CHICAGO - They include a retired nurse from Chicago’s South Side, a former teacher from Mount Vernon and a lawyer in Carbondale.
They joined others from all races and ethnicities, from deeply Republican to deeply Democratic parts of the state, more old than young, but all adding up, day after day, to propel Illinois to reach one more grim milestone for the pandemic this month: 25,000 official COVID-19 deaths, and counting.
Illinois crossed that threshold Oct. 1, after closing out its deadliest month since last winter, tallying more than 1,000 deaths in September alone. And the 25,000 doesn’t count about 2,700 additional deaths deemed as probable COVID-19 cases.
As the known death toll has grown over 18 months, a Tribune analysis of state and federal data shows how the pandemic’s deadly waves have evolved since March 2020 amid starkly different mask-wearing and vaccination habits across the state.
Deaths were originally clustered in Chicago’s more Black and Latino neighborhoods, but then spread beyond the Chicago area, to the point the virus has killed a greater proportionate share of residents in rural southern Illinois than dense Chicago.
Those trends were accentuated by the fourth and most recent of the pandemic’s surges, which began after vaccines were widely available. The Tribune found residents near Illinois’ southern tip — the least vaccinated — were nearly eight times as likely to have died in the latest surge than those living in the most vaccinated region, covering DuPage and Kane counties.
“We’ve had a pandemic now that’s among the unvaccinated,” said Dr. Ngozi Ezike, the director of Illinois’ Department of Public Health.
“And that just makes it more sad that we haven’t been able to get that same message across to everyone: that vaccines are one of the key strategies to preserving life and wellness in the midst of this ongoing pandemic,” she said.
As Illinoisans approach another winter battling the pandemic, the latest data may offer some comfort: The last two surges haven’t been nearly as deadly as the first two, and the latest one appears to be waning.
But in other ways, the latest data may fuel even more frustration, particularly Downstate: Deaths surged while huge swaths of residents didn’t take vaccines widely deemed safe and effective, and shunned masking rules meant to contain the virus’ spread.
“We’ve had a rough ride, and a lot of people died,” said southern Illinoisan Robert Hughes, whose mother was among the victims. “Those kind of behaviors have caught up with us.”
Left to try to make sense of the last 18 months are Hughes and others whose loved ones died from the virus. Among them is Robert Chapman, a Lincoln Square resident whose vaccinated father, Jim, died in mid-August.
“You still have the feeling that someone was taken from you before they should have been,” he said. “And I’m sure there are hundreds of thousands of families who had the same feeling.”
For them, the tragedy can be traced to the first news of a new, unusually deadly virus from a city halfway across the world, and the first indications it had crossed the ocean and entered Chicago.
First wave: Chicago hit hard
In early March 2020, Patricia Frieson hosted a family birthday party in her three-flat in Auburn Gresham.
There was singing and hugging. Over the coming days, they got together twice more. Then the retired nurse began having trouble breathing.
This was in an era of confusion and mixed signals over what was being called the novel coronavirus.
In just a few months, this strange new virus had hitched a ride in travelers from China and other infected countries, then began spreading here. Public health officials weren’t yet telling people to mask up or stay apart. Then-President Donald Trump had declared the infection was “totally under control” and complained his enemies were exaggerating the virus’s danger to help him lose reelection that fall.
Frieson, 61, wouldn’t live to the election. She died March 16, 2020 — marking Illinois’ first officially recorded death from COVID-19.
Experts now believe other Illinoisans likely had died sooner of undiagnosed cases, in a time when few people were being tested and symptoms could be confused for another respiratory disease. But, with Frieson’s death and more consistent testing, the official death figures quickly grew. And what developed was a pandemic that, initially, left a devastating toll in the Black and Latino neighborhoods of Chicago, like Frieson’s.
Epidemiologists have blamed that in part on the long-standing health inequities. Even before the pandemic, Black and Latino residents suffered from more underlying medical conditions and typically died younger than white residents.
On top of that, Black and Latino residents have been more likely to work “essential” jobs, such as bus drivers and grocery store clerks, that require they interact with others outside their homes, making it easier for the virus to infect them and their families.
By late July 2020, Latino Chicagoans were nearly twice as likely to have died as white Chicagoans. For Black Chicagoans, the rate was even higher: about 2 ½ times as likely as whites. And that helped fuel trends that have lingered since.
Killing the vulnerable
Dr. Allison Arwady, Chicago’s public health commissioner, said another key reason COVID-19 killed a greater share of Black Chicagoans in the first wave was that Black residents make up a larger share of long-term care residents.
The state had barred visitors from facilities and required that workers be screened for symptoms. But the virus often got in anyway. It was able to infect and spread from people not showing symptoms, entering often-understaffed facilities that struggled early on to get adequate testing or protective gear for workers, while the state cut back on health and safety inspections.
By late April 2020, the majority of COVID-19 deaths each week were tied to those living or working in long-term care.
That spring, the virus had inundated long-term care facilities in dense urban neighborhoods as well as the Chicago region’s farthest edges, killing not only residents but workers, too.
In one Kane County facility, the virus killed nearly a fourth of the residents in less than a month. In a Niles facility, the death toll approached 50 by the fall, as one nursing assistant recalled to the Tribune that “nobody knew how to handle this situation.”
The virus also had infiltrated some Downstate facilities too.
Jacey House, a funeral director at the Hughey Funeral Home in Mount Vernon, recalled times when her home would get two or three calls a night from one long-term care facility alone, “because everyone there had it.”
Deaths shift downstate
Early in the pandemic, most COVID-19 deaths were concentrated in the Chicago area. And that was true even after adjusting for population differences in the 11 health regions set up by the state.
One glaring statistic: By August 2020, a Chicago resident was six times as likely to have died from COVID-19 as a resident in the state’s South region, which covers 20 counties spread from roughly Mount Vernon to Illinois’ southern tip and east to the Indiana line.
But as fall 2020 approached, experts warned that rural Illinois was ripe to be hit hard by a second infection wave. Then came the second surge, the deadliest of them all.
When adjusting for population difference, the Tribune found the hardest hit was the state’s South region. By New Year’s Day, the South region’s death rate had caught up to and surpassed Chicago’s. And the gap widened still through the spring and summer.
Even as deaths skyrocketed Downstate, state surveys showed rural residents were less likely to wear masks than those in the suburbs or cities. In September 2020, only about half of rural residents said they always wore a mask in public.
Masking did grow in rural areas during the second surge, but still remained well behind rates in suburban and urban areas.
With the virus infiltrating all parts of the state, the death toll rose faster and faster.
By late October 2020, while updating reporters to the increasing pace of deaths, Ezike turned away from TV cameras to wipe tears, after noting the roughly 9,400 dead, by then, were “people who started with us in 2020 and won’t be with us at the Thanksgiving table.”
Two weeks later, Illinois crossed the 10,000 threshold. By mid-February, the state had crossed the 20,000 threshold.
Among the victims: Jane Marlene Hughes of Mount Vernon.
She grew up during the Great Depression on a hardscrabble farm in Missouri. She went on to become a schoolteacher in southern Illinois and raise five children, while bringing food and clothing to students who would have otherwise gone without.
She hoped to make 100, but died of COVID-19 at 98, in early January, before she had access to the COVID-19 vaccine, said her son, Robert Hughes, also of Mount Vernon.
Robert’s wife, Elizabeth Hughes, said she hears from people who still believe COVID-19 doesn’t exist or that it’s just like the flu and not meant to be taken seriously. Others will minimize the death count, saying it’s mainly the elderly who have been killed by the virus.
“It’s very hurtful,” Robert Hughes said. “Every moment is precious. I never thought I’d see people in Illinois — southern Illinois — become so hardhearted.”
The most recent surge offered the first time that the vast majority of Illinoisans could arm themselves with free, effective and easy-to-get vaccinations.
And, with a heavy push to vaccinate those in long-term care, that could help explain why that group makes up a far smaller share of those dying in more recent surges.
But other groups have been less likely to seek the shots. Their hesitancy has been fueled by massive disinformation campaigns that fed misleading and false information on social media. That disinformation came on top of already-deep distrust of the medical community by some Black and Latino residents, mindful of past racism in health care.
In that atmosphere, Black and Latino Chicagoans have continued to lag behind white and Asian neighbors in the rate of vaccination. A Tribune analysis of city and census data found roughly 41% of Black Chicagoans were fully vaccinated, compared with nearly 65% of white Chicagoans.
Arwady told the Tribune that the racial and ethnic gap in vaccinations has fueled the racial and ethnic gap in deaths. During the first wave, Black and Latino Chicagoans were two to three times as likely to die than white Chicagoans. From mid-March through late July, when vaccination became plentiful, the lower vaccination rates meant Black and Latino men were five to six times as likely to die than white men in Chicago.
“Now, the disparity is simply because of vaccine uptake,” she said.
Black Chicagoans and, to a lesser extent, Latino Chicagoans are joined by another group that has been far less likely to get vaccinated: residents of rural, mostly white, parts of the state.
It’s a trend tied to Republicans being far less likely than Democrats to get the vaccine, with some conservatives stoking distrust in vaccines, downplaying the virus’ severity or painting vaccine refusal as patriotic pushback of government overreach.
It’s hardened vaccine resistance in Illinois’ more rural areas, particularly in the struggling South region, where several residents told the Tribune this summer they were shunning the shots. Ten months into the mass vaccination campaign, the South region continues to have barely 4 in 10 of its residents fully vaccinated.
And, as experts feared, simple math became a key predictor of what areas would be hit the hardest, with less vaccinated areas seeing higher death rates in the latest surge.
For example, the South region saw a death rate of nearly 46 per 100,000 residents in the past two months. During the same period, in the state’s most vaccinated region of DuPage and Kane counties, the death rate was less than 6 — or just one-eighth of South region’s rate.
The troubling gap can be found in other state and federal data analyzed by the Tribune.
When looking at weekly data that compares statewide death figures for vaccinated Illinoisans compared with unvaccinated ones, the Tribune found the rate of death was more than triple for those yet to be fully vaccinated, compared with those who have been.
Risk to vaccinated, too
The analysis also highlights how the infection surge raised the risk even for those vaccinated.
No vaccine works perfectly for everyone, meaning the vaccine can dramatically lower the odds of death, but not eliminate them. So in areas where the virus is spreading rapidly, its floating droplets are more likely to be inhaled by the vaccinated, some of whose immune systems still may not be up to the fight.
That creates so-called breakthrough cases, some of which can still be deadly, such as Jim Chapman’s.
Chapman grew up in the Hyde Park neighborhood, graduated from Harvard Law School and dedicated much of his life helping the incarcerated and impoverished. He spent about two decades as president of the Uptown People’s Law Center in Chicago, then moved near the state’s southern tip and started a Carbondale nonprofit to support those in need.
He got vaccinated and continued working, at age 91, until he got sick with COVID-19.
His two sons, Robert and Richard, could visit their dad only briefly in the hospital, and to do so, they had to don a gown, N95 mask, plastic shield and gloves.
Robert Chapman said he wishes those avoiding COVID-19 shots could see the pandemic’s toll on families like his.
“If they could think more about others, or if they themselves had to go through that experience, they might view their decision about not getting vaccinated differently,” he said.
And there could be other deaths tied to the pandemic, even if not directly to COVID-19.
Researchers study so-called excess deaths, which are how many more deaths are occurring than typically have in the past. While many recent ones are attributed to the virus itself, there also has been a rise in other deaths, according to data kept by the Centers for Disease Control and Prevention.
Not counting the approximately 25,000 known COVID-19 deaths during the pandemic, or another roughly 2,700 the state deems probable COVID-19 deaths, the Tribune found the state had at least 5,000 additional deaths beyond the average for the past 1 ½ years.
Researchers blame these additional, non-COVID deaths on a host of factors, from sick people more leery of seeking care, to an overwhelmed hospital system that has to delay surgeries for the chronically ill to treat surges of COVID-19 patients. And, nationally, they’ve hit Black and Latino communities disproportionately.
How many more will die?
If there is positive news in the fourth surge, it’s that it has been nowhere near as deadly as last fall’s, and it appears to be waning.
Illinois deaths from COVID-19 now average a little more than 30 a day, after topping out near 40 in the most recent surge, which in turn was far less than last fall’s peak average of more than 150 deaths a day.
Deaths are expected to drop even more in the coming weeks because cases and hospitalizations generally have been dropping too in Illinois, with an increase in vaccinations and more natural immunity built up in survivors.
Plus, new treatments continue to be developed, the latest being a pill that its drugmaker said halves the chance of hospitalization and death in those recently infected. (It could be approved by regulators later this year.) And regulators are now weighing a request from Pfizer to OK their vaccine for kids 5 to 11, which if approved could limit spread in schools and lessen the chance adults catch COVID-19 from kids.
That said, epidemiologists have warned that Illinois could still see another surge. The virus could mutate into something more contagious or vaccine-resistant. As the weather turns colder, people may mingle more indoors without wearing masks, giving the virus an easier time spreading.
And immunity, from vaccination or a prior infection, can lessen over time. Health officials say booster shots are needed for Pfizer recipients who are six months past their second shot, if they live in long-term care facilities, are seniors, or are at least 50 with underlying health conditions. Other Pfizer recipients can get booster shots too, and regulators are considering OK’ing them for Moderna and Johnson & Johnson recipients.
As the infection rate ebbs and flows, one near constant may be the grief over the dead, and frustration the toll continues rising 18-plus months after the first COVID-19 death.
“Somehow we’re able to normalize the fact that ... 700,000 American people died in the last year and a half,” Robert Chapman said. “Thousands of people are dying every day from this. Somehow, we act as though this is normal.”