What is driving the surge in COVID-19 hospitalizations in North Carolina?

The roll-out of coronavirus vaccines last winter helped empty COVID-19 wards and intensive care units at hospitals across North Carolina, as the number of patients dropped from nearly 4,000 in January to a few hundred in June.

Now that trend has reversed, as the more contagious delta variant preys on people who have not gotten vaccinated.

Statewide, 817 people were hospitalized with COVID-19 on Thursday, according to the state Department of Health and Human Services. That number has doubled since early July and is the most since mid-May.

About 94% of new COVID-19 cases are among people who have not been vaccinated, according to state health officials. And a growing number are among people who have contracted the delta variant of the virus, which spreads more easily than other versions.

“Delta has swamped all of the other types of COVID at this point,” Dr. Mandy Cohen, secretary of the state Department of Health and Human Services, said this week.

Of the coronavirus samples tested at Duke Health hospitals in the Triangle last week, 82% were the delta variant, according to Dr. Adia Ross, chief medical officer at Duke Regional Hospital in Durham.

And of the coronavirus samples collected the week ending July 11 and analyzed by UNC hospitals, 90% were the delta variant, up from less than 10% in June.

Given the spread of the variant across the country, those number aren’t surprising, said Dr. David Wohl, an infectious disease expert at UNC.

The people with COVID-19 ending up in hospitals are different from earlier patients in another important way: They’re younger.

“When we look at the ICU for COVID-19, we’re taking about people in their 30s, 40s and 50s,” Wohl said. “I mean there’s hardly a person there who is older. It just really tells you a completely different story than what we saw before. Much younger people are coming into the hospital.”

Wohl says that reflects the higher vaccination rate among older people in North Carolina. About 57% of adults 18 and up in North Carolina are fully vaccinated against COVID-19, but that number jumps to 84% when you look at just those age 65 and older, according to DHHS.

In January, those age 60 and older accounted for about 70% of people hospitalized with COVID-19 in North Carolina. Now it’s about 40%, according to DHHS.

“There’s just fewer people in that age group who are vulnerable,” Wohl said. “The older people have really gotten the message regarding prevention measures and have adopted vaccination at the highest rates.”

Vaccination is not a guarantee against getting sick with COVID-19. From the beginning, the manufacturers and public health officials have noted that the vaccines are 90% to 95% effective, meaning some vaccinated people will get sick.

But it’s rare that vaccinated people end up sick enough to be hospitalized. Ross said she knows of a couple of cases at Duke, and they had underlying health conditions that suppressed their immune systems.

“The vaccines are not 100% foolproof,” she said. “But they’re really, really good in general.”

Ross said the rising hospitalizations are sobering and should temper any sense that the pandemic is over.

“What is hard for folks is that we were celebrating getting vaccinated and so many of us have done that. But there still is work to be done to reach those who are unvaccinated and convince them to get vaccinated,” she said. “We’re not where we were in January, but we also need to remain vigilant.”