Here's why some Indianapolis metro counties were hit harder by coronavirus pandemic

Months before the first coronavirus case hit Indiana, the Hamilton County Health Department started preparing for a worst-case scenario.

Health officials didn’t know exactly what form a threat might take — would it be terrorism, an environmental disaster or a new disease — but they wanted to get ahead of whatever would come.

So when reports started coming about a new and potentially deadly virus, health officials paid close attention. They braced for an onslaught of deaths and ordered temporary morgues, fearing that the county might face a rash of deaths that would fill funeral homes and hospitals.

“We were expecting it to get worse much faster than it did,” said Chris Walker, public health preparedness coordinator. “We kept those two to three months and we were able to demobilize those… The alternative is not a pleasant thought.”

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Still, he said, while he and his colleagues knew the pandemic would last for some time, they never thought it would go on as long as it has — or that it would result in so many deaths, more than half a million for the United States alone.

While no country, state, or county has been immune from COVID-19, some have been harder hit than others. In the Indianapolis metro area, one factor played a significant role in which counties suffered more — age.

Simply put, places with older populations tend to have higher death rates. Johnson County's death rate per 100,000 residents, for instance, was nearly twice that of Hamilton County, which tends to have a younger population.

“What we have seen consistently from across studies, age is the largest predictor independent of these other factors,” said Brian Dixon, an associate professor of epidemiology at Indiana University's Fairbanks School of Public Health. “Where there’s a larger number of older adults, we are probably going to see higher death rates.”

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Central Indiana's numbers come against the backdrop of the toll that the COVID-19 pandemic has taken on the state and the nation as a whole.

Of the 20 countries most affected by COVID-19, only four other than the United States logged more deaths per 100,000 population, according to the Johns Hopkins University Coronavirus Resource Center. The United States saw just under 162 deaths per 100,000.

Indiana had an even higher rate than the national average with about 190 deaths per 100,000, according to the Kaiser Family Foundation.

Johnson County leads metro area in death rate

Johnson County has the highest rate in the metro area with nearly 230 deaths per 100,000 residents. Hamilton County has the lowest in the metro area at 118 deaths per 100,000. In Hamilton County, 399 have died. In Johnson County, 363 have died.

Marion County, which leads the state in death totals having lost about 1,670 residents to COVID-19 since the pandemic’s start, has a death rate of 173. Hendricks and Hancock Counties have similar rates of just under 178 and 173, respectively.

With a death rate of just over 134 deaths per 100,000, Boone County resembles Hamilton County while Shelby County’s rate of just under 206 deaths per 100,000 people comes closer to the Johnson County rate.

County health officials see the impact of age up close. In Hamilton County, which had one of the lowest death rates in the state, 87% of the population is younger than 65, Walker said.

“I think we have that going for us,” he said.

In addition, a high percentage of residents have health insurance and the county has six full service hospitals so people who fell ill likely had access to care, he said.

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'One became two became 10...'

Johnson County has many residents with underlying health factors as well as many large long-term care facilities that housed a number of seniors, said Betsy Swearingen, Johnson County Health Department Director.

The county's first death, however, occurred in a person who was not a long term care resident. That death occurred just hours after the state’s first death — and was just the first of many that Swearingen would learn of in the coming days, weeks and months.

“It was shocking because we had been tracking this particular individual,” she said. “It was scary. One became two, became 10, become 20 and it was a wonder of when it would ever stop.”

For a while, over the summer the death rate fell. On July 4, the seven-day average daily deaths dipped to a single digit and for much of the summer, it hovered just above 10 deaths per day.

Then the case and death count stated climbing again. The higher the number of cases an area sees, the higher the hospitalization and death rates likely climb a few weeks later.

In the early fall, a major outbreak hit the southside of Indianapolis, bleeding into Johnson County, Dixon said. A number of large events such as weddings contributed and the Burmese population, as well as the school population felt the impact.

“That’s one of the reason that Johnson County sticks out,” he said. “It did have a large number of cases that crossed ages, ethnicities.”

Numbers improving

The pandemic’s two-pronged surge — one in the spring and then a far uglier one in the fall — caught some by surprise.

After the spring bulge in cases and deaths, Shelby County Health Department Director Robert Lewis hoped the worst had passed. That county saw a cluster of nursing home deaths early on but then the virus appeared to have gone elsewhere. Then the county would see another set of deaths.

“It stayed stagnant at 15, 16 at the longest period, then we had another outbreak,” Lewis said. “We were at 18, 19 for the longest time, then we had a little spike and stopped again and next thing you know, they’re (the state) showing 91…. It’s the personal thing that shocks us more than the number, knowing them in the community.”

While the state has Shelby County at more than 90 deaths, the Shelby County Health Department had only registered 73, Lewis said.

It’s not clear how the difference arose, Lewis said. The state may rely on ZIP codes to assign deaths, which could lead deaths that occurred in Johnson or Hancock counties to be appear as Shelby deaths.

Or, he said, hospitals may report some deaths to the state but not the county.

“I think there’s some discrepancies with the numbers,” he said.

Either way, Lewis along with other health officials, hope that the state has seen the worst that the virus can do. Indiana has taken an age-based approach to its vaccine rollout, with state officials saying that they have prioritized those most at risk of dying or being hospitalized should they fall.

Since the start of the year, the number of people dying each day from COVID-19 has dropped dramatically. At the beginning of January, just under 100 people died each day in Indiana over a seven-day average. Now, that number hovers just above 10.

On a recent day the Johnson County Health Department noted an unusual occurrence. No new COVID-19 cases were reported for any private residences, Swearingen said.

It's the first time that has happened since the pandemic began.

Contact IndyStar reporter Shari Rudavsky at shari.rudavsky@indystar.com. Follow her on Facebook and on Twitter: @srudavsky.

This article originally appeared on Indianapolis Star: Here's why some Indianapolis metro counties were hit harder by coronavirus pandemic

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