Utah adults have been eligible for the coronavirus vaccine for months. So who is still dying?

A lack of vaccination — or full vaccination — isn’t the only reason for continuing deaths in Utah from COVID-19.

(Trent Nelson | The Salt Lake Tribune) Donna Burton preps a shot as teachers and staff of the Canyons School District received their second shots of the Moderna vaccine at Mount Jordan Middle School in Sandy on March 11, 2021. All Utahns age 16 and older became eligible for coronavirus vaccines later that month.

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About two and a half months ago, all Utahns ages 16 and older became eligible to receive the coronavirus vaccine.

But since that day, more than 100 Utahns have died from coronavirus. The state has lost about a person a day, on average, for the past month. Most were over 65 — an age group that, for the most part, has been vaccine-eligible since mid-January. Three of those seniors were fully vaccinated.

So who is still dying? And why?

Lots of at-risk people still aren’t getting vaccinated

Seniors are the most-vaccinated age group in Utah: Almost 80% are fully immunized, the Utah Department of Health reported, compared to 76% of seniors nationally.

But that also means about 75,000 Utah seniors aren’t fully vaccinated. And seniors’ risk of serious illness as a result of COVID-19 is so elevated that Utahns ages 65 and up still are dying at higher rates than other age groups, even though they are far more likely to be vaccinated.

“We know the disease affects the older population in general. It’s who it attacks more. It could be natural immunity, it could be a whole variety of things,” said Melanie Crossland, epidemiologist for Salt Lake County.

People at lower risk are making up a larger share of COVID-19 deaths

Utah seniors and patients with high-risk medical conditions still are the ones most likely to die from the coronavirus if they catch it.

But with vaccination rates high among those groups, younger and healthier Utahns are making up a bigger share of COVID-19 patients who die.

Before vaccines were first offered to the public on Jan. 11, Utahns ages 45 to 64 made up 17% of coronavirus deaths.

But that same age group has made up nearly a quarter of deaths since then, absorbing the sharply declining share of deaths among Utahns age 85 and older.

In Salt Lake County, deaths shifted even more dramatically to the 45-to-64 age group after vaccination began: from 19% to 30%, Crossland said.

“My guess — and this is strictly a guess — I would assume it’s vaccine uptake,” Crossland said. “I know we have really great coverage for our 65 and older population.”

In Utah, 79.6% of residents 65 and older are fully vaccinated, compared to 74.6% nationwide.

Meanwhile, Utahns who die of COVID-19 now are less likely to have an underlying medical condition that elevates their risk of serious illness. Before Jan. 11, about 62% of coronavirus patients who died also had some other, risk-heightening condition, like cancer, diabetes or obesity.

Of the Utahns who have died since Jan. 11, just under half had underlying conditions.

Some Utahns who died contracted COVID-19 before they were eligible for a full course of vaccine

All Utahns age 16 and older became eligible for coronavirus vaccines on March 24, which made the shots available for the first time to about 2 million Utahns, or 60% of the state’s population.

But most people in that massive group had to wait a few weeks for the first available appointment. And with more than 90% of vaccinated Utahns receiving the Pfizer or Moderna shots, the vast majority of younger adults couldn’t have been fully protected until about May 1 at the earliest.

Patients also typically do not die from the coronavirus immediately after they’re infected. On average, Utah COVID-19 deaths have occurred about 17 days after diagnosis — but that average is artificially low, as it includes some “negative numbers” where testing occurred after the patient had died, said Tom Hudachko, spokesman for the Utah Department of Health.

Utah patients who were tested before they died have lived as long as 164 days after diagnosis, Hudachko said. At Intermountain Healthcare, for example, patients have spent about two weeks in the hospital before dying, said Dr. Todd Vento, an infectious diseases specialist — and that’s after the typical three to 10 days between when a patient starts feeling sick and needs to be admitted.

That means younger patients who have died in recent weeks likely didn’t have enough time to have been fully vaccinated when they were infected.

Many patients who are infected aren’t seeking the most effective treatment for COVID-19 until it’s too late

While attention has shifted to vaccination, less focus has gone to treatments for patients who already are infected — or the mounting body of evidence that those treatments can make a big difference if patients receive them in time.

“We have incredibly effective therapies, not just in the form of vaccines,” Vento said. Monoclonal antibodies, for example, have drastically reduced patients’ risk of serious illness.

But that treatment needs to be given within seven days of a positive test — when most patients still have mild symptoms and are unlikely to seek a doctor’s care.

Anyone who is at heightened risk of serious illness “really should not blow off a positive COVID test, even if you feel, ‘Ehhhh, it’s really mild,’” Vento said.

When Intermountain receives a positive test, it is matched against the patient’s medical records for evidence of other risk factors. The hospital system calls anyone who is at heightened risk and urges the antibody treatment.

But lots of patients don’t internalize the risk, Vento said, especially as the level of alarm in the community drops alongside the number of new cases.

“It’s concerning that a lot of people are thinking, ‘Oh, things are better.’ I think it’s important to remind folks that COVID is still a severe illness, with a high percentage of people who still have symptoms three to six months later,” he said.

Anyone with risk factors who tests positive for COVID should contact their doctor to see if they are a good candidate for preemptive treatment, Vento said.

White Utahns appear to make up an increasing share of the state’s deaths — but that might just be a data-collection fluke

Non-Hispanic white Utahns have experienced fewer COVID-19 deaths than their share of the population would predict. While 78% of the state is white, only about 65% of Utahns who died from the virus before Jan. 11 were white.

About 64 in every 100,000 white Utahns have died from the coronavirus. That compares to 131 among Utahns who are Native Hawaiian and Pacific Islander; 107 among Utah’s Indigenous population; and 70 in 100,000 people in the whole state.

But white Utahns’ share of COVID-19 deaths has risen since January to 75%, closer to the group’s share of the population.

It’s not clear why white people have represented more of Utah’s coronavirus deaths since vaccinations began; 45.3% of white Utahns are fully vaccinated, the highest rate of any racial or ethnic group in the state.

But data on race and ethnicity has been difficult to nail down during the pandemic, Crossland noted. For example, before vaccinations began, “other” and “unknown” were the two largest categories for COVID-19 deaths, after non-Hispanic white. Those details were particularly hard for local health departments to confirm when the weekly death toll was much higher.

“There’s a ton of unknowns,” she said.

Utah men still are significantly more likely than women to die from the coronavirus

Since COVID-19 began to spread in China, most of the patients who died have been men. In Utah, the split has been about 60-40, without much change even as vaccination rates for women exceed those for men in every age group.

In many countries — like Mexico, China and much of Europe — the imbalance is even bigger, and in parts of southeast Asia, male deaths outnumber female deaths by three or four to one.

The reasons for the imbalance aren’t certain. Researchers have identified stronger immune responses in women and more behavioral risk factors — like smoking — for men.

But those factors don’t appear to play out consistently. In Utah, for instance, the gender gap is almost nonexistent for coronavirus hospitalizations: less than 51% male versus more than 49% female.

And in some countries, like India, female deaths outnumber male deaths.

“The gender fatality gap is a complex issue influenced by multiple factors, and a robust controlled study is necessary to better understand these factors and how they differ from those that affect hospitalization rates,” wrote Janelle Degadillo, epidemiologist for the Utah Department of Health. “In other words, we don’t have that data.”