At the end of March, 32-year-old Adam Hergenreder went to the hospital because he couldn’t breathe.
His parents pleaded with him to find help another way. They were scared that in a hospital, their son would catch the coronavirus and be too weak to fight it off. But Hergenreder, who has struggled with lung issues and asthma his entire life, admitted himself.
He got his breathing under control and tested negative for COVID-19, so Hergenreder was discharged and went home to Clearwater, where he lived with his parents.
Because of his breathing symptoms, he had been briefly placed in a COVID-19 unit. Days later, he began to experience coronavirus symptoms and tested positive. That landed Hergenreder back in the hospital.
Weak from being bedridden so long, he often fell. Then came pain medication for the back injury that left him constipated, and later, surgery. His condition deteriorated until he died on July 6. He tested positive for COVID-19 for 94 straight days.
“If the virus wasn’t around, I’m sure he’d still be alive,” said his mother, Elaine Minichino.
Deaths among younger people like Hergenreder have been notably rare during the pandemic. In Florida, 18 percent of people who have died from the coronavirus were under the age of 65. But Hergenreder had a history of health problems, including diabetes, that made him especially vulnerable. From the beginning, Minichino said she worried that if her son caught the virus, he wouldn’t survive.
Across Florida, 84 percent of people under the age of 65 who died from the coronavirus had an underlying medical issue, according to a Tampa Bay Times analysis. Reporters reviewed thousands of death reports compiled by medical examiners from across the state.
Some of the common ailments were diabetes, heart issues and obesity. Many patients had more than one condition.
Public health officials have said for months that seniors, who tend to be most at risk for pre-existing medical conditions, are the most vulnerable in the pandemic. But assessing the risk for patients like Hergenreder has become increasingly important.
When cases swelled at the start of June, the largest share of infections came from people in their 20s and 30s, according to the Florida Department of Health.
The Times’ data analysis is based on an early July report by the Florida Medical Examiners Commission, which lists 6,013 COVID-19 related deaths. It shows that 1,067 people under the age of 65 have died in Florida.
Dr. Timothy Brewer, a professor of medicine and epidemiology at UCLA, said most young people who die from COVID-19 have other health issues that complicate chances of recovery.
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“While it’s tragic when anybody dies unnecessarily or prematurely from an infection like COVID-19 at least so far most people, particularly under the age of 50, seem to tolerate the infection well,” Brewer said. “And those individuals who do end up in the hospital with severe disease or tragically do die are the exception.”
Who are the state’s youngest deaths?
Not all the young deaths attributed to COVID-19 in Florida have been among people with underlying conditions.
The youngest death, in fact, was a 9-year-old in Putnam County, Kimora Lynum. She had no identified medical issues, according to her family.
Most have had other health concerns, the Times analysis found. An 11-year-old in Miami-Dade, Daequan Wimberly, had health issues since birth and underwent dialysis before his death, according to the Miami Herald.
Yansi Ayala, 11, who died in Broward County, suffered from epilepsy, asthma, cerebral palsy and other issues, according to NBC6.
Two 17-year-olds also have died, in Pasco and Lee counties. Carsyn Davis, the Fort Myers girl who died from the virus, was a cancer survivor and had an autoimmune disorder.
Before coming down with the coronavirus, Davis had gone to a church party and was then treated with the unproven drug hydroxychloroquine.
Other deaths include a 22-year-old in Palm Beach County. She hadn’t had a seizure since she was 3 years old but experienced one in the hospital where she was diagnosed with an anoxic brain injury. She died eight days after arriving at the hospital. The medical examiner didn’t identify any previous medical conditions in their report.
In all, 19 people in Florida under the age of 24 have died from the virus since March.
Age is the biggest risk factor. But overall health is a close second
Even a healthy 70 or 80-year-old is at risk for dying from the virus, said Dr. Jeffrey Laurence, a professor of medicine at Weill Cornell Medical School in New York. But for people of all ages, pre-existing health conditions have made the coronavirus far more deadly.
The severity of the virus depends on how healthy the person is at the time they contract it, Laurence said. But what makes the disease fatal for some remains a mystery as research struggles to keep up with the growing death toll.
When the virus surged in New York in March, one of the first patients Laurence saw was a 30-year-old bodybuilder. That patient was still on a ventilator into summer, Laurence said. The next patient he treated was a 40-year-old woman who suffered severe heart failure as a result of COVID-19.
Physicians are still puzzled about why men are more likely to die from the coronavirus than women. Across all age groups, men die more often, Laurence said. In Florida, 68 percent of all coronavirus deaths under 65 years old are men.
“You’re going to find these outliers and that’s going to teach us a lot,” Laurence said.
Conditions like diabetes, hypertension and obesity create an additional strain on the body to fight the virus, Laurence said. That’s true even if they’re young.
“It’s not the virus. It’s all the stuff that the virus does,” Laurence said. “And if you’re not good at shutting it off very quickly, then the virus stays there. It’s an immune system problem.”
Those people may produce more immune proteins than normal, Laurence said. That means their systems may respond more “dramatically” to fight infections. While that may seem like a positive response, this overreaction can lead to other serious health problems, like blood clotting.
“Somehow this virus seems to be evading the antivirus part of this immune system,” Laurence said.
Close quarters means more exposure and greater risk
Some of the youngest fatalities also involved those in the most at-risk environments for contracting the coronavirus.
Of the deaths in Florida under age 65, at least 10 were among cruise ship employees. One was a FedEx pilot who flew to China. Another was a chief engineer on an international cargo ship. And there was a Transportation Security Administration agent from Osceola County.
Physicians said that the closer the proximity to others in busy indoor areas, like in airports or jails, the easier it is for the virus to spread.
The reason someone with a high-exposure job may die, even at a younger age, has more to do with the odds of getting infected and less to do with repeat exposure, UCLA’s Brewer said.
Some early studies show people with the coronavirus may develop neutralizing antibodies, which offer protection against getting the virus again. But working in a high-contact environment generally means they’re more at risk.
Why are some young people seemingly unfazed?
Viral images of crowds on Clearwater Beach made national headlines in April, which ushered in the temporary closures of beaches across the state.
Before the Department of Business and Professional Regulation shuttered bars in mid-June, young people packed into pubs and long lines snaked down 7th Avenue on the weekends in Ybor City. Some local businesses chose to close because employees tested positive for COVID-19.
Laurence Steinberg, a professor of psychology at Temple University, said young people are “just thinking about how much fun it’ll be and not thinking about the likely cost.”
Early on, Steinberg said, it seemed the virus would only affect older adults, making younger people think they’re invincible.
Being cooped up during quarantine also made young people want to focus on short-term rewards they are generally drawn to, Steinberg said.
“Strategies that try to educate young people to avoid risky behavior tend not to work very well,” he said. “(Young adults) are more likely than older adults to take risks and act recklessly, even in situations where they’ve been told not to.”
Because of that, Steinberg said he thinks it’s more appropriate to change the environment. If local leaders don’t want to keep seeing young cases from bars and beaches, they should close bars and beaches, he said.
“As we’ve seen in the case of Florida and Texas, getting the word out hasn’t done anything to curb young people’s behavior,” he said.
As coronavirus cases in Florida and Tampa Bay continue to spike, the state has ordered bars to close and local governments have imposed mandatory mask orders, to slow community spread.
How the virus will affect a patient long-term still isn’t clear. Researchers and physicians are rushing to learn more about the illness and publish their findings. Meanwhile, the age of people being hospitalized in Florida is getting younger. Nearly half of hospitalizations are people age 64 and younger, according to the state health department.
“If you have mild or moderate disease, you’ll probably have a complete recovery and you’ll have antibodies,” said Laurence, from the Weill Cornell Medical School in New York. “For severe and critical patients, there are probably some long-term manifestations of having gone through it, we just don’t know how long and what they are.”
As Hergenreder lay in the hospital in Pinellas County, he posted videos to Facebook warning friends to be safe, to take the virus seriously and to not go out.
His mom described the last few months of his life as “painful.” She couldn’t visit him in the hospital. He called, but she worried that nurses were stretched too thin and that she couldn’t be there to ensure he was getting the best care.
“It’s really hard. Really, really hard, to deal with this virus,” Minichino said. “It causes so much heartache.”
This story is part of a collaboration with FRONTLINE, the PBS series, through its Local Journalism Initiative, which is funded by the John S. and James L. Knight Foundation and the Corporation for Public Broadcasting.
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