Was omicron more deadly than it needed to be in Mass.? Some experts say yes

By the latest official count, 3,736 Massachusetts residents have died of COVID since omicron first surged in the state in December.

Now that the spike in cases has abated, experts are debating whether this latest COVID wave was bound to be so deadly — or if something could have been done differently, and they want to know how the commonwealth compares to other places.

The answers to these questions can offer important insights into what needs to change in the state's pandemic response and how. But it's been a puzzle for researchers to figure out the best way to measure and compare COVID deaths.

By looking at the data in a few different ways, researchers are starting to draw some compelling conclusions. For starters, more people died during the omicron wave than the delta surge, even though omicron caused more mild illness.

Collectively, the numbers suggest Massachusetts fared better than many other states against omicron. And yet, despite its world-renown medical centers and high vaccination rate, the commonwealth does not measure up well in at least one international comparison.

Researchers say behind the numbers is a story of how vaccinations and boosters saved lives. But also, they say, behind many of the funerals is a story of how more emphasis needed to be placed on getting boosters to those who needed them the most.

“We botched it. We felt really good about ourselves delivering millions of booster doses to the young and healthy, but we didn't really protect the vulnerable that way.”

Dr. Jeremy Faust, Brigham and Women’s Hospital

“We botched it,” said Jeremy Faust, an emergency room physician at Brigham and Women’s Hospital and a faculty member in its division of health policy and public health. “We felt really good about ourselves delivering millions of booster doses to the young and healthy, but we didn't really protect the vulnerable that way.”

Older individuals are particularly vulnerable in this pandemic. In Massachusetts, more than two-thirds of residents 65 and older are boosted, as are the vast majority of long-term care residents.

State officials declined an interview request for this story, but pointed out the state has among the highest vaccination and booster rates in the country, and jabs are readily available to all eligible residents.

Despite this, omicron took a significant toll.

"We just had the biggest surge in cases ever, even a year after the rollout of vaccines, which is probably the worst case scenario that any of us could have imagined," said Shira Doron, a hospital epidemiologist at Tufts Medical Center.

And, new analyses suggest, alongside surging cases came a substantial number of deaths.

Excess Deaths: Omicron Was Worse Than Delta

Public health experts are very good at predicting how many people will die each week of the year, in normal times.

When there are more deaths than expected, researchers call these "excess deaths" or "excess mortality." It's a measure some public health experts are closely watching as they try to assess the impact of the pandemic. “Generally, we found that number tracks pretty tightly with COVID, [with] COVID deaths,” said Faust.

Every week, since the summer of 2021, there have been significant numbers of excess deaths in the commonwealth. That trend ended in the last week of February when there were no excess deaths. In March so far, there have been no — or very low — excess deaths.

Faust argues this is a good sign that the emergency phase of the omicron surge has ended.

However, during the height of omicron, Faust says excess deaths were "historic."

“Week after week there's 200, 300, even 150 more deaths in the state per week,” said Faust. “We had more excess mortality during omicron than we did during delta in Massachusetts.”

Although the omicron surge was shorter, and the variant caused less severe disease overall, so many people became infected that more people died. And Faust found that in Massachusetts, “the excess mortality that we experience in omicron was highly concentrated in the regions with the lowest vaccination rates.”

According to Faust, Massachusetts is especially quick at reporting data that allows researchers to calculate excess deaths. “We are the best in the country and probably the best in the world,” said Faust.

As a result, there is often a lag in getting similar data for other states, so it’s hard to know how Massachusetts measures up — yet. But there is another metric that does allow for quick comparisons.

'We're On The Lower End' (And That's A Good Thing)

Case-fatality rates are a measure of how many people got COVID and died as a result. Researchers calculate the rate using state reporting of the total number of COVID cases and deaths.

“It looks like for case-fatality, we're on the lower end of the spectrum,” said Emily Pond, a Massachusetts-based epidemiologist who works for Johns Hopkins’ Coronavirus Resource Center.

During the omicron wave, Massachusetts came in at number 17 in Johns Hopkins' ranking, which suggests the variant was less deadly in 14 other states plus the District of Columbia and Puerto Rico. But in the majority of states, omicron was more deadly than in Massachusetts.

Pond acknowledges the case-fatality rate is far from a perfect metric. Case counts are often a severe undercount. During the omicron wave, there was a shortage of testing, and many people turned to at-home rapid tests, which rarely get included in the official case counts.

Pond says the availability of testing varied a lot state-to-state, as does the overall health and age of different populations. All of this can influence case-fatality rates significantly.

How COVID deaths are counted also varies. Earlier this month, Massachusetts narrowed its definition of a COVID death, resulting in the removal of roughly 4,000 deaths from the state’s COVID total. “Our approach proved to be too expansive and led to a significant overcount of deaths in Massachusetts,” said Margret Cooke, commissioner of the Department of Public Health.

And, since COVID can trigger other, potentially fatal health problems, what is recorded on a death certificate is often a judgment call.

Despite these challenges, Pond believes there is still value in looking at the broad trends. They allow researchers to answer questions like what states with lower case-fatality ratios are doing compared to states with higher case-fatality ratios.

For Massachusetts and other states with relatively low fatality rates, “they tend to have higher vaccination coverage, [and] they tend to test a lot,” Pond said.

Why Massachusetts Was Worse Than The UK 

Vaccinations and testing may have helped more Massachusetts residents survive omicron, but some experts believe the state could have done better.

Throughout the pandemic, health experts have drawn parallels between Massachusetts and the United Kingdom, pointing to similar age distributions in the populations and a high degree of health care coverage. They have found that COVID trends in the U.K. have often foreshadowed what happened in Massachusetts.

However, their paths diverged in one crucial way during omicron: The U.K. recorded far fewer COVID deaths per capita than Massachusetts.

"...as omicron came on the scene, it has been worse than it needed to be."

William Hanage, Harvard T.H. Chan School of Public Health

“The cumulative deaths in Massachusetts relative to the U.K. are between two and three times what you would expect once you correct for the population size,” said Bill Hanage, an epidemiologist at Harvard’s T.H. Chan School of Public Health.

He attributes the difference in omicron deaths to booster shots.

“The U.K., as soon as omicron came on the scene and indeed before then, was rolling out boosters at a real rate of knots.” he said. “They did extraordinarily well and got considerably more than 90% of the over 65s vaccinated. We've lagged.”

Massachusetts has boosted nearly 3 million residents, including nearly 70% of people over 65 years old and 90% of long-term care residents.

"Massachusetts is a national leader in vaccination rates," the state's Executive Office of Health and Human Services said in an emailed statement. "This nation-leading progress has helped keep Massachusetts’ positivity and hospitalization rates among the lowest in the nation currently."

Hanage says the right way to think about boosters is to consider the unboosted population: Less than 10% of the U.K.’s older population is not yet boosted compared to roughly 30% of Massachusetts’ older population.

To some degree, Hanage agrees the state has done a good job. After what he calls a disaster in responding to the first wave of the pandemic, Hanage says Massachusetts was doing really well during the delta wave.

“The point where it starts to become less impressive is the last few months," he said. "Because as omicron came on the scene, it has been worse than it needed to be.”