After 18 months of public-health guidance promoting universal vigilance, I think hardly any American has a clear view of just how dramatic these differentials are. All else being equal, an unvaccinated 66-year old is about 30 times more likely to die, given a confirmed case, than an unvaccinated 36-year-old, and someone over 85 is over 10,000 times more at risk of dying than a child under 10. And although many infections still go undetected (complicating any attempt at a universal calculation of risk), your chances of dying from a confirmed case roughly double with every five to eight years of age, as countless data across multiple countries demonstrated last year — an effect larger than even the most significant comorbidities. The “exponential growth” of mortality risk by age is, in other words, another aspect of the pandemic we have processed only poorly.
Over the past nine months, vaccination has utterly transformed the shape of the pandemic in the places where it has penetrated the whole population. The effect isn’t just visible in countries like Portugal or Iceland — where the threat appears to be fast receding and which give an encouraging picture of our possible future — but in parts of the United States as well. But for all its transformative, liberating power, vaccination has not broken the basic age skew of the disease or offered anyone an exit ramp from it. Instead, in two profound ways, vaccination has confirmed the age skew: by producing severe breakthrough cases concentrated overwhelmingly in the elderly and by reducing the risk faced by individuals by an astonishing degree that is nevertheless smaller than the still more striking effect of age.