Troubling trend in pandemic: More young people infected, ill

San Francisco Chronicle, By Catherine Ho, August 10, 2020

As the coronavirus enters its eighth month, a troubling trend has emerged in the Bay Area and around the nation: More young people are getting sick, in numbers so large that in some regions they now make up the largest and fastest-growing demographic contracting the virus.

It marks a dramatic shift from the narrative that dominated the early weeks of the pandemic, when health experts emphasized that older adults, in part due to the higher likelihood of chronic health conditions, were most at risk of falling ill.

“We are seeing increased rates of infection among young adults,” Santa Clara County public health officer Dr. Sara Cody said at a July county board of supervisors meeting. “It’s where the epidemic is spreading the most quickly. … This is disproportionately accelerating among young adults.”

In six Bay Area counties, people in their 30s or younger make up the largest proportion of cases. In San Francisco, for instance, 18-to-40-year-olds represent 48% of all cases; in Santa Clara County, 20-39­year-olds represent 39% of all cases. Anecdotally, the region’s medical clinics are reporting a major uptick in younger people coming in with COVID-19 symptoms like shortness of breath, fever and cough.

Statewide, the number of cases among people ages 18 to 34 shot up 1358% between May 1 and Aug. 1, from 12,373 to 180,354 — representing an increase from 24% of all cases to 35% of all cases, according to the California Department of Public Health. During the same period, the number of cases among people 65 and older grew more slowly, 387%, from 11,547 to 56,206 — representing a drop from 22% of all cases to 11% of all cases.

At the Stanford coronavirus outpatient clinic, the proportion of patients under age 40 has more than doubled since April, from about 25% to 55%, said Dr. Maja Artandi, the clinic’s medical director.

In the South Bay, Kaiser is seeing more patients under age 30 getting hospitalized with COVID-19, which was unusual during the first surge in March. And more patients in their 20s are also seeking medical care for the virus from their primary care doctors.

“It’s worrisome,” said Dr. Charu Ramaprasad, an infectious disease physician in Kaiser’s San Jose Medical Center, who has been leading much of the health system’s coronavirus response.

Health officials and physicians have not pinpointed exactly why younger adults appear to be driving the latest surge in infections. But many believe it is likely because young people have been going out more — either for jobs that require them to interact with the public frequently, or in social settings — and are being more lax about social distancing and wearing masks.

And younger people may experience less severe symptoms, which may lead them to think it’s OK to gather with friends if they have just a minor cough or a scratchy throat, said Dr. Aisha Mays, medical director of the Dream Youth Clinic at Roots Community Health Center in Oakland.

“We have seen our young folks have a false sense of security that make them more susceptible to contracting COVID,” Mays said. “In the beginning, we were really concerned about our elderly population because they are so much more susceptible to the negative effects of COVID, including death. At the same time, it might have sent an unintended message to our young people that they were more immune to contracting COVID.

“We know that’s not true. We know young people can still contract COVID as easily as anyone else.”

People in their 20s and 30s are less likely to be hospitalized or die from the coronavirus than people in their 60s and 70s. Eight out of 10 coronavirus-related deaths in the United States have been among adults 65 or older, according to the U.S. Centers for Disease Control and Prevention. And hospitalization rates for people between 18 to 29 years old are 56 per 100,000, compared to 281 per 100,000 for people between 65 and 74 years old.

Still, many young people have symptoms severe enough to send them to the emergency room or intensive care. And even if they have mild symptoms, they still risk exposing older family members or friends who may get much sicker from the virus.

One of them is Tyler Lopez, 27, who in June began experiencing fatigue and chest congestion and lost his sense of smell. Lopez tested positive for the coronavirus, quarantined for 10 days and felt like he had recovered — but was soon hit with a second and much more severe wave of symptoms.

His heart rate repeatedly shot up to above 120, at times going as high as 140, even when he was sitting or lying down, and he had a fever and chest pain so bad it felt like the inside of his chest was inflamed, he said.

Lopez, who lives in Riverside, was admitted to a hospital twice. Doctors ran tests and concluded the COVID-19 infection likely caused inflammation in the tissue surrounding the heart, and that he could’ve gone into cardiac arrest if the medication he received at the hospital had not reduced the inflammation fast enough, he said.

“It’s just crazy what COVID can do,” said Lopez, who was released from the hospital last week and is recovering at home. He plans to go back to his doctor next week to see if he can get cleared to return to work — nearly two months after he first noticed symptoms. “The past couple months, it totally changed my life.”

Before he got sick, Lopez said, he did not take the virus seriously and continued going to the gym and meeting up with friends.

“I was like, ‘It’s not that big of a deal, whatever, if I get it, I get it,’ ” he said. “I was just living life without taking that extra precaution.”

He now wishes he had been more careful.

“It jacked me up,” he said. “I wouldn’t wish this on my worst enemy.”

Local health officials recently launched initiatives to urge people in their teens and 20s to practice social distancing, wear masks and limit activities to the outdoors like biking or hiking. Contra Costa County beginning Aug. 10 will start training hundreds of youth ambassadors to help get the message out to their peers.

A regional effort led by seven Bay Area public health departments, Crushing the Curve, has a similar aim.

Brandi House, 19, will participate in both programs as a youth leader. She said many of her acquaintances and coworkers have been going to parties during the pandemic, not believing the virus is serious or that they will get sick. She hopes to help dispel such attitudes.

“The message I’d like to put out for young people is to know this is real,” said House, of Richmond. “I know a lot of people not believing COVID is real. I know people that are still going to parties and stuff. I’m like, ‘Why are you going to parties during this time?’

“There’s a lot of people that have been getting sick and passing from it. That’s one message I want to get out.”