Young, healthy people dying from COVID-19 in Charlotte

In January, the deadliest month of the pandemic so far in Mecklenburg County, a higher rate of adults under 40 and those without underlying health conditions died from coronavirus complications, a new analysis of public health data by the Charlotte Observer reveals.

Adults ages 20-39 account for 1.64% of all county deaths — a roughly 50% increase since mid-October, based on data published by Mecklenburg County Public Health on Friday.

Put differently, in the six months between April and October, officials reported four total people in that age group had died from coronavirus complications in Mecklenburg. In January and February so far, six people ages 20-39 died.

While that age group still makes up the lowest share of total COVID-19 deaths in the county, it’s the most noticeable change in fatality data over recent weeks — and experts warn there’s no single reason why younger and healthier people are dying more often. The 20-39 group also accounts for the highest percentage of overall cases reported in Mecklenburg.

All told, as of Thursday evening, 797 people have died locally from COVID-19 since mid-March. January accounted for about one-quarter of all deaths.

Younger people and adults with better health histories are generally thought to be less susceptible to severe complications from COVID-19. But in January — compared to mid-October, a low-point for spread of the virus — Mecklenburg saw an 80% increase in the percentage of total deaths among people not believed to have pre-existing health problems.

Health experts say scant information about such deaths — including whether those who died faced heightened exposure risks or lacked equitable access to medical care — makes it difficult to understand why seemingly low-risk, healthy Mecklenburg residents were unable to recover from respiratory ailments.

But the deluge of infections from holiday gatherings, which also strained hospital systems in December and January, is likely a key factor.

“This is why myself and others were painting this dire picture about what January, February and March was going to look like — we were seeing in the crystal ball what was coming,” said Melinda Forthofer, a public health professor at UNC Charlotte.

“Colder weather drives people indoors. That can translate into a higher dose of the virus they get exposed to — and there is evidence that the higher the dose, the more severe the infection.”

For months, private events among friends and family have fueled COVID-19 spread more acutely than other in-person activities, such as dining out at restaurants and attending worship services, according to contact tracing data shared previously by Mecklenburg health officials.

”To me, it’s really a reflection of how many people got sick in December and over the holidays,” said Lisa Gralinski about the data showing more deaths among healthier people. Gralinski is a virologist and assistant professor of epidemiology at the UNC Gillings School of Global Public Health.

She points to three major unknowns that could help explain why there’s been such a shift: Whether younger people are taking more risks to be social or whether they work essential jobs, leaving them more exposed — and whether they faced barriers to healthcare, due to systemic inequities.

January was the deadliest month of the pandemic locally, with 211 COVID-19 deaths reported. That followed an unprecedented surge in hospitalizations in Charlotte between Thanksgiving and early January. The county, by contrast, recorded 110 deaths in December and 63 in November.

Coronavirus research has consistently shown a spike in deaths lags several weeks behind spikes in COVID-19 cases and hospitalizations.

Hospital systems in Mecklenburg deployed surge capacity plans to accommodate the influx of patients, but Forthofer said there’s only so much pressure medical resources can withstand.

“When the healthcare system is dealing with a higher volume of cases — and it certainly has been — there is a risk of having fatalities go up because the system is being stretched more thinly,” Forthofer said. “Our healthcare system is getting smarter about how to treat COVID…but the system also has some finite capacity.”

Data on local coronavirus deaths does not specify how many young adults or those without known health problems sought hospital-level care before dying.

This age group is prioritized last in North Carolina’s vaccination framework, meaning it will take months before young adults are widely protected from the virus.

Preexisting conditions

Last October, Mecklenburg Public Health Director Gibbie Harris predicted COVID-19 would be third leading cause of death for the county in 2020, trailing only cancer and heart disease.

People age 60 and older, as well as people with underlying or chronic health problems, are the most likely to die from COVID-19, data throughout the pandemic has consistently shown.

Mecklenburg did not record its first death of a resident with no underlying conditions until May 26. Through December, an additional nine fatalities were listed as deaths among residents with no known health problems — less than 2% of all COVID deaths in the county.

But in January, the county saw nearly as many previously-healthy people die in a single month as had been recorded the seven in months prior.

For other deaths recorded, it is unclear what those pre-existing health conditions were, such as lung disease, cancer or diabetes, which the Centers for Disease Control and Prevention warns can escalate the severity of infections.

“People not realizing they have some sort of preexisting condition could be a part of things,” Gralinski said. “As much as we like to assume ‘I’m young, I’m healthy, I’m active’ — you never know who’s going to turn out more vulnerable than they think.”

COVID deaths by age

Since the start of the pandemic, the virus has been particularly virulent among seniors who are at elevated risk of developing serious illness. The risk is compounded by the complexity of infection control at long-term care facilities, including nursing homes, where nearly half of all county deaths occurred.

In recent months, the pandemic turned deadly for some of Mecklenburg’s youngest residents.

“We have to remember while sometimes we still think of this as an infection that disproportionately affects the elderly … It can affect everybody. The virus doesn’t necessarily respect age boundaries,” Dr. David Priest, Novant Health infectious diseases specialist, told reporters Friday morning.

“That’s been some of the mystery of the COVID pandemic in general — you have a very elderly person with a lot of different health problems that recovers, and then you can have someone younger who has no health problems who doesn’t it.”

Harris, the county health director, issued a directive urging Mecklenburg residents to stay at home as much as possible after a 22-year-old died of the virus on Jan. 12. Days later, Harris disclosed news of a pediatric death, saying it was “not an acceptable situation for Mecklenburg County.”

Thirteen residents ages 20 to 39 have died from the virus, according to the latest county health data. Officials reported the first death in this age demographic in mid-July — and five in total by Dec. 1. The volume doubled by Jan. 12, according to an Observer analysis.

County officials also say 92 deaths involved residents ages 40 to 59, or about 18.5% of community deaths.

Researchers anticipate deaths will skyrocket again later this spring, as the United Kingdom and South African variants take a firmer hold here. But a lack of testing and screening infrastructure has left officials with little specific data on how far those new strains are spreading.

“It’s almost a given that we have more than one variant, sort of U.S-grown, already present,” Forthofer said.

That leaves an important question unanswered, she said: “If there are other different variants circulating, do they affect some groups more than others?”