With the Omicron wave of COVID-19 sweeping the country, we previously calculated the number of people who were not up to date with vaccination in vulnerable areas as of June 2, 2022. Specifically, we looked at counties classified by the Centers for Disease Control and Prevention (CDC) has having “medium” or “high” COVID-19 community levels, signifying not only that new COVID cases were on the rise but also strains on hospital capacity. Since then, the BA.5 Omicron variant, which appears to be even more contagious and is able to evade prior immunity, has become dominant, driving up cases and hospitalizations even further.

Now, less than two months later, the share of the population living in medium or high community level counties and the number of people in those counties who are not up to date on vaccination have grown significantly; in addition, most who are not up to date are now living in counties with high community levels. We provide an update here, as of July 21, 2022.

Findings

  • The share of the U.S. population living in counties with medium or high COVID-19 community levels is 87% or 283 million people. This is up from 55% of the population (180 million people) in early June. Also, in contrast to early June, most people are living in high community level counties (61% of the total population now compared to 21% in early June).
  • The number of people not up to date on vaccination in vulnerable counties has jumped to 198 million, up from 120 million. This represents a 65% increase since June 2. Most of these individuals (139 million) live in counties with high community levels, representing an increase from just 46 million people in such counties in early June. The share of those not up to date on vaccination living in high level counties has also grown, from 20% in early June to 70% now.

  • Of the 198 million not up to date on vaccination in medium and high community level counties:
    • 73 million are unvaccinated, including 50.4 million living in counties with high COVID-19 community levels (up from 14 million in high level counties in early June).
    • 29.8 million are partially vaccinated, including 20.9 million who are in high level counties (up from 8 million).
    • 95.4 million are vaccinated but not yet boosted, including 67.7 million in high level counties (up from 25 million).

Most Americans are not up to date with their COVID-19 vaccines. As of July 21, 2022, 227.8 million Americans (70%) were unvaccinated, had not completed their primary series, or had not gotten a booster dose. In each state, at least half the population is not up to date on COVID-19 vaccines. In Alabama, North Carolina, and Virginia, over 80% of people are not yet up to date on COVID-19 vaccines.

Implications

In just a short time, with the spread of the latest COVID-19 Omicron variant, the number of people in the U.S. who are particularly vulnerable to the impacts of COVID-19, because they are not up to date on vaccination and live in vulnerable counties, has grown considerably, rising from 120 million in early June to 198 million now. Moreover, an even greater share of people now live in counties with high community levels. The most vulnerable among them – those who remain unvaccinated and live in counties with high community levels – has grown from 14 million to 50.4 million.

CDC recommends that all people mask indoors in areas that have high COVID-19 community levels, and that people living in medium-level counties mask based on their personal risk, but most jurisdictions and facilities do not require masking. These updated data illustrate how quickly the current wave is spreading and increasing risk across the country. These data underscore the significant vulnerability to COVID-19 illness that still exists at this time, more than a year since vaccines became widely available in the U.S. to most people. As such, they point to the importance of other public health measures, such as masking and testing, in addition to vaccination, in many parts of the country.

COVID-19 Community Level: COVID-19 community level data were sourced from the Centers for Disease Control and Prevention (CDC) “United States COVID-19 Community Levels by County,” using data released on July 21, 2022. Counties lacking a COVID-19 community level were excluded.

COVID-19 Vaccinations: County-level data on COVID-19 vaccinations were sourced from the CDC “COVID-19 Vaccinations in the United States, County” using data reported as July 20, 2022. Only data from the 50 states and District of Columbia were included (data from territories were excluded as territories are not included in the COVID-19 community level dataset). Counties lacking any vaccination data were also excluded from this analysis. In some cases, the residence county is unknown, and therefore these vaccination data cannot be attributed to a specific county. However, for states where only one COVID-19 community level was possible as of July 20, 2022, namely, the District of Columbia (Medium), Maine (Low), and Rhode Island (Low), vaccination data with unknown county information but attributed to these states were coded as the corresponding COVID-19 community level. Other vaccination data without county information and not attributed to these states were excluded from the analysis (accounting for about 13 million people). For this reason, we are potentially overestimating the number of people not up to date on vaccination. We define up to date on COVID-19 vaccination as people who have completed a primary series and received a booster (except for children under age 5 who are considered to be up to date with primary series COVID-19 vaccination). We calculate the number not up to date on COVID-19 vaccination as population in each county minus people who received primary series and booster. We calculate the number of unvaccinated people as the difference between the county population and the number of people who have received at least a first dose of a COVID-19 vaccine. In a few counties where the population estimate exceeds the number of people who have received a first dose of the COVID-19 vaccine, the number of unvaccinated individuals is assumed to be 0. We calculate people who are partially vaccinated as the difference between the number of people who completed a primary series and those who received at least one dose. We calculate the number of people that have completed a primary series but not received a booster as the difference between the number of people who have completed a primary series and the number of people who have received a booster dose. Although the CDC now recommends that all immunocompromised individuals and people over the age of 50 receive a second booster dose, there are currently no county-level data available on the number of booster doses received. Therefore, we are unable to capture how many individuals are fully up to date on COVID-19 vaccines. Furthermore, children under 5 years of age have recently become eligible to receive COVID-19 vaccination. Children in this age group that have received a first dose are considered to be partially vaccinated.



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