Covid-19 deaths among young adults in some areas temporarily rivaled or exceeded opioid deaths in parts of the US this year

In research published today in JAMA, my colleagues and I report that among US adults ages 25-44, nearly 12 thousand more deaths occurred between March 1st and July 31st than were projected based on prior trends. All-cause mortality was around 120% of normal in this group. Covid-19 deaths in regions like New York/New Jersey as well as parts of the South and West, appear to have matched or exceeded unintentional opioid deaths during a similar timeframe in 2018, which is the most recent year that national overdose data are available. Normally, unintentional overdoses are the leading cause of death among adults in this age group. Whether covid-19 or unintentional overdoses are the leading cause of death in many regions currently is unknown. But the shocking truth is that in many areas, it's a close call.

This goes against our previous assumptions that covid-19 is relatively harmless to young adults. While in comparison to adults over 65 years of age, covid-19 has caused a far lower number of deaths. Work previously published by the U.S. Centers for Disease Control and Prevention (and our work) shows that the age group with the largest increase in all-cause mortality above baseline expectations is in fact adults ages 25-44. In fact, more Americans under the age of 40 have died of covid-19 than died among the U.S. military during Operation Iraqi Freedom.

In addition, adults in the ages we studied are among the lowest on the vaccine priority list. Policies that decrease spread among young adults in the coming months will save thousands of young adult lives.


Growing divide in vaccine allocation

Amidst the flood of data emerging from the covid-19 pandemic, one resoundingly clear piece of information is that minority and members of poorer socioeconomic communities have felt a greater effect. This has led to an ongoing ethical discussion as to whether those at highest risk of catching or dying from the virus should receive the vaccine first. 

This discussion was outlined in the Journal of the American Medical Association in October. Previous recommendations from the National Academies of Sciences, Engineering, and Mathematics placed healthcare workers just ahead of those with significant comorbidities in terms of vaccination priority. 

While such thought to tiering should apply globally, contract data collected from Duke University in partnership with UNICEF's vaccine supply dashboard shows that wealthy nations have reserved the vast majority of potential vaccines, in some cases on the order of six times the size of a nation's population. Given the early uncertainties around vaccine candidate success rates and unpredictable rollout timelines, nations with the ability to do so finalized contracts with multiple vendors in anticipation of production. For some impoverished nations—in many cases, those whose populations have worse covid-19-related morbidity and mortality—this means the ability to only cover a fraction of their population. Even with pledges from nations to donate their extra supplies, some experts believe an adequate global supply may not be available until 2024.  Various.

—Brief19 Policy Team

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