On a map showing levels of COVID-19 across the U.S., Nevada stands out as a rare oasis of green.
Green, on the map displayed on the Centers for Disease Control and Prevention website, means that a community is experiencing low levels of COVID-19 hospitalizations and cases. For weeks, Nevada has been among the greenest states, with all – or all but one – of its counties at low levels.
This is good news, though it doesn’t mean that Nevada is in the clear. There are signs that there are far more new cases than are being reported. And even though the summer’s wave of infections is subsiding earlier here than in much of the country, certain populations continue to be hit hard, a Review-Journal analysis of data for Clark County indicates.
“Even though you get four gold stars, you cannot become complacent,” said Dr. William Schaffner, a professor of infectious diseases at Vanderbilt University.
COVID deaths drop
In each of the past three summers, there has been a surge in COVID-19 cases, hospitalizations and deaths across the United States.
Data from the Southern Nevada Health District suggests that this past summer has been milder in Clark County than the previous summers, with a few caveats.
From June through August of this year, there were about 400 reported COVID-19 deaths in Clark County, less than half the number of either of the two previous summers.
There were more than 1,200 COVID-19 hospitalizations, roughly one-third the number in summer 2020 and less than half of 2021’s tally.
However, this summer’s figure may capture fewer of the COVID-19 infections in patients hospitalized primarily for a different ailment; some hospitals have stopped routinely testing all admitted patients for the virus, the Nevada Hospital Association confirmed. But hospitals still routinely test patients who have symptoms or known exposure to the virus, association representative Jeanne Corbit said.
In Clark County, there were more than 53,000 reported cases of COVID-19 in the summer of 2020 and again in the summer of 2021. This past summer, reported cases dipped to more than 45,000, according to health district data. However, the increasing use of at-home rapid tests, whose results go unreported, means there were likely at least as many cases this past summer, and possibly more.
Wastewater surveillance indicates that official tallies are undercounts. The surveillance monitors levels of the virus shed from the body into toilets, sinks and showers and then found in the wastewater system.
The surveillance shows that virus concentrations “still remain well above the levels that would be expected based on confirmed case data,” said Daniel Gerrity, principal research microbiologist for the Southern Nevada Health District.
“That is not surprising, however, because of the availability of at-home rapid antigen testing,” he said. “This simply suggests that there are still quite a few new infections occurring each week, but these are not translating into hospitalizations or deaths based on (health district) recent data.”
Omicron subvariants currently circulating, though highly infectious, generally are causing milder illness than earlier strains, and are resulting in fewer hospitalizations and deaths, public health authorities say.
Elderly hit hard
Yet county residents continue to die of the disease, especially the elderly. This summer, those 65 and older accounted for 79 percent of COVID-19 deaths and 64 percent of hospitalizations, but only 18 percent of cases. All three metrics are up for this age group.
Early in the pandemic, before people built up immunity through vaccination or prior infection, working people were more affected by COVID-19 than elderly retirees who had the option of staying at home, said Julie Swann, a professor at North Carolina State University who researches COVID-19 trends and advises the CDC.
By now, many of those who were homebound are returning to normal daily interactions, exposing them to more disease, she said.
As people age, their immune systems weaken and, as a group, they acquire more underlying health conditions. “They get heart disease, lung disease, a lot of Type 2 diabetes,” Schaffner said. These underlying conditions are linked to becoming more severely sick from COVID-19.
In Clark County, between 56 percent and 59 percent of people who died with COVID-19 in the county in each of the past three summers had underlying health conditions, according to health district data.
Compared with the elderly, those under the age of 25 generally are getting off easier. As with those 65 and older, cases in this younger age group represented 18 percent of all cases in the county this past summer. However, those under age 25 accounted for only 6 percent of hospitalizations and 1 percent of deaths. There were four deaths in this age group; three of these were in children under the age of 5, the greatest number of the past three summers.
Younger people not only have stronger immune systems, but many of them by now have become ill from COVID-19 and recovered, acquiring a degree of natural protection against the virus, Schaffner said.
Despite the disparity, COVID-19 is still a leading cause of death for young people, Swann noted. In January, it was the fourth-leading cause of death in children ages 5 to 14 and in those ages 15 to 25, according to a study by The Peterson Center on Healthcare and the Kaiser Family Foundation.
‘Keep your guard up’
That Nevada is emerging from the summer wave of infections earlier than many other states is largely a function of timing, said Brian Labus, an assistant professor of epidemiology and biostatistics at UNLV’s School of Public Health.
“The wave hit us first,” Labus said. “And it passed us first. So right now, we are, just timeline-wise, a few weeks ahead of the rest of the country.”
It’s also possible, Swann said, that Nevadans have developed higher levels of immunity as a result of exposure to so many visitors, some infected with various strains of COVID-19.
However, the waning of immunity, along with the potential for a new variant to emerge that is better able to evade built-up immunity, create the possibility of another surge of infection this fall and winter, public health authorities say.
“Protection with COVID, as it will with influenza, will wane over time, so you have to keep your guard up,” Schaffner said. Nevada’s good metrics are “not a reason for you to blow off this new updated vaccine,” he said, referring to the reformulated booster shots recommended for those 12 and older.
“Right now, I would not be as concerned about Nevada as maybe some states,” Swann said. “But you just don’t know what will happen next month.”
Nevada’s good standing in terms of hospitalizations and cases “does not mean the pandemic is over,” she said.