NEW BEDFORD — Deaths from COVID-19 surged here in August and September at a rate the city hasn’t seen in almost a year, according to a new set of death certificates obtained by The New Bedford Light.
COVID-19 claimed 13 lives in August and 21 in September, a rapid ascent from the beginning of the summer, when deaths dropped to zero for five consecutive weeks. From mid-June to mid-July the pandemic claimed not a single death in New Bedford.
That respite was brief compared to the pandemic’s more sustained retreat statewide. Cases in New Bedford soared in the first two weeks of August, and new cases have remained high throughout the fall, with an average daily rate consistently exceeding 30 cases per 100,000. By contrast, COVID-19 cases across Massachusetts dropped to fewer than five cases per 100,000 in May and have remained below 20 most of this fall.
The newest death certificates reviewed by The Light bring the city’s total COVID-19 death toll to 459 from the beginning of the pandemic to the end of September. This count includes deaths of New Bedford residents throughout Massachusetts, along with deaths that occurred at health care facilities in New Bedford. COVID-19 was the leading cause of death in 2020, and it continues to hold that grim mantle in 2021.
Public health experts, health care providers, and a hospital clinician all point to New Bedford’s sluggish vaccination rate as the driver of new cases and deaths. The city’s fully vaccinated population has been growing by about 500 per week during the late summer and fall. On Thursday, Nov. 4, 50.2% of New Bedford’s population was fully vaccinated, compared to 68.2% in Massachusetts.
“If we have 50 patients admitted into a hospital, we’re seeing only five to 10 of them are vaccinated. The rest are unvaccinated,” said Noelle Kohles, chief nursing and clinical operations officer for the Greater New Bedford Community Health Center. “This is the reason people are dying. The focus for community health is outreach to our patients to help them understand the importance of the vaccine. Unfortunately, it didn’t hit home until loved ones were dying.”
New Bedford Mayor Jon Mitchell also cites the city’s low vaccination rate as a factor.
“The persistently elevated case counts and deaths from COVID-19 in Southeastern Massachusetts are a stark reminder that the unvaccinated in our region have allowed themselves to be vulnerable to the disease, and that they pose a grave risk to others who are already vulnerable,” Mitchell said. “My suggestion to those who remain unvaccinated is to talk to your doctor about the vaccines, just as you would for any other medication. That way, at least you can be confident you’ve made an informed decision.”
The New Bedford Health Department said 1.7% of cases diagnosed in August resulted in death, an elevated rate compared to the rest of the state.
“However, it remained below the monthly case fatality rates observed prior to the widespread introduction of the COVID vaccine,” the Health Department said in a statement to The Light. “This is important because it showed that vaccinations are helping to protect our most vulnerable populations even during surges, and we should continue to encourage vaccinations in our community in order to reduce this CFR (case fatality rate) during future surges.”
Deaths in Massachusetts must be certified immediately and registered with the state Department of Public Health’s electronic vital records system. The information is reported by a medical certifier — an attending nurse or physician who cared for the person in their final days or weeks of life. Their certification is a critical step for families to obtain death benefits and begin making funeral arrangements. The record is also used for disease surveillance and public health programs.
A spreadsheet containing the cumulative record teems with granular detail about those who have died — including the date, time, and location; the cause of death and underlying conditions; and the time since onset of disease. Each line offers a glimpse into a person’s life and identity, with columns for age, race, ethnicity, occupation, level of education, birthplace and marital status.
Death certificates continue to offer the first full accounting of the pandemic’s death toll in the city. Taken as a whole, the information provides a devastating and continuing chronicle of loss in New Bedford.
More than a third of the people who died from May through September were born in New Bedford. Eight were immigrants from the Azores and two from other cities in Portugal. There were two born in Cape Verde. And eight came to Massachusetts from Puerto Rico.
There were 23 whose jobs would have put them on the frontline of the pandemic, including five nurses and nurse’s aides, a hospital custodian and a social worker, four supermarket employees, two school cafeteria workers, three delivery drivers, two city police officers, a correction officer and a firefighter.
Ten were veterans of the U.S. armed forces, including the Army, Navy and Marine Corps.
A man who moved to New Bedford from Middleboro and worked at a gas station was the youngest to die over the summer, at age 37. The oldest was 102.
The majority died at St. Luke’s Hospital, where 45 people succumbed to COVID-19 over the past five months, and 317 in total since the beginning of the pandemic. St. Luke’s is increasingly becoming the primary location for COVID-19 mortality in New Bedford.
Emergency room visits for COVID-19 increased every week this summer and fall from 226 visits in the last week of June to 625 during a week in mid-September across Southcoast Hospital Group’s three facilities, which include St. Luke’s, Charlton Memorial Hospital in Fall River, and Tobey Hospital in Wareham.
“Hospitals at this time are really, really full, including St. Luke’s,” said Dr. Dani Hackner, a pulmonologist and chief clinical officer for Southcoast Health.
The strain on Southcoast’s hospitals extends above their ground-floor emergency departments.
“Just getting folks upstairs is one of our biggest challenges,” Hackner said. “We are seeing more emergency care, and at the same time, getting folks out to long-term is greatly slowed. It’s been very difficult. We encourage folks to access primary care and urgent care wherever possible. But if you’re very sick, you need to come in, and you should come in early.”
Hackner said he’s seeing COVID-19 patients in their teens and 20s, an age group that is least likely to be vaccinated or have any past experience of being hospitalized.
More than half of all victims over the last five months were younger than 75, the cutoff age used to define premature mortality in the state’s annual report on death in Massachusetts. On average, COVID-19 victims this year are about five years younger than in 2020, when the average age of victims was 79. In the past five months, age skewed younger still, with an average age of 72.
Most of the recent victims battled COVID-19 for days or weeks. In four cases, medical certifiers indicated an onset of disease at least a month before death.
Mortality in people hospitalized for COVID-19 has fallen dramatically from the first wave of the pandemic when 5-10% of people hospitalized died. The standard of care includes therapies that weren’t yet authorized last year, like passive vaccination through monoclonal antibody infusion, or weren’t yet firmly established in clinical guidance, like dexamethasone, the immune-modulating steroid used to suppress the cytokine storm that occurs before COVID-19 patients worsen.
Monoclonals are becoming more accessible in Massachusetts, including through the St. Luke’s emergency department, and at least two of Southcoast’s urgent care centers in the region. GNBCHC also said they are poised to offer infusions if the state expands its partnerships with local providers.
Patients who seek care early have the best chance to benefit from monoclonals, which block the virus’s replicating machinery and prevent the explosive spread of infection in the initial phase of COVID-19.
COVID-19’s mounting toll in August and September suggests there are many patients missing the window for this treatment, despite evidence in their death certificates of comorbidities that would make them eligible.
“After 10 days, the horse is maybe out of the barn,” Hackner said. “We can’t give you antibodies because they’re designed to block the machinery that produces new virus. We can try to tamp down the cascade, but in effect thousands of doors are open in your cells. They’re leaking in your lungs; your lungs are filling up with water. In the coming week or two, a repair process can work or it can fail.”
Access to testing and primary care are important factors in New Bedford when it comes to surviving COVID-19. GNBCHC provides primary care to roughly a quarter of New Bedford’s population. Some 70% of the health center’s patients are covered by Medicare or Medicaid. Some are uninsured.
“At the beginning, when there were so many unknowns, we told people not to go to the hospital unless they needed urgent care,” said Greater New Bedford Community Health Center CEO Cheryl Bartlett. “We didn’t know what to do at that point and we didn’t want to overwhelm hospitals so people could get the care they needed. We tried to talk people through it, but they were staying home too late and I’m still not sure people understand that.”
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COVID-19 victims in New Bedford had, on average, four underlying conditions when they died. Their death certificates provide a cross section of the burden of chronic illness they carried when they arrived at the hospital. The Massachusetts Department of Public Health instructs medical certifiers to use these fields to “tell a story about how a person died.”
Many of the diagnoses recur again and again as COVID-19 wreaks havoc in the upper and lower respiratory system, causing pneumonia and hypoxia. The Light’s analysis shows that heart disease is the most broadly shared category, covering more than a tenth of all the diagnoses, including cardiac arrest, heart failure, coronary artery disease, atrial fibrillation, and heart attack.
Chronic lung diseases, like chronic obstructive pulmonary disease and emphysema, appeared in 64 instances. Forty-three of those who died had diabetes, and 41 had hypertension.
Comorbidities for COVID-19 include conditions not ordinarily risky for other diseases. Hypertension and elevated Body Mass Index (BMI) for example, do not necessarily increase the risk of mortality for hospitalized patients in general, but appear to be a risk for COVID-19 patients, health experts say.
Vaccination remains the dominant factor in preventing COVID-19 mortality in New Bedford. The risk of hospitalization from COVID-19 for vaccinated individuals in Massachusetts is 0.04% and the risk of mortality is 0.009%.
“Far and away, that is the most important determinant of survival with COVID,” said Hackner. “In socially vulnerable areas we see very low vax rates, and New Bedford is one of them. New Bedford is still the lowest in Bristol County.”
Since March, the state has funneled resources toward New Bedford and 19 other cities to improve their vaccination rates. New Bedford’s vaccinations have increased in recent months, with 57.8% of people having received at least one dose of either the Pfizer or Moderna vaccines as of Nov. 2.
“In the community we work with, COVID has been devastating,” said Corinn Williams, executive director of the Community Economic Development Center, which serves New Bedford’s North End. “They work in fish houses, where eight people in a household all got infected. There was a vax site on the waterfront. That was early on to target the seafood processor workers. But there was this disconnect. A lot of fanfare, but for the people who work there, there was no motive.”
Email Abigail Nehring at firstname.lastname@example.org.
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