Hospitalization, Death, and COVID-19 Vaccinations

Globally, we’re in a race to vaccinate the world against COVID-19. We’re moving into the winter months across the Northern Hemisphere, there is increasing concern regarding COVID-19 transmission over this winter. Colder months drive people indoors, holiday travels, and children are back in school—all things that can help spread respiratory viruses, like COVID-19.

In the United States, 55.4% of the population is fully vaccinated. Meaning, we still have a lot of work to do, especially when we consider the latest recommendations for boosters for those over 65 years of age, more vulnerable to severe disease, or those working in high-risk professions. The COVID-19 vaccines have been amazingly effective against severe illness and death, but nonetheless the question of ability to prevent infection and reduce transmission has been a huge topic of discussion. As we move into a period of boosters and longer immunity, we’re still working to understand hospitalizations and deaths in adults after being vaccinated.

A new study published in The BMJ breaks down the risk prediction of death or hospitalization related to COVID-19 in adults following their vaccination. In a national prospective cohort study, the research team assessed adults 18-100 years of age from December 2020 to June 2021 who were vaccinated. Drawing on primary outcomes of death and hospital admission, they reviewed such data 14 days after each vaccination dose (one or two doses). The authors noted that over 6.9 million vaccinated patients were studied in the cohort, with over 5.1 million having two vaccine doses. In this group. 2031 COVID-19 associated deaths occurred and 1929 hospitalizations were related to COVID-19. Of those vaccinated and 14 or more days after vaccination, 81 deaths occurred, and 71 hospital admissions occurred. The authors noted that “Cause specific hazard ratios were highest for patients with Down’s syndrome (12.7-fold increase), kidney transplantation (8.1-fold), sickle cell disease (7.7-fold), care home residency (4.1-fold), chemotherapy (4.3-fold), HIV/AIDS (3.3-fold), liver cirrhosis (3.0-fold), neurological conditions (2.6-fold), recent bone marrow transplantation or a solid organ transplantation ever (2.5-fold), dementia (2.2-fold), and Parkinson’s disease (2.2-fold). Other conditions with increased risk (ranging from 1.2-fold to 2.0-fold increases) included chronic kidney disease, blood cancer, epilepsy, chronic obstructive pulmonary disease, coronary heart disease, stroke, atrial fibrillation, heart failure, thromboembolism, peripheral vascular disease, and type 2 diabetes. A similar pattern of associations was seen for covid-19 related hospital admissions. No evidence indicated that associations differed after the second dose, although absolute risks were reduced.”

This particularly study is important in risk stratification in regards to multiple doses of COVID-19 vaccines and helped provide insight into those at highest risk for disease and death after vaccination, which is something we’re increasingly in need of as we navigate the winter and topics of boosters. In this interim, it’s important we increase access to vaccines globally and break through barriers that prevent people from having easy access to vaccination. Moreover, until we have global vaccine equity, the threat of variants will continue, meaning that as we study the long-term protection of vaccines, we need to continue to mask in high-risk environments and help reduce the threat of infection.