Pandemic of the Unvaccinated

Here is a heat-map showing percentage of Black population in each county in the U.S.:

Original Source: https://www.reddit.com/r/MapPorn/comments/gdwty5/percentage_of_black_population_in_the_us_by_county/

I have highlighted areas of particularly dense concentration in green.

Here is a heat-map showing percentage of Hispanic population in each county in the U.S.:

Original Source: https://en.wikipedia.org/wiki/File:2010_US_Census_Hispanic_Population_by_County.svg

I have highlighted most of the areas of particularly dense concentration in purple.  For reasons I'll explain in a bit, I've left out California.  I've also highlighted one county in Oregon that has a particularly low concentration of Hispanics.

Now here is a heat-map showing the current spread-rate of Covid per county.  I have transferred those same highlights from the previous two maps to this map (by hand, in Paint, so excuse the crudity of my model):

Original Source: https://twitter.com/EricTopol/status/1426549915581251590/photo/2

My highlights from the previous maps are covering the bulk of the high-transmission counties.  So then the last piece of data is the vaccination rates of Black and Hispanics:

Original Source: https://kff.org

These vaccination rates are only national averages, and are thus not the whole story.  Vaccination rates of Blacks in the south seem particularly bad, when I look at them.  In Florida, they're terrible--high 20s if I remember correctly.

So obviously, I'm driving at a pattern here.  My hypothesis is that a very significant portion of this surge in Covid is being driven by Black and Hispanic communities with low levels of vaccinations.  Remember: diseases don't actually spread geographically so much as they spread through socially connected networks of people.  Therefore, it doesn't matter that Florida actually has an above-average vaccination rate if there exists within Florida a community of socially connected people having a shared low vaccination rate.  In this case, Covid will spread through that specific community at a rate that is high concomitantly with their lack of vaccination.

A few anomalies on the combined map

There are a few things on the Covid heatmap that might seem a bit anomalous, given my hypothesis.

1. California and Wyoming maybe seem a little reversed compared to what you would expect.  California should maybe have more Covid spread based on its high percentage of Hispanics, and Wyoming seems anomalously high, maybe.
   
   But California also has had one of the strictest anti-Covid regimes of any State in the Union, fairly consistently from early on in the pandemic.  I think we can maybe see the result of this type of policy in the heatmap.  Other places where I might see the result of public policy are Virginia--which has an interesting clear demarcation from North Carolina, and also has been more Covid-cautious in its public policies--and New York, which became much more Covid-cautious after early disaster.
   
   And as for Wyoming, I don't think it actually fits that badly with the hypothesis--its most infected county is, after all, also its county with the highest percentage of Hispanics, and the state overall does have a fair share of Hispanics.
   
   I also suspect that if you really dug into the statistics (if you could get them), you would probably find that there was an inverse correlation between social "class" and low vaccination rates, as well.  I do know that Wyoming is ranch-heavy and therefore hires an awful lot of migrant worker, and I suspect vaccination rates among them are *quite* low.
   
   
2. There is that one area in Oregon which has a very low percentage of Hispanics, but a very high Covid transmission rate.  This, it turns out, is the exception that proves the rule.  This area is comprised of two counties: Douglas and Josephine counties.  And although those two counties may not have high percentages of Hispanic populations, for whatever reason they are considerably less vaccinated than other counties around them:
   
   

   

   Vaccination Rate per 10,000: Taken from the Oregon Health Authority COVID-19 Site

   So this just highlights that the problem here isn't race or ethnicity per se: the problem is vaccination rate among socially connected persons.

So, what we have been told is in fact correct: this is--now--a pandemic of the unvaccinated.

What does this imply?

I think the implications of this reality are pretty straightforward: the highest priority for ending this pandemic in the United States should be increased vaccination, and the area where this most needs to happen is in Black and Hispanic communities.  How we increase vaccination in these communities . . . I have no idea myself.

Furthermore, I think we need to be particularly concerned with the vulnerable people in those communities: the elderly, the sick, and the immunocompromised.  Greater effort should now be exerted, I believe, to seek out those individuals for vaccination.

One thing that has puzzled me recently is how the death rate from Covid compared to infections has not really decreased *that* much since vaccination.  Data is still sketchy on this, but my initial estimations put it at 1/2 to 1/3rd what it used to be before the vaccines.  That's better--but it doesn't match up very well with the great efficacy we have been seeing in the vaccines preventing hospitalization and death, *and* the relatively high rates of vaccination among those most in danger.  If 80% of the elderly are vaccinated and the vaccines are 95% effective at preventing death, then you wouldn't expect the death rate among the elderly to drop just by 1/2 or 2/3rds--it should be a lot more.

But if the spread is happening primarily in communities in which vaccination is low, this now makes a lot more sense.  In fact, deaths from nursing home residents have fallen drastically as a percentage of overall Covid deaths since vaccinations (see New COVID-19 Cases and Deaths Among Nursing Home Residents Have Dropped Since Vaccinations Began).  But not all elderly and infirm live in nursing homes; plenty of them live at home with family among these vulnerable communities.  I believe it very likely that the bulk of the deaths from this latest surge of Covid are coming from these people: elderly, hesitant unvaccinated parents of hesitant unvaccinated children.

So none of this gives us a way forward, per se.  But I think it *does* give us a focal point and I would like to start hearing more discussion about how we are going to solve this specific problem.