Despite strong vaccination levels among the elderly, Covid killed them at much faster rates during this winter’s Omicron wave than last year, with long delays since their last shots and the variant’s ability to evade immune defenses.
This winter’s spate of deaths among the elderly belies the relative mildness of the Omicron variety. Nearly as many Americans age 65 and older died in four months of the Omicron wave as in six months of the Delta wave, although the Delta variant, for one person, tended to cause more serious illness.
Although overall death rates per capita from Covid have fallen, the elderly still account for an overwhelming proportion of them.
“This isn’t just a pandemic of unvaccinated people,” said Andrew Stokes, an assistant professor of global health at Boston University who studies age patterns of Covid deaths. “There is still an exceptionally high risk in older adults, even those with primary vaccine series.”
Covid deaths, while always concentrated in older people, will target older people more in 2022 than at any time since vaccines became widely available.
That turnaround in the pandemic has increased pressure on the Biden administration to protect older Americans, with health officials in recent weeks encouraging everyone 50 and older to get a second booster and develop new models of antiviral pill distribution. to introduce.
In much of the country, however, the booster campaign remains lethargic and disorganized, older people and their doctors said. Patients, many of whom struggle to drive or get online, must maneuver through an often labyrinthine healthcare system to receive potentially life-saving antivirals.
Covid deaths nationwide in recent weeks have been near the lowest level of the pandemic, below the average of 400 a day. But the death gap between older and younger people has widened: Middle-aged Americans, who suffered their share of pandemic deaths last summer and fall, are now benefiting from new stocks of immune protection in the population as Covid deaths re-cluster around elderly.
And the new wave of Omicron subvariants may pose additional threats: While hospitalizations in younger age groups have remained relatively low, admissions rates among people 70 and older in the Northeast have risen to a third of the towering peak of the winter Omicron-type. golf.
“I think we’re going to see death rates rise,” says Dr. Sharon Inouye, a geriatrician and professor of medicine at Harvard Medical School. “It’s getting more and more risky for older adults as their immunity wears off.”
Harold Thomas Jr., 70, of Knoxville, Tennessee, is one of many older Americans whose immunity may be waning because he didn’t get a booster shot. The Covid States Project, an academic group, recently estimated that of those over 65, 13 percent are unvaccinated, 3 percent have had a single Moderna or Pfizer injection, and another 14 percent are vaccinated but not vaccinated.
When the vaccines first arrived, Mr Thomas said, the state’s health department made it “convenient” to get them “handy” by administering injections to his apartment community for older people. But he was not aware of such an effort for booster doses. Rather, he recalled a state official having public doubts about boosters when they became available.
“The government was not sure about the booster shot,” he said. “If they weren’t sure, and they’re the ones who brought it out, why would I take it?” Thomas said Covid recently killed a former boss of his and hospitalized an elderly friend of the family.
Deaths have plummeted from the heights of the winter wave, in part because of increasing immunity to past infections, experts said. For older people, there’s a grittier reason, too: So many of the most vulnerable Americans have been killed by Covid over the winter that the virus now has fewer targets in that age group.
But scientists warned that many older Americans remained susceptible. To protect them, geriatricians called on nursing homes to organize home vaccinations or require additional injections.
In the longer term, scientists said policymakers needed to address the economic and medical problems that have primarily affected non-white older Americans, lest Covid continue to shorten their lives so much.
“I don’t think we should view the premature death of older adults as a way to end the pandemic,” said Dr. Stokes. “There are still many susceptible older adults — living with comorbid conditions or in multigenerational households — who are very vulnerable.”
The pattern of Covid deaths this year has mimicked the dynamics of 2020 — before vaccines were introduced, when the virus was killing older Americans at significantly faster rates. Early in the pandemic, death rates rose steadily with each additional year, Dr. Stokes and his collaborators in a recent study.
That changed last summer and autumn, during the Delta Wave. The elderly were vaccinated faster than other groups: In November, vaccination rates among Americans 65 and older were about 20 percentage points higher than those in their 40s. And critically, those older Americans had been given vaccines relatively recently, giving them strong residual protection.
As a result, older people were less likely to suffer from Covid than before vaccines became available. Among people 85 and older, the death rate last fall was about 75 percent lower than in the winter of 2020, the recent study by Dr. Stokes.
At the same time, the virus engulfed younger and less vaccinated Americans, many of whom also went back to work in person. The death rate for white people in their late thirties more than tripled last fall compared to the previous winter. Death rates for black people in the same age group more than doubled.
The rebalancing of Covid deaths was so pronounced that among Americans aged 80 and older, total deaths returned to prepandemic levels by 2021, according to a study posted online in February. The opposite was true for middle-aged Americans: Life expectancy in that group, which had already fallen more than the same age group in Europe, fell even further in 2021.
“In 2021 you will see the impact of the pandemic on mortality getting younger,” said Ridhi Kashyap, lead author of that study and demographer at the University of Oxford.
By the time the highly contagious Omicron variant took over, researchers said, there had been more elderly Americans since their last Covid vaccination, weakening their immune defenses.
By mid-May, more than a quarter of Americans age 65 and older had not had their most recent vaccine dose within a year. And more than half of the people in that age group hadn’t received an injection in the past six months.
The Omicron variant was better than previous versions of the virus at evading the already weakened immune defenses, reducing the effectiveness of vaccines against infection and more serious diseases. That was especially true for older people, whose immune systems react less aggressively to vaccines in the first place.
For some people, even three doses of vaccine seem to become less protective against Omicron-related hospitalizations over time. A study recently published in The Lancet Respiratory Medicine found that that trend was true for people with weakened immune systems, a category older Americans were more likely to fall into. Sara Tartof, the study’s lead author and epidemiologist at Kaiser Permanente in Southern California, said about 9 percent of those over 65 in the study were immunocompromised, compared with 2.5 percent of adults under 50.
During the Omicron wave, death rates from Covid were again dramatically higher for older Americans than for younger ones, said Dr. Stokes. The elderly also made up an overwhelming proportion of the additional deaths — the difference between the number of people who actually died and the number who would have been expected to die if the pandemic had never happened.
dr. Jeremy Faust, an emergency physician at Brigham and Women’s Hospital in Boston, found in a recent study that the number of deaths during the Omicron wave was more concentrated in people age 65 and older than with the Delta wave. Overall, the study found that there were more deaths in Massachusetts during the first eight weeks of Omicron than during the 23-week period when Delta dominated.
As older people died faster, the number of Covid deaths also included greater numbers of vaccinated people. In March, about 40 percent of people who died from Covid were vaccinated, an analysis of figures from the Centers for Disease Control and Prevention shows.
There are also fewer older Americans infected during the pandemic than younger people, leading to lower levels of natural immunity. As of February, about one-third of people age 65 and older showed signs of previous infections, compared with about two-thirds of adults under 50.
Covid cases from long ago do not prevent future infections, but re-infected people are less likely to become seriously ill.
A decline in Covid precautions this winter, combined with Omicron’s high transmissibility, left older people more exposed, scientists said. It is unclear how their own behavior has changed. An earlier study conducted by scientists at Marquette University suggested that although older people in Wisconsin once wore masks more often than younger people, that gap had effectively disappeared by mid-2021.
Antiviral pills are now being administered in greater numbers, but it is difficult to know who will benefit. Scientists said the winter spike in Covid death rates among older Americans required a more urgent policy response.
dr. Inouye, of Harvard Medical School, said she had been waiting for a message from her mother’s health care facility about the introduction of second booster shots, even when reports came in that employees were becoming infected. Even so, the facility’s director said a second booster-shot drive was impossible without state guidance.
In the end, her family had to arrange a trip to a pharmacy for a second booster on their own.
“It seems that the responsibility now rests entirely with the individual,” she said. “It’s not like it was made easy for you.”
