The Perfect Enemy | What the numbers tell us about COVID-19 in Ohio after 3 years, 40,000-plus deaths and millions of vaccines - cleveland.com
April 10, 2024

What the numbers tell us about COVID-19 in Ohio after 3 years, 40,000-plus deaths and millions of vaccines – cleveland.com

What the numbers tell us about COVID-19 in Ohio after 3 years, 40,000-plus deaths and millions of vaccines  cleveland.com

CLEVELAND, Ohio – The impact has been staggering since the first COVID-19 cases were confirmed in Ohio three years ago this week. Tens of thousands of Ohio deaths. More than 100,000 hospitalizations. And 3 million-plus known cases.

So many people have died that if they were all in one place, they would make up one of Ohio’s 15 largest cities.

Have we all had COVID-19 by now? No.

But by some recent research, at least half of us have been infected, probably more and increasing by the day. And 10 to 20 Ohioans still die daily from the virus. Yet, the severity of late is just a fraction of what it once was, thanks largely to highly effective vaccines and what the medical field has learned about treatments.

Here’s what we know and, in some cases still don’t know, about the numbers behind pandemic that became real for Ohio with the first three cases confirmed on March 9, 2020.

Lives lost

By official accounting from the Ohio Department of Health, 41,242 Ohioans died because of the coronavirus during the first three years of the pandemic – 13,621 in the first year, 18,277 in year two, and 9,344 last year.

Yet other data suggests those numbers undercount the real toll by several thousand.

At least 57,540 more Ohioans died from all causes from the start of the pandemic in 2020 through 2022 than had died the previous three years, from 2017 through 2019, according to data from the state health department’s mortality database.

Deaths were on the rise in the decade ahead of the panademic – averaging about 1,700 more a year annually – but the shift was dramatic once the coronavirus arrived.

Total deaths jumped nearly 20,000 – from 123,705 in 2019 to 143,360 in 2020. Then there were 147,583 deaths in 2021, and 137,946 reported so far for last year in preliminary reports.

Deaths from “natural causes” overwhelmingly is the leading reason for the increase – accounting 53,000 of the extra deaths over the last three years, according to the mortality database. Not because of things like homicides (up 610), suicides (down 212) and drugs (up 2,002), though close to 500 cases are still pending a determined cause.

Among the possibilities for the gap between official COVID-19 death numbers and the increase in deaths overall are failure to identify COVID-19 cases, especially early on, patients skipping regular appointments or delaying treatment for other health reasons during the pandemic, and lifestyle changes.

Ohio deaths, 2017-2022

Ohio deaths for all causes in the three years before the COVID-19 pandemic, and since the virus reached Ohio in 2020.Rich Exner, cleveland.com

People infected

The Ohio Department of Health reports 3,392,320 cases so far among the 11.8 million Ohioans.

The big year was not year one of the pandemic (740,300 in 2020), but rather the second year (1,357,343 in 2021). Even lately, Ohio continues to report close to 10,000 new cases each week.

But case reports don’t equate to people infected, because some people have been infected multiple times.

And even the number of confirmed cases never should have been considered an accurate reflection – first because tests weren’t available to everyone, then the likely under-reporting of results from now widely available home tests, and the lack of true scientific sampling of the entire population. Some groups, for example, were subject to required testing even without symptoms, such as students returning to college at times, while others were not.

Plus, the question lingers: how many sick people aren’t testing?

One study by a consortium of researchers from five universities released in mid-December said that half of the American adults surveyed reported having COVID-19 at some point, though only a third said they had tested positive. Those shares would be higher now.

Vaccines work, but many continue to skip them

Strong evidence suggests three things about vaccines: (1) they are highly effective in keeping people out of hospitals and from dying, (2) many people continue to refuse to get the shot, and (3) boosters have not fully caught on even among those who got initial doses.

To date, 1-in-4 Ohio adults has not received even one shot.

But even among the 6.8 million adults who have been vaccinated, only 3.8 million returned for a booster at some point, and only 1.7 million have received the latest booster, available since September.

Yet there is ample evidence that the shots work.

Tracking by the state health department for cases starting in 2021 shows that people who received the initial round of vaccines (two Pfizer or Moderna shots, or one Johnson and Johnson) account for just 5.3% of the deaths and 7% of the hospitalizations.

Put another way, those who have not been vaccinated now make up only a small share of Ohioans, but they account for close to 93% of the deaths and hospitalizations.

Including children, 7.6 million Ohioans have received at least one shot.

Ohio vaccinated, not vaccinated COVID-19

Tracking by the Ohio Department of Health since the start of 2021 shows a small minority of the COVID-19 hospitalizations and deaths have involved people who received full initial vaccinations. Boosters are not factored in.Rich Exner, cleveland.com

Surges

Whereas case numbes are dicey, hospitalizations offer a consistent, though not perfect, look at the trends, especially so for severe cases. Efforts were made from the very beginning to identify COVID-19 patients in hospitals and report out that information.

What data from daily surveys by the Ohio Hospital Association shows is that Ohio avoided the feared winter surge this time around, with far lower bed counts than each of the last two winters.

For example, the daily count of patients in Ohio hospitals with COVID-19 this past December and January averaged 1,129, down from 5,211 during the same months in 2021-22 and from 4,253 during those months the first year of the pandemic.

As for just COVID-19 patients in intensive care beds, the daily average was 163 in December and January, down from 1,150 in December-January a year ago, and 1,030 two years ago.

Ohio COVID-19 Hospitalizations, 2020-2023

The daily count of patients in Ohio hospitals with COVID-19 since 2020 shows surges each of the first two winters.Rich Exner, cleveland.com

Nursing homes

Nursing home patients are still dying from COVID-19, but nowhere near the frightening levels from early on, according to reporting by the nursing homes to health departments.

There were 4,856 nursing home deaths reported in 2020, dipping to 3,448 in 2021 and then to 1,106 last year. Nursing home patients, starting in December 2020, were among the first to be vaccinated.

To date, there have been 9,543 deaths and 102,743 cases reported among nursing home patients.

The age factor

Early on, COVID-19 deaths disproportionately involved the oldest Ohioans. That no longer is the case, based on historical trends.

Ohioans age 80 and up accounted for more than half the COVID-19 deaths reported in the first 12 months (52%). That has dropped to 42%, which is close to the normal share for this group from all causes. In 2018, people 80 or above accounted for 44% of all Ohio deaths.

The share for deaths among people in their 70s also edged down, but just slightly from 27% over the first year to 26% for all three years.

Factors likely include targeted efforts early on to reduce nursing home deaths and high vaccination rates. Older Ohioans are far more likely to have been vaccinated – close to 90% for everyone over 60.

In pure numbers, however, deaths and hospitalizations for people 60 and older far exceed the numbers for younger people, accounting for 87% of the deaths and 64% of the hospitalizations.

By race, Blacks who make up 14% of Ohio’s population have accounted for 16.5% of the COVID-19 hospitalizations. Whites, 82.8% of Ohio, have accounted for 74% of the hospitalizations, according to the health department.

Ohio COVID-19 death by age group, March 2023

The share of deaths by age group from COVID-19 in Ohio is similar to the overall breakdown of all deaths ahead of the pandemic.Rich Exner, cleveland.com

COVID-19 by age in Ohio, March 2023

Most serious COVID-19 cases have involved older Ohioans.Rich Exner, cleveland.com

Geography matters, or is it the vaccine?

A rural/urban divide shows up in the numbers, with people in smaller counties more likely to have died because of the coronavirus. These same rural counties collectively have a notably lower vaccination rate.

There have been 313.1 deaths per 100,000 residents in the 10 largest counties, where the vaccination rate as a group is 66.6%, including in that share anyone who has received at least one shot.

Among the other 78 counties, there have been 399.6 deaths per 100,000. The vaccination rate for those counties is 55.7%.

Taking it a step further, the death rate in the 10 smallest counties is 495.9 per 100,000, and the vaccination rate is 48.8%.

Delaware County north of Columbus has the highest vaccination rate (80.1%) and the lowest death rate (141.5 per 100,000). It’s the 13th largest county in Ohio.

Holmes County in the heart of Amish Country has the lowest vaccination rate (19.8%) and is 43rd for deaths (431.9 per 100,000).

Cuyahoga County ranks third for vaccinations (69.2%) and has the 17th lowest for death rate (326 per 100,000). The state’s largest couinty, Franklin, is second for vaccinations (69.8%) and has the third lowest death rate (213.6 per 100,000).

Vaccines have also become a political issue. The largest counties are Democratic strongholds, while Republicans have wide support in the smaller counties.

Population Pct.
Vaccinated
Deaths Deaths
per
100,000
Delaware 214,124 80.1% 303 141.5
Franklin 1,323,807 69.8% 2,828 213.6
Cuyahoga 1,264,817 69.2% 4,123 326.0
Summit 540,428 69.1% 1,856 343.4
Lake 232,603 68.9% 823 353.8
Warren 242,337 68.3% 646 266.6
Lorain 312,964 68.3% 1,060 338.7
Medina 182,470 67.5% 541 296.5
Hamilton 830,639 67.4% 2,237 269.3
Union 62,784 66.7% 117 186.4
Ottawa 40,364 65.5% 154 381.5
Wood 132,248 64.2% 395 298.7
Statewide 11,799,448 64.2% 41,749 353.8
Geauga 95,397 63.9% 294 308.2
Fairfield 158,921 62.3% 463 291.3
Lucas 431,279 62.1% 1,520 352.4
Erie 75,622 61.8% 294 388.8
Greene 167,966 61.7% 544 323.9
Portage 161,791 61.6% 488 301.6
Clermont 208,601 61.5% 618 296.3
Butler 390,357 61.2% 1,252 320.7
Montgomery 537,309 60.9% 2,214 412.1
Mahoning 228,614 60.7% 1,187 519.2
Lawrence 58,240 59.4% 290 497.9
Washington 59,771 59.3% 247 413.2
Licking 178,519 58.1% 522 292.4
Stark 374,853 58.0% 1,827 487.4
Madison 43,824 57.9% 145 330.9
Trumbull 201,977 56.7% 1,017 503.5
Athens 62,431 56.6% 157 251.5
Scioto 74,008 56.6% 281 379.7
Ashtabula 97,574 56.1% 472 483.7
Henry 27,662 55.8% 114 412.1
Sandusky 58,896 55.8% 263 446.5
Hancock 74,920 55.5% 296 395.1
Pickaway 58,539 55.4% 241 411.7
Clark 136,001 54.9% 624 458.8
Marion 65,359 53.5% 287 439.1
Ross 77,093 52.8% 325 421.6
Jefferson 65,249 52.4% 346 530.3
Belmont 66,497 52.2% 343 515.8
Fulton 42,713 52.1% 185 433.1
Meigs 22,210 52.1% 106 477.3
Seneca 55,069 52.0% 250 454.0
Defiance 38,286 52.0% 176 459.7
Monroe 13,385 52.0% 85 635.0
Muskingum 86,410 51.9% 324 375.0
Hocking 28,050 51.8% 132 470.6
Putnam 34,451 51.6% 165 478.9
Gallia 29,220 51.3% 141 482.5
Noble 14,115 51.1% 61 432.2
Huron 58,565 50.9% 232 396.1
Jackson 32,653 50.8% 150 459.4
Wyandot 21,900 50.6% 111 506.8
Pike 27,088 50.5% 138 509.5
Clinton 42,018 50.5% 184 437.9
Miami 108,774 50.4% 518 476.2
Columbiana 101,877 49.6% 512 502.6
Wayne 116,894 48.6% 476 407.2
Harrison 14,483 47.9% 82 566.2
Crawford 42,025 47.7% 230 547.3
Allen 102,206 47.6% 510 499.0
Fayette 28,951 47.5% 134 462.9
Guernsey 38,438 47.5% 166 431.9
Williams 37,102 47.4% 175 471.7
Carroll 26,721 47.3% 136 509.0
Champaign 38,714 47.1% 159 410.7
Tuscarawas 93,263 46.9% 542 581.2
Ashland 52,447 46.9% 237 451.9
Morgan 13,802 46.8% 62 449.2
Richland 124,936 46.6% 547 437.8
Knox 62,721 46.5% 250 398.6
Logan 46,150 46.0% 180 390.0
Perry 35,408 45.8% 134 378.4
Van Wert 28,931 45.5% 162 560.0
Brown 43,676 45.0% 197 451.0
Morrow 34,950 44.9% 113 323.3
Paulding 18,806 44.5% 78 414.8
Preble 40,999 44.0% 208 507.3
Vinton 12,800 43.0% 60 468.8
Hardin 30,696 42.8% 167 544.0
Coshocton 36,612 41.8% 169 461.6
Auglaize 46,422 41.3% 202 435.1
Highland 43,317 41.0% 189 436.3
Darke 51,881 40.5% 248 478.0
Adams 27,477 40.4% 165 600.5
Mercer 42,528 39.2% 147 345.7
Shelby 48,230 39.0% 203 420.9
Holmes 44,223 19.8% 191 431.9

Not seeing the county-by-county chart above? Some mobile users may need to use this link instead.

Date used throughout this story was the latest available as of Saturday, March 4, 2023.

Rich Exner has been tracking the COVID-19 numbers daily for cleveland.com since the the beginning of the pandemic.