As Illinois hospitalizations swell with COVID-19 patients and case numbers reach record highs, Cook County has entered a bleak third wave of deaths caused by the virus — even though vaccines have been widely available since last spring.
The weekly death toll as of Jan. 9 climbed to almost 400 — a nearly four-fold increase since the highly contagious omicron variant arrived a month earlier, according to a WBEZ analysis of data from the Cook County medical examiner’s office.
It’s the highest weekly number of deaths since December 2020, when vaccines had just arrived and were restricted to certain groups of people.
Largely unvaccinated patients infected with COVID-19 have been pummeling hospitals, exhausting the health care providers who treat them day after day after day.
“People are coming to the hospital with chest pain, with heart failure, with no immune system from active chemotherapy. And now we’re taking care of COVID-19 patients at the same time,” said Dr. Michael Alebich at John H. Stroger Jr. Hospital on the Near West Side. “We didn’t have to be like this, and yet we are.”
Many health experts say they aren’t surprised the death toll is so high. The sheer volume of COVID-19 circulating in communities across Illinois means there’s bound to be more hospitalizations, and ultimately deaths.
“It’s a numbers game, right?” asked Dr. Sadiya Khan, an assistant professor with Northwestern University who studies the novel coronavirus. “If we have a bigger pool of people, as we’re seeing with more and more cases than ever before, it’s unfortunately not surprising that the deaths are going to be higher.”
Health experts say there are likely many factors fueling deaths. For one, unvaccinated people have shown to get sicker from the virus than vaccinated people, and there are still a lot of people who aren’t vaccinated. Across Illinois, just under 70% of residents who are eligible for shots are fully vaccinated, according to the state public health department. Drill down to the community level, and vaccination rates vary widely. There are entire suburbs in Cook County where fewer than half of all residents are fully vaccinated.
For people who are immunocompromised, such as transplant recipients or those who are getting cancer treatment, the vaccine might not protect them as well.
And for elderly people who were among the first to be vaccinated in early 2021, immunity likely waned by the late summer or early fall, experts say. Perhaps they got boosters, but many may not have. And if they got those boosters months ago, that immunity may be less effective now, as omicron is contributing to record-setting numbers of infections.
There’s also this: The constant chatter that the omicron variant is mild, which could be prompting people to be less careful than they should be.
“Mild makes it sound like this is not a big deal,” Khan said.
While many people don’t get very sick if they are infected with omicron, it’s very contagious — infecting even people who are boosted — and can spread to those who are at risk of severe illness. This week, there were more people hospitalized across Illinois with COVID-19 than at any other time during the pandemic, with more than 7,000 patients filling up beds.
Who is still dying of COVID-19
When the pandemic first hit in March 2020, COVID-19 killed Black residents in Chicago and in the suburbs at disproportionately higher rates.
In Chicago, Black residents are still bearing the brunt of COVID-19, but to a lesser degree, hovering around 51% of all deaths in January through the 12th, even though they make up about 30% of Chicago’s population.
Across Cook County, however, including Chicago and the suburbs, white residents make up the largest share of deaths, around 45% in January through the 12th. Black residents trailed white residents with 34% of deaths, yet they make up about only about one quarter of all residents in Cook County, U.S. Census data show.
“It’s similar to what we were seeing during the second wave” a year ago, said Cook County Medical Examiner Dr. Ponni Arunkumar.
The older population also continues to bear the brunt of the virus. Month after month, the virus has consistently killed those ages 60 and older the most, making up at one point 88% of deaths over the course of a month compared to other age groups. This age group did get a brief reprieve over the summer, when their percentage of deaths dropped to 61%, the lowest it had been during the pandemic. But then deaths started to rise again, and so far in January, this age group makes up around 83% of all COVID-19 deaths in Cook County.
Arunkumar attributed some of the increase in deaths among the elderly to the fact that many had not received booster shots of the vaccine. And their immune systems are already likely to be weaker compared to other age groups.
Statewide, only around 35% of people 65 and older have received booster shots, Illinois public health records show. In Chicago, that dips to about 25%.
Still, one long-known fact remains unchanged — unvaccinated people make up the bulk of deaths.
Arunkumar said the county doesn’t have complete medical records for everyone whose death they investigate, but for those they do have the vaccination status for, the majority of them were unvaccinated, or elderly and vaccinated but not boosted.
What it looks like on the ground
Dr. Lisa Green, a family physician who runs a group of clinics in the south suburbs for many low-income and uninsured Black residents, spends her days and nights tending to worried patients and their families, and encouraging them to get vaccinated and boosted. The south suburbs have some of the lowest vaccination rates in Cook County, though they used to be even lower.
One of her patients is sick with COVID-19 in a hospital intensive care unit, an otherwise healthy person in their early 60s who forgoed a vaccine despite multiple conversations with Green.
“Just did not trust it,” she recalled of her patient. “You always still question yourself. Could I have said something different? Could I have drawn it out a little bit differently?”
She’s not surprised so many Black residents in Cook County are still dying of COVID-19. She said there’s still plenty of fear and mistrust of vaccines, built up over generations of racism in medical care and disinvestment in Black communities. It’s not something that would disappear once vaccines arrived, she said.
But Green is optimistic. She sees this moment — the surge brought on by omicron — as an opportunity to educate more people about the vaccine, and to put them at ease. Green said her clinics have been particularly busy these last few weeks with patients who want to get tested for the coronavirus, or vaccinated against it.
“What we’re seeing now is a different level of fear, almost a PTSD from other family members who are coming in to get COVID tested because their brother, their sister, their cousin, died from COVID last year,” Green said.
“When you have deaths at the rate you have in our communities, along with everything else, I really think it’s getting people’s attention, even more than before for those who are not vaccinated,” she said
Dr. Alebich at Stroger, the biggest safety net by far in the region for low-income and uninsured people, said he plays the role of gatekeeper, treating patients who are too sick to go home, but not sick enough for the crowded intensive care unit. These days, he’s seeing eight to 10 patients a day. Six to seven of them have COVID-19. Of those, at least half are gravely ill.
While the numbers of patients are on par with what Alebich said he experienced during other surges, the context of this moment is different for him — because this surge is happening despite the wide availability of vaccines.
The patients who have COVID-19 and need oxygen to help them breathe? Unvaccinated, he said. Those under his watch who he says are probably not going to survive? Unvaccinated, he said.
“It’s just all those emotions. It’s frustrating. It’s sad. It’s angering, and it deflates you really. And I think at the end of it, it’s numbing,” Alebich said. “I was speaking with one of my ER colleagues who was working I think … six shifts in a row, which is almost unheard of, and it’s because people are sick and we both just acknowledged, we’re numb.”
At Sinai Health System, which treats mostly low-income Black and Latino patients on the West and Southwest sides of Chicago, doctors have actually seen a decline in the number of people dying of COVID-19 during the pandemic, even though the majority of infected patients at Sinai are unvaccinated.
When the pandemic first struck, some 28 people a week with COVID-19 at Sinai were dying, said system chief medical officer Dr. Russell Fiorella. Now, it’s around six to seven patients a week, while acknowledging that’s still many deaths. He credits the decrease in mortality to knowing much more about how to take care of people, having better treatments available, and that for the most part, people aren’t showing up to the hospital with lung infections so bad they need to be put on lifesaving ventilators to help them breathe.
“We have anybody that has the sniffles or a cough or a fever, they get rapid and/or PCR testing,” Fiorella said. “So we know early on in their disease that they have coronavirus.”
Where we’re headed
Dr. Ngozi Ezike, who runs the Illinois Department of Public Health, recently said she sees no sign that COVID-19 cases have reached their peak in the state.
But there are some hopeful outlooks. Dr. Rachel Rubin, who helps lead the Cook County Department of Public Health, said omicron is so contagious that people get sicker faster, but then they’re not sick for as long. That means in some cases shorter hospital stays. And in other places where omicron has surged, it’s rapidly declined, Rubin said.
Still, she and other health experts are bracing for hospitals to be slammed for the next several weeks, and for deaths to likely continue to climb. That’s because it can take two to four weeks for a person to wind up in the hospital with COVID-19 after testing positive, and cases are still so high.
Arunkumar — Cook County’s medical examiner — is preparing to potentially handle more deaths, and trying to keep morale up among her staff.
“We all thought this was coming to an end, and suddenly we see a spike again,” Arunkumar said. “It’s not that we are not able to do it. It’s just we have to do this again, right? How long is this going to go for?”
Kristen Schorsch covers public health and Cook County on WBEZ’s government and politics team. Alden Loury is senior editor for WBEZ’s Race, Class and communities team. Follow them @kschorsch @aldenloury.