"Last year, people 65 and older died
from Covid at lower rates than in previous waves. But with Omicron and waning
immunity, death rates rose again.
Despite strong levels of vaccination
among older people, Covid killed them at vastly higher rates during this
winter’s Omicron wave than it did last year, preying on long delays since their
last shots and the variant’s ability to skirt immune defenses.
This winter’s wave of deaths in
older people belied the Omicron variant’s relative mildness. Almost as many
Americans 65 and older died in four months of the Omicron surge as did in six
months of the Delta wave, even though the Delta variant, for any one person,
tended to cause more severe illness.
While overall per capita Covid death
rates have fallen, older people still account for an overwhelming share of
them.
“This is not simply a pandemic of
the unvaccinated,” said Andrew Stokes, an assistant professor in global health
at Boston University who studies age patterns of Covid deaths. “There’s still
exceptionally high risk among older adults, even those with primary vaccine
series.”
Covid deaths, though always
concentrated in older people, have in 2022 skewed toward older people more than
they did at any point since vaccines became widely available.
That swing in the pandemic 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
distributing antiviral pills.
In much of the country, though, the
booster campaign remains listless and disorganized, older people and their
doctors said. Patients, many of whom struggle to drive or get online, have to
maneuver through an often labyrinthine health care system to receive
potentially lifesaving 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 older and younger people has grown:
Middle-aged Americans, who suffered a large share of pandemic deaths last
summer and fall, are now benefiting from new stores of immune protection in the
population as Covid deaths once again cluster around older people.
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 Northeast have climbed to one-third of the winter Omicron wave’s
towering peak.
“I think we are going to see the
death rates rising,” said Dr. Sharon Inouye, a geriatrician and a professor of
medicine at Harvard Medical School. “It is going to become more and more risky
for older adults as their immunity wanes.”
Harold Thomas Jr., 70, of Knoxville,
Tenn., is one of many older Americans whose immunity may be waning because he
has not received a booster shot. The Covid States Project, an academic group, recently estimated
that among people 65 and older, 13 percent are unvaccinated, 3 percent have a
single Moderna or Pfizer shot and another 14 percent are vaccinated but not
boosted.
When vaccines first arrived, Mr.
Thomas said, the state health department made getting them “convenient” by
administering shots at his apartment community for older people. But he did not
know of any such effort for booster doses. On the contrary, he remembered a
state official publicly casting doubt on 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’re the
ones who put it out, why would I take it?” Mr. Thomas said Covid recently
killed a former boss of his and hospitalized an older family friend.
Deaths have fallen from the heights
of the winter wave in part because of growing levels of immunity from past
infections, experts said. For older people, there is also a grimmer reason: So
many of the most fragile Americans were 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 in-home vaccinations or mandate additional shots.
In the longer term, scientists said
that policymakers needed to address the economic and medical ills that have affected
especially nonwhite older Americans, lest Covid continue cutting so many of
their lives short.
“I don’t think we should treat the
premature death of older adults as a means of ending the pandemic,” Dr. Stokes
said. “There are still plenty of susceptible older adults — living with
comorbid conditions or living in multigenerational households — who are highly
vulnerable.”
The pattern of Covid deaths this
year has recreated the dynamics from 2020 — before vaccines were introduced,
when the virus killed older Americans at markedly higher rates. Early in the
pandemic, mortality rates steadily climbed with each extra year of age, Dr.
Stokes and his collaborators found in a recent study.
That changed last summer and fall,
during the Delta surge. Older people were getting vaccinated more quickly than
other groups: By November, the
vaccination rate in Americans 65 and older was roughly 20 percentage points
higher than that of those in their 40s. And critically, those older Americans
had received vaccines relatively recently, leaving them with strong levels of
residual protection.
As a result, older people suffered
from Covid at lower rates than they had been before vaccines became available.
Among people 85 and older, the death rate last fall was roughly 75 percent
lower than it had been in the winter of 2020, Dr. Stokes’s recent study found.
At the same time, the virus walloped
younger and less vaccinated Americans, many of whom were also returning to
in-person work. Death rates for white people in their late 30s 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 80 and older, overall deaths returned to
prepandemic levels in 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 dropped more than it had among the same age
range in Europe, fell even further in 2021.
“In 2021, you see the mortality
impact of the pandemic shift younger,” said Ridhi Kashyap, a lead author of
that study and a demographer at the University of Oxford.
By the time the highly contagious
Omicron variant took over, researchers said, more older Americans had gone a
long time since their last Covid vaccination, weakening their immune defenses.
As of mid-May, more than one-quarter
of Americans 65 and older had not had their most recent vaccine dose within a
year. And more than half of people in that age group had not been given a shot
in the last six months.
The Omicron variant was better than
previous versions of the virus at evading those already weakening immune
defenses, reducing the effectiveness of vaccines against infection and more
serious illness. That was especially true for older people, whose immune
systems respond less aggressively to vaccines in the first place.
For some people, even three vaccine doses appear to become
less protective over time against Omicron-related hospital admissions.
A study published recently in The
Lancet Respiratory Medicine found that trend held for people with
weakened immune systems, a category that older Americans were likelier to fall
into. Sara Tartof, the study’s lead author and an epidemiologist at Kaiser
Permanente in Southern California, said that roughly 9 percent of people 65 and
older in the study were immunocompromised, compared with 2.5 percent of adults
under 50.
During the Omicron wave, Covid death
rates were once again dramatically higher for older Americans than younger
ones, Dr. Stokes said. Older people also made up an overwhelming share of the
excess 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
excess deaths were more heavily concentrated in people 65 and older during the
Omicron wave than the Delta surge. Overall, the study found, 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 dying at
higher rates, Covid deaths also came to include higher proportions of
vaccinated people.
In March, about 40 percent of the 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, leading to lower levels of
natural immunity. As of February, roughly one-third of people 65 and older
showed evidence of prior infections, compared with about two-thirds of adults
under 50.
Long-ago Covid cases do not prevent future infections, but
reinfected people are less likely to become seriously ill.
A drop-off in Covid precautions this
winter, combined with the high transmissibility of Omicron, left older people
more exposed, scientists said. It is unclear how their own behavior may have
changed. An earlier study,
from scientists at Marquette University, suggested that while older people in
Wisconsin had once been wearing masks at rates higher than those of 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 is benefiting from them.
Scientists said that the wintertime 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 a notice from her mother’s assisted living
facility about the rollout of second booster shots even as reports started
arriving of staff members becoming infected. But still, the facility’s director
said that a second booster shot drive was impossible without state guidance.
Eventually, her family had to
arrange a trip to a pharmacy on their own for a second booster.
“It just seems that now the onus is
put completely on the individual,” she said. “It’s not like it’s made easy for
you.”"
