During the Omicron wave, death rates soared among the elderly

Despite strong vaccination levels among the elderly, Covid killed them at much higher rates during this winter’s Omicron wave than last year, taking advantage of long delays since their last vaccinations and the capacity of the variant to bypass the immune defences.

This winter’s wave of elderly deaths belied the relative mildness of the Omicron variant. Almost as many Americans 65 and older died during the four months of the Omicron surge as during the six months of the Delta wave, even though the Delta variant, for one person, tended to cause a more serious illness.

While overall per capita death rates from Covid have plummeted, the elderly still make up an overwhelming share.

“It’s not just a pandemic of unvaccinated people,” said Andrew Stokes, an assistant professor of global health at Boston University who studies the age patterns of Covid deaths. “There is still an exceptionally high risk in older people, even those with a series of primary vaccines.”

Covid deaths, while still concentrated among the elderly, in 2022 favored older people more than they have at any time since vaccines became widely available.

This pandemic shift has intensified 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 introducing new models of distribution of antiviral pills.

In much of the country, however, the recall campaign remains listless and disorganized, senior citizens and their doctors said. Patients, many of whom struggle to drive or connect, must maneuver through an often labyrinthine healthcare system to receive potentially life-saving antivirals.

Nationwide Covid deaths in recent weeks have been near the lowest levels of the pandemic, below an average of 400 a day. But the mortality gap between old and young has widened: Middle-aged Americans, who suffered a large share of pandemic deaths last summer and fall, are now enjoying new reserves of immune protection in the population as Covid deaths again concentrate around the elderly.

And the new wave of Omicron subvariants may create additional threats: While hospitalizations in younger age groups have remained relatively low, admission rates among people 70 and older in the North -East soared to a third of the towering peak of Omicron’s winter wave.

“I think we’re going to see death rates go up,” said Dr. Sharon Inouye, a geriatrician and professor of medicine at Harvard Medical School. “It’s going to get more and more risky for older people as their immunity wanes.”

Harold Thomas Jr., 70, of Knoxville, Tennessee, is one of many older Americans whose immunity may wane because he didn’t get a booster. The Covid States Project, an academic group, recently estimated that among people 65 and older, 13% are unvaccinated, 3% have only one Moderna or Pfizer vaccine, and 14% are vaccinated but not boosted.

When the vaccines first arrived, Thomas said, the state health department made getting them “convenient” by administering shots in its apartment community for the elderly. But he was unaware of such an effort for booster doses. On the contrary, he recalled that a state official had publicly questioned the boosters as they became available.

“The government wasn’t sure about the booster shot,” he said. “If they weren’t sure about it, and they were the ones who posted it, why would I take it?” Mr Thomas said Covid recently killed one of his former bosses and hospitalized an older family friend.

Deaths have fallen from the heights of the winter surge in part because of rising levels of immunity from past infections, experts said. For the elderly, there is also a darker reason: so many of the most frail Americans were killed by Covid over the winter that the virus now has fewer targets in that age group.

But scientists have warned that many older Americans remain susceptible. To protect them, geriatricians called on nursing homes to organize home vaccinations or impose additional injections.

Longer term, the scientists said policymakers need to address the economic and medical ills that have affected older, non-white Americans in particular, lest Covid continue to cut so many of their lives short.

“I don’t think we should treat premature death of the elderly as a way to end the pandemic,” Dr Stokes said. “There are still a lot of susceptible older people – living with comorbid conditions or living in multi-generational households – who are very vulnerable.”

The pattern of Covid deaths this year has recreated the dynamics of 2020 – before the introduction of vaccines, when the virus killed older Americans at significantly higher rates. Early in the pandemic, death rates steadily increased with each additional year, Dr. Stokes and colleagues found in a recent study.

That changed last summer and fall with the Delta thrust. Older people were getting vaccinated faster than other groups: In November, the vaccination rate for Americans 65 and older was about 20 percentage points higher than for people in their 40s. Importantly, these older Americans had received vaccines relatively recently, leaving them with strong levels of residual protection.

As a result, older people have suffered from Covid at lower rates than they did before vaccines became available. Among people aged 85 and over, the death rate last fall was about 75% lower than in the winter of 2020, according to a recent study by Dr Stokes.

At the same time, the virus hit younger, less vaccinated Americans, many of whom were also returning to work in person. Death rates for white people in their late thirties more than tripled last fall from the previous winter. Death rates for blacks in the same age group have more than doubled.

The rebalancing of Covid deaths has been so pronounced that, among Americans 80 and older, overall deaths have returned to pre-pandemic levels in 2021, according to a study published online in February. The opposite was true for middle-aged Americans: life expectancy in this group, which had already fallen more than it had in the same age bracket in Europe, fell further in 2021. .

“In 2021, you see the impact of the pandemic on younger mortality,” said Ridhi Kashyap, lead author of this study and a demographer at the University of Oxford.

By the time the highly contagious variant of Omicron took over, researchers said, more older Americans had spent a long time since their last Covid vaccination weakening their immune defenses.

As of mid-May, more than a quarter of Americans 65 and older had not received their last dose of vaccine in a year. And more than half of people in that age group had not received a vaccine in the past six months.

The Omicron variant was better than previous versions of the virus at evading ones that already weakened immune defenses, reducing the effectiveness of vaccines against more serious infections and diseases. This 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 over time against Omicron-related hospitalizations. A study recently published in The Lancet Respiratory Medicine found this trend in people with compromised immune systems, a category that older Americans were more likely to fall into. Sara Tartof, lead study author and epidemiologist at Kaiser Permanente in Southern California, said about 9% of people 65 and older in the study were immunocompromised, compared with 2.5% of adults younger. 50 years old.

During the Omicron wave, Covid death rates were again significantly higher for older Americans than for younger ones, Dr Stokes said. Older people also accounted for an overwhelming share of excess deaths – the difference between the number of people who actually died and the number of people who would have had 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 excess deaths were more highly concentrated among people 65 and older during the Omicron wave than the Delta surge. Overall, the study found that there were more excess deaths in Massachusetts during the first eight weeks of Omicron than during the 23-week period when Delta dominated.

As older people began to die at higher rates, Covid deaths also came to include higher proportions of vaccinated people. In March, about 40% of people who died from Covid were vaccinated, according to an analysis of figures from the Centers for Disease Control and Prevention.

Fewer older Americans have also been infected during the pandemic than younger people, resulting in lower natural immunity. In February, about a third of people aged 65 and over had signs of previous infections, compared with about two-thirds of adults under 50.

Covid cases from long ago do not prevent future infections, but reinfected people are less likely to become seriously ill.

A drop in Covid precautions this winter, combined with Omicron’s high transmissibility, has left older people at greater risk, scientists have said. It is unclear how their own behavior may have changed. An earlier study, led by scientists at Marquette University, suggested that while older people in Wisconsin once wore masks at higher rates than younger people, that gap had effectively closed by mid-2021.

Antiviral pills are now being given in greater numbers, but it is unclear who benefits. Scientists said the winter spike in Covid death rates among older Americans demanded a more urgent policy response.

Dr Inouye, of Harvard Medical School, said she had waited for notice from her mother’s assisted living facility about rolling out second booster shots even as reports began to come in of infected staff members. Nonetheless, the facility’s director said a second recall was impossible without state assistance.

Eventually, her family had to arrange a trip to the pharmacy on their own for a second booster.

“It just seems like the responsibility now rests entirely with the individual,” she said. “It’s not like it’s easy for you.”

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