVID syndrome, and others) as a cause of death or a contributing factor. They matched these certificates to medical records with a code related to COVID-19.
They identified 3,544 Americans who died from long-term COVID from January 1, 2020 to June 30, 2022. This group is a fraction of the 1.02 million people who have died from COVID-19 during that time. Their results will be published in December 2022 CDC Vital Statistics Rapid Release Report.
“I find the study fascinating and interesting. It brings perspective to the aftermath of COVID, even after we no longer focus on the acute infection itself,” said Thomas Gut, DO, associate chair of medicine and medical director of the Post-COVID Recovery Center at Staten Island University Hospital in New York city.
It’s still early, he says. “This is just the tip of the iceberg… for the long-term consequences that lie ahead.”
In terms of the 3,500 deaths, “I think that’s a low number overall,” says Gut. “Probably many more people died. We probably missed a lot of long COVID early on without even knowing it was it.”
It’s unlikely that death certificates earlier in the pandemic would list acute COVID infection as the cause of death 3 to 6 months later, Gut says. In the future this could change. Long COVID is a chronic condition, so it’s more likely to be listed on a death certificate.
Some with higher risk
More than half of long-COVID-related deaths, 57%, occurred in people aged 75 and older. Also, men accounted for 51.5% of long COVID deaths.
Additionally, 79% of long COVID deaths were non-Hispanic whites, followed by 10% non-Hispanic blacks and about 8% Hispanics.
Although non-Hispanic American Indians/Alaska Natives experienced less than 2% of all long COVID deaths in the study, they emerged as a high-risk group in a separate analysis. Their age-adjusted death rate for long COVID was the highest at 14.8 deaths per 1 million people. In contrast, non-Hispanic Asians had the lowest age-adjusted mortality rate at 1.5 per 1 million.
Minority groups, such as American Indians and Alaska Natives, “were disproportionately affected by the virus from the beginning of the pandemic — and were also among the harder to reach and access the vaccine,” says Schaffner.
This report shows that efforts to reach these underserved communities remain essential, he says. “We have to keep doing this — and if we needed one more reason to do it, here it is.”
The CDC researchers suggest a murky reason why the study didn’t find higher death rates from long COVID in non-Hispanic blacks and Hispanics, even though these groups have higher COVID-19 death rates: lots of COVID-19 patients in these groups likely died of their original illness before they could develop a long COVID.
Some Study Restrictions
Although the medical community continues to learn and recognize the burden of long COVID and healthcare professionals are using the term more frequently, there are many differences as we still do not have a consistent diagnosis of this disease.
“The fact that the number of long-labelled COVID-19 deaths has increased over time may be the result of greater awareness in the medical community and therefore make it very difficult to draw specific conclusions from this study,” says Fidaa Shaib, MD, to Associate Professor of Medicine in the Department of Pulmonary, Critical Care and Sleep Medicine and Director of the Post COVID Care Clinic at Baylor College of Medicine in Houston.
Although the study found more deaths among males, “our experience and the experience of others have shown that PASC [post-acute sequelae of COVID] or long COVID patients are predominantly middle-aged women.”
Shaib points out some limitations of the study. Some causes of long COVID deaths could be due to other conditions – like heart disease – that increase the risk of death from acute COVID-19 itself. In addition, the data did not include information about the time span from initial COVID-19 illness to time of death. “As such, the PASC/long COVID diagnosis may not be very accurate.”
“Overall, this study is a good start to draw more attention to the severity of acute and protracted COVID illnesses,” says Shaib, “but more specific data are needed.”
“Keeping the Pedal to the Metal”
Avoiding COVID-19 in the first place remains the best protection against long-lived COVID, Schaffner says. Like many public health officials, he stressed the importance of staying up to date on COVID vaccinations as it is the most effective strategy.
“As a population, the United States has really underutilized the freely available — and actually quite effective — boosters that are now available,” according to the latest CDC estimates 13.5% of Americans 5 years and older have received an updated booster dose.
For that reason, “we really have to step on the gas and try to get the message across,” says Schaffner.
“This holiday season, the best gift you can give yourself and members of your family, loved ones and friends is to get the booster – and bring some of them when you get the vaccine so they can get the booster too.” .”