Why This Coastal County in New Jersey Has the State’s Highest COVID-19 Death Rate

Rafael Berroteran, left, registers for a coronavirus vaccine with his daughter Annia, 8, at Woodlake Country Club in Lakewood, N.J., on Sunday, March 6, 2022. (Bryan Anselm/The New York Times)

Rafael Berroteran, left, registers for a coronavirus vaccine with his daughter Annia, 8, at Woodlake Country Club in Lakewood, N.J., on Sunday, March 6, 2022. (Bryan Anselm/The New York Times)

Ocean County, a coastal region in central New Jersey, is home to some of the state’s most exclusive waterfront communities and its fastest-growing town, Lakewood.

A Republican bastion in a state controlled by Democrats, the county is largely suburban, encompassing more land than all but one other county in New Jersey.

Now, as the United States begins to chart a path through a third year of the pandemic, Ocean County also illustrates a stubborn public health challenge: A large share of its residents have not been vaccinated against the coronavirus, and its COVID-19 death rate is the highest in the state.

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The county has recorded 459 virus-related deaths for every 100,000 residents, state data show. This outpaces fatality levels in every other county in New Jersey, an affluent, well-educated and densely populated state still struggling to limit its virus death rate. New Jersey has the fifth-highest fatality rate from COVID-19 in the United States, behind Mississippi, Arizona, Alabama and West Virginia.

Explanations for the high number of deaths in Ocean County include the large percentage of residents older than 85 and low vaccination rates among people 65 and younger, a factor that some studies show is most closely tied to partisan politics.

The county also has a large and growing Orthodox Jewish population, who were hit hard during the first wave of the pandemic and whose vaccination rates are far lower than statewide averages, reflecting similar trends in Orthodox Jewish neighborhoods in New York.

In the 2020 presidential contest, when New Jersey supported Joe Biden by an overwhelming margin, voters in Ocean County backed then-President Donald Trump by almost 29 percentage points — the largest share of any of the state’s Republican strongholds.

“At this stage of the game, whoever made the decision to get it has gotten it,” John Ducey, longtime Democratic mayor of Brick, a 74,000-person Ocean County township, said about the vaccine.

“A lot of people who are not in favor of getting the vaccine make it on a political judgment,” he said, adding, “They don’t want an invasion of their bodies.”

COVID-19 vaccines have been proven to significantly lower the risk of serious illness or death, particularly for people who also have booster shots.

But among Ocean County residents eligible for a COVID-19 vaccine, only 58.4% have had at least two shots of Moderna’s or Pfizer-BioNTech’s vaccines or one shot of Johnson & Johnson’s, according to the Centers for Disease Control and Prevention. That is well below the statewide vaccination rate of 79.8% and the nationwide rate of 69.8%.

Lakewood, which is home to a thriving Orthodox Jewish community and is the county’s largest township, has the region’s lowest vaccination rates. Just 40% of Lakewood residents older than 5 are fully vaccinated; of these, 38% of residents eligible for a booster shot have received one, according to the state’s Department of Health.

In New York, Borough Park, a hub of Orthodox Jewish life in Brooklyn, has the city’s lowest vaccination rate. But it significantly outpaces Lakewood’s: About 53% of residents 5 and older in the Brooklyn neighborhood are vaccinated.

Most of Ocean County’s 2,925 confirmed and probable virus fatalities occurred in the first year of the pandemic, before vaccines or therapies to treat the disease were widely available. The average number of daily deaths, which peaked at 18 in May 2020, has now plummeted to about one a day.

Still, deaths have continued to accrue steadily: Since last spring, the number of people who have died each quarter in Ocean County has surpassed the number of fatalities during the three months before.

In Brick, where about 64% of residents eligible for COVID-19 shots are vaccinated, roughly 28% of the 357 virus-related deaths occurred after vaccines became widely available, according to county data.

Still, Ducey said he opposed vaccine mandates.

“There’s people out there that do not want the vaccine, and I think it should be left up to them,” said Ducey, who is vaccinated and has received a booster shot. “That’s the great thing about our country: We have freedom of choice.”

As the worst days of the pandemic fade from memory and politicians plot a road toward normalcy, persuading more people to be vaccinated has become a priority for infectious-disease specialists such as Dr. Meg Fisher, a pediatric immunologist working as a consultant to New Jersey’s health commissioner.

For them, nudging vaccination rates higher is considered vital to protect the broader community against new variants, such as the highly transmissible omicron subvariant, BA.2, which is now the dominant version of the coronavirus in the United States and around the world.

“Overcoming people’s complacency — this becomes very important right now,” Fisher said. «We need the younger people vaccinated.”

A nationwide study by the Pew Research Center found that 73% of people who identified as Democrats and were eligible for a booster shot had one, compared with 55% of the people surveyed who said they were Republicans. Younger Republicans were particularly hesitant to be vaccinated, the study showed, with just 52% of people between the ages of 18 and 29 reporting being vaccinated, compared with 88% of Democrats in the same age group.

“The biggest gap we’ve seen that’s been consistent has been partisanship,” said Alec Tyson, associate director of research at Pew Research Center. «It’s not narrowing. If anything it’s growing even wider.”

Ocean County, which hugs the Jersey Shore and is a retirement destination, has the fourth-highest percentage of residents older than 85 in the United States, behind three similarly large counties in Florida, census data show. At one county hospital, Community Medical Center, 73% of patients qualify for Medicare, the federally funded health care that is available to people 65 and older and some younger people with disabilities.

“When you put that in perspective, it’s not that much of a surprise that the death rate would be high,” said Patrick Ahearn, CEO of the medical center in nearby Toms River.

Daniel Regenye, Ocean County’s chief health officer, said his office created an extensive network of vaccination sites; none of the county’s 649,000 residents lives more than 2 miles from a location offering COVID-19 vaccines, he said.

The county’s low vaccination rates do not apply to all age groups. Among people older than 65, who are considered most vulnerable to severe disease, 88% are vaccinated, just 6 percentage points lower than the statewide rate.

Dimitri Svarnas and his wife, Janis, are registered Republicans who are ardent supporters of Trump’s.

The couple got vaccinated to take cruises and travel out of the country but were still deciding about booster shots.

“You can’t control my body,” Svarnas, 76, of Brick, said outside the ShopRite where he was first vaccinated last year. “Nobody controls my body.”

To entice younger people, Ocean County has run pop-up clinics that have dangled incentives such as free admission to Six Flags Great Adventure, an amusement park in Jackson, and seasonlong access to the park’s popular safari ride.

In Lakewood, where nearly half of the residents are younger than 18, shots were offered during events held on Sundays that featured children’s bounce houses, free food and mini golf.

“There’s a general perception — and it’s being fed by a lot of people — that says natural infection is better,” Regenye said. “My concern is a resurgence of vaccine-preventable disease.”

Dr. Dovid Friedman is CEO of CHEMED, the Center for Health Education Medicine and Dentistry in Lakewood, a community-based health care provider that receives federal funding to provide primary care services to residents. He said the original government messaging failed to give enough credence to many Jewish residents’ beliefs that being infected with the virus was nearly equivalent to vaccination.

There is also widespread misunderstanding, he said, about the primary role of the COVID-19 vaccine.

“People get confused with ‘Why is there still a disease?’” he said. “But the vaccine wasn’t designed to stop disease. It was designed to prevent hospitalizations and deaths.”

To try to increase vaccination rates among the county’s large number of Orthodox Jewish people, the state began a targeted advertising campaign in early February that was instantly derided as culturally inappropriate. Digital billboards depicted a smiling Jewish man, but the hat, hairstyle and necklace he wore did not accurately reflect the religious customs of Lakewood residents.

The state quickly pulled the ads and switched advertising companies.

New print ads focus on the importance of getting vaccinated as a way to “boost” the body’s natural defenses, said Elie Rosenfeld, CEO of Joseph Jacobs Advertising, the newly hired firm. The ads also stress the vaccine’s ability to limit disruptions to the “normal rhythm” of life, including school and family activities, as well as the obligation each resident has for keeping the broader community safe, he said.

David Djmal, manager of an e-commerce site in Lakewood, is one of the people the revised ad campaign is trying to reach.

He said he had COVID-19 during the first wave of the pandemic, in March 2020, and had not been reinfected, even though he is not vaccinated and has had close contact with people who have tested positive for the virus.

This “only proved further to myself the strength of my immunity,” said Djmal, 29. He said he would probably get the shot if his job were at risk.

“It depends,” he said, “on how inconvenient they made my life.”

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