The vaccine effect in Spain: lower mortality across all groups and a drop in average age of death

After being fully immunized, the over-80s are no longer the majority demographic in the fatality statistics: people in their 70s have taken their place

Covid Cataluña
A patient in intensive care at Vall d'Hebron Hospital in Barcelona on May 4.MASSIMILIANO MINOCRI

Covid-19 is still a disease that preys on the vulnerable, with age being the most decisive risk factor. The vaccination campaign has not changed this, but as it progresses, it is changing the profile of those dying from the virus. The group with the highest mortality rate has shifted from those over 80 to those in their 70s, and this will shortly become those in their 60s. It does not mean that more young people are dying now. On the contrary, deaths are falling in all age groups and are almost 10 times fewer than in January. But they are distributed differently as the older age groups get vaccinated.

Mortality data emerging from the Carlos III Health Institute shows that at the beginning of May – three weeks must pass before the data is consolidated and reliable – those over 80 accounted for 35% of mortality, just half that of January. Those in their 70s now account for 37% of deaths, compared to 20% in January; those in their 60s account for 17.4% which is more than double the figure four months ago; those in their 50s account for 7.8%, up from 2.7%; those in their 40s represent 2.8% of deaths instead of 0.6% in January. Meanwhile, the cases are so few among thirty-somethings that the comparison becomes complicated. In February, 15 people died in this age bracket; there were 10 deaths in March; 12 in April and three between May 1 and 9. In younger people, deaths are even rarer: on most days no one under 30 dies.

The picture has changed dramatically since the beginning of the year. In January there were more than 500 deaths a day. At the beginning of May, this moved towards fewer than 50. The cumulative incidence rate has started to flatten and been almost stagnant for a few days now, but most of the infections are among people under 50, who are far less likely to become seriously ill or die from Covid-19.

Experts are in no doubt that the data is the result of vaccination. Both the number of deaths in absolute terms and their redistribution mirror the increase in the numbers that have been vaccinated in each age bracket. Older people continue to die, but mostly because they became infected before getting immunized. According to José Carlos Igeño, head of the Intensive Care Unit (ICU) at the San Juan de Dios Hospital in Córdoba, “people should not think that if the elderly are protected, those who die now must be young. Those dying now are mostly people in their 60s and 70s who were admitted to the ICU a while back, even months ago, and there is nothing to be done. Many of them die from fungi and multi-resistant bacteria that colonize and crush lungs that were already badly damaged by Covid.”

Gabriel Heras, head of the Intensive Care Department for the Southern Area of Granada, agrees that the deaths and serious cases correspond to the demographics still not fully vaccinated. “No one who is very old is being admitted anymore,” he says. “And fewer people in their 60s and 70s. What we are now seeing are people in their 50s. Those who die are usually older people who have been hospitalized for a long time, suffering massive muscle weakness and post-ICU syndrome, meaning the risk of complications increases.”

The younger patients admitted to intensive care are frequently suffering from obesity. Along with diabetes and hypertension, it is the most commonly associated condition, a conclusion reached by a study of more than 4,000 patients to be presented next week by intensive care specialist Alejandro H. Rodríguez, at the congress of the Spanish Society of Intensive Care Medicine, Critical Care and Coronary Units.

Among this younger demographic are a number of people who are being admitted after receiving one dose of the vaccine, or who have just received the second dose, meaning there has not been time for an immune response to develop. But Rodríguez has found practically no instances after both shots, although it can happen: vaccines are not infallible. A small percentage of people can get sick after having both doses of the vaccine and can, though less likely still, be admitted to hospital and even die. The Health Ministry has no data published on these cases, but, according to the experts consulted, it is extremely rare.

The data shows that both regular hospital wards and intensive care units are gradually emptying out, although there is still some way to go before normal levels return; the level of occupancy in the former is similar to what was being seen at the beginning of September, when the second wave was gaining momentum; and ICUs, where occupancy levels are dropping more gradually, are comparable to the beginning of October.

The elderly’s status as the main demographic in ICUs has been supplanted by younger people with underlying health conditions, but, in general, the cases are less severe and these patients have a better chance of survival, according to Rodríguez. Again, this is relative. It is not that more young people with health conditions are being admitted, it is just that this type of patient is now proportionally more frequent.

Pablo Demelo, an internist at Gregorio Marañón Hospital in Madrid, says that his time is mostly taken up by people even younger than 40. “The cases are usually less serious and they are discharged earlier, but now they stand out more because there are fewer older patients,” he says.

A report by the health data consultancy IQVIA predicts that in the best-case scenario, Covid hospital admissions will gradually decline over the summer and will be anecdotal or virtually non-existent by September. Everything indicates that the tendency for fewer deaths, fewer admissions and a proportionally younger profile will persist as the immunization of the elderly is consolidated. Virtually everyone over 70 is already protected by two doses of the vaccine. The most critical age group now is the 60s age bracket. Although nine out of 10 have received one shot, only 13% have been fully vaccinated. This is due to the fact that most have received the AstraZeneca vaccine, which requires doses to be 12 weeks apart.

English version by Heather Galloway.

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