Shirlonda Tucker didn’t leave the house much in the past year, and she double-masked when she did. So her positive COVID-19 test came as a shock.
“I said, ‘Are you sure, you’re really sure?’” she quizzed the nurse who tested her last month after she began showing symptoms.
Cases, hospitalizations and deaths are all down significantly in Maryland from the winter surge, but people continue to get sick — in some cases, very sick. On Saturday, 375 were hospitalized, 94 in intensive care. Seven more deaths were reported, bringing the state’s coronavirus death toll to 9,387.
Through time and targeted efforts by public health officials, there have been shifts big and small in who is most likely to end up in a hospital bed. The data shows the typical patient now looks a lot like Tucker — a 47-year-old African American woman with asthma who was not yet vaccinated.
Minorities have been affected disproportionately since the pandemic’s start last year, and though the gap has narrowed, a stark fact remains: More Black than white Marylanders are admitted to the hospital each day, though Black people make up less than a third of the state’s population.
Hispanic residents, too, continue to wind up in the hospital with COVID in disproportionate numbers.
What has changed is the age of patients, with hospital patients no longer dominated by those 65 and older, an analysis of hospitalizations since the beginning of March shows.
People 45-64 now account for more than 40% of those hospitalized in Maryland with COVID, followed by patients over 65 (about a third) and those 25-44 (almost 20%). Distantly behind are those ages 15-24, at 4%, and those up to age 14, under 2%.
Many have underlying health conditions. Rare are the fully vaccinated patients, two weeks past their most recent shot.
The profile of Maryland hospital patients comes from interviews with doctors from the state’s four largest hospital systems and data from the Maryland Health Department. The hospital admissions data was collected by CRISP, the state-designated electronic medical records system, and released to The Baltimore Sun.
Doctors say, not surprisingly, the shift in those hospitalized partly follows who wants to — and can — get vaccinated.
“Vaccinated people don’t get so sick and come to the hospital, though we’ve seen people not fully vaccinated,” said Dr. Esteban Schabelman, chief medical officer at Sinai Hospital in North Baltimore, part of the LifeBridge Health System.
The U.S. Centers for Disease Control and Prevention no longer collects data on every COVID case in vaccinated people, but last month the number was just over 9,000 nationally. About 133 million Americans, or 40%, are fully vaccinated.
Almost 2.9 million Marylanders, or about 47%, are fully vaccinated.
Leading the vaccinations are the elderly, thanks to early prioritization after the virus stampeded through nursing homes. More than eight in 10 of those over age 65 now have received at least one dose of COVID-19 vaccine.
As disparities in vaccinations between Black and white Marylanders emerged, state and local health officials sought different ways to reach minorities, both those hesitant to get inoculated and those without access to a vaccine provider. The state formed a task force and, along with local health departments and hospitals, began hosting small clinics in apartments and churches, with mobile vans and going door-to-door.
Such efforts have diminished but not closed the gap. Early this year white Marylanders were being vaccinated at four times the rate as Black people. The rate still exceeds 2.5 times; it should be 1.9 times based on population share.
That continues to leave Black Marylanders, even younger ones, vulnerable to more severe illness.
A Sun analysis of state data shows that by the end of the pandemic’s first wave in April and May 2020, the hospitalization rate of Black residents was almost three times that of white residents. It’s now about two times.
In all, among cases where race and ethnicity is known, more than 19,000 Black Marylanders have been admitted to the hospital during the pandemic while about 17,000 white residents have been admitted.
Meanwhile, almost 6,900 Hispanic people have been hospitalized, about 15.5% of the total hospitalizations, though they make up only about 9% of the population.
Tucker said her hospitalization changed her perspective. She was initially hesitant about getting vaccinated because she thought the government moved too quickly to authorize the vaccines, but after some reading decided to seek an appointment. Like many Marylanders until recently, she couldn’t find one but felt no sense of urgency.
Then her nose began to run and she felt achy and went for the COVID test. As she was quarantining at home, she got more fatigued and then had trouble breathing. Tucker, who lives in Baltimore, eventually was taken by ambulance to Grace Medical Center and then transferred to Northwest Hospital in Randallstown where she spent 12 days on oxygen.
She was released May 18 with a mission.
“I tell everyone to get vaccinated now, my daughters, everyone,” Tucker said. “You think this is a disease of seniors, but it’s a disease of everybody.”
Tucker has to wait 90 days to get her vaccination because she was treated with monoclonal antibodies before she was hospitalized. The treatment is intended for early use in those who become infected with COVID-19 and are at high risk of becoming severely sick. It can keep mild cases from becoming worse and reduce hospitalizations, though demand hasn’t been strong nationally.
Maryland has been more aggressive in marketing the therapy to doctors, and as of May 9 had administered 7,887 doses, almost two-thirds of what it was allocated by federal health officials.
The state, meanwhile, is contending with a drop in demand for the vaccines. Gov. Larry Hogan offered $100 in incentive money to state employees and more recently announced that anyone who gets a shot will be entered into a lottery for cash prizes.
Sinai’s Schabelman said the patient mix could shift again as the vaccination effort evolves. He said the most striking thing is the lopsided number of women who have been scheduling vaccinations through the hospital clinic compared to men.
At Johns Hopkins, Dr. Panagis Galiatsatos, a pulmonary and critical care medicine physician, said he sees the gap closing somewhat between white patients and those who are Black or Hispanic.
“Health care disparities existed before the pandemic, and we still have a lot of work to do,” Galiatsatos said. “But we’re seeing our efforts work and seeing that disproportionate impact coming down. The gaps were appalling.”
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Doctors say health disparities are a key factor in the hospitalizations.
Minorities disproportionately suffer from many conditions, and the CDC reports that heart disease, high blood pressure and obesity are big risk factors for more severe COVID-19.
Public health officials recognized early on that minorities are more likely to have front-line jobs and live in congregate settings where they are more easily exposed to the virus. Now doctors say people are socializing more as mask mandates and other restrictions are lifted. And new, more contagious variants are behind more cases and more serious cases.
Everyone unvaccinated is at risk, but those with underlying health conditions are at particular risk, said Dr. Stuart Bell, vice president of medical affairs at MedStar Good Samaritan and MedStar Union Memorial hospitals.
Bell said the pandemic has made the racial disparities in the health of Marylanders starker. He said medical and public health authorities have an opportunity to better understand and tackle them.
“A crisis is a terrible opportunity to waste,” Bell said. “It may be forced, but I hope we learn from it.”
Baltimore Sun data analyst Steve Earley contributed to this article.