Health

During the Omicron wave, the mortality rate for the elderly skyrocketed


Despite strong vaccination levels among older adults, Covid killed them at a much higher rate during this winter’s Omicron wave than last year, bracing for a lengthy delay since the last shot. together and the immunodefence capacity of the variant.

This winter’s wave of elderly deaths demonstrates the relative mildness of the Omicron variant. Nearly as many Americans age 65 and older died in the four months of the Omicron surge as in the six months of the Delta wave, although the Delta variant, for any person, tends to cause more severe illness. .

While the overall Covid death rate per capita has fallen, older people still make up the bulk of it.

“This is not simply a pandemic of people who haven’t yet,” said Andrew Stokes, an assistant professor of global health at Boston University who studies age patterns of Covid deaths. vaccinated. “There is still a particularly high risk in the elderly, even those with the main series of vaccines.”

Overall deaths, while consistently concentrated among older adults, are more tilted toward older adults in 2022 than at any time since the vaccine became widely available.

That blow during the pandemic has increased pressure on the Biden administration to protect older Americans, with health officials in recent weeks, encourage people 50 years of age and older to get a second booster shot and Introducing new models distribution of antiviral drugs.

In most countries, however, the intensifying campaign remains listless and disorganized, the elders and their doctors said. Patients, many of whom struggle to drive or get online, must travel through the healthcare system as often as a maze to receive potentially life-saving antiviral drugs.

Covid deaths nationwide in recent weeks have been near the pandemic low, below the 400-a-day average. But the death gap between the elderly and the young has widened: Middle-aged Americans, who suffered a large proportion of pandemic deaths last summer and fall, are now benefiting from New stores of immune defense in the population as Covid deaths are once again concentrated around older people.

And the new Omicron sub-wave could pose additional threats: While hospitalization rates among younger age groups remain relatively low, hospitalization rates among those 70 and older in the Northeast have declined. climb a third of the towering peak of the winter Omicron wave.

“I think we are going to see an increase in mortality,” said Dr. Sharon Inouye, a geriatrician and professor of medicine at Harvard Medical School. “It will become more and more risky for older adults as their immunity weakens.”

Harold Thomas Jr., 70, of Knoxville, Tenn., is one of many older Americans whose immunity is weakened by not receiving a booster shot. The Covid States Project, an academic group, recent estimates that of those 65 and older, 13 percent were unvaccinated, 3 percent had a shot of Moderna or Pfizer, and another 14 percent were vaccinated but not given a booster.

When the vaccine was first introduced, the state health department made it “convenient” by administering the shots in his apartment community, Mr. Thomas said. he for the elders. But he was unaware of any such attempt at a booster dose. On the contrary, he remembers a state official who openly doubted the boosters when they became available.

“The government is uncertain about the ramp-up,” he said. “If they weren’t sure about it, and they were the ones who brought it out, why would I take it?” Mr. Thomas said Covid recently killed a former boss of his and sent an elderly family friend to the hospital.

Experts say the death toll has dropped from the peak of the winter wave in part due to increasing levels of immunity to past infections. For older people, there’s also a tougher 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 warn that many older Americans still have the disease. To protect them, geriatricians have urged nursing homes to organize home vaccinations or prescribe additional shots.

In the longer term, scientists say, policymakers need to address the economic and medical ills that have affected especially older non-white Americans, lest Covid continue to cut short lives. their life.

Dr Stokes said: “I don’t think we should consider the premature death of older adults as a means to end the pandemic. “There are still a lot of vulnerable older people – living with comorbidities or living in multi-generational households – who are very vulnerable.”

This year’s Covid mortality pattern has recreated momentum from 2020 – before a vaccine was introduced, when the virus killed older Americans at a markedly higher rate. During the early stages of the pandemic, the mortality rate steadily increased with each additional age, Dr. Stokes and his colleagues found in a recent research.

That changed last summer and fall, during the Delta surge. Older adults vaccinate faster than other groups: Because Novembervaccination rates among Americans 65 and older are about 20 percentage points higher than those in their 40s. And more seriously, those older Americans were vaccinated relatively closely. here, leaving them with a strong residual protection level.

As a result, older people get Covid at a lower rate than before the vaccine. Among people aged 85 and over, the death rate last fall was about 75% lower than it was in winter 2020, Dr Stokes’ recent study found.

At the same time, the virus has also spilled over into younger and less vaccinated Americans, many of whom are also returning to face-to-face jobs. The death rate for whites in their late 30s tripled last fall compared with the previous winter. The death rate for Blacks in the same age group more than doubled.

The rebalancing in Covid deaths is so pronounced that, among Americans 80 years of age and older, the total number of deaths has returned to pre-pandemic levels by 2021, according to a new report. Research is posted online in February. The opposite is true for middle-aged Americans: Life expectancy for this group, which has already fallen more than its European counterparts, will fall even further in 2021.

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

By the time the highly contagious Omicron variant takes over, many older Americans have had a long time since their last Covid vaccination, weakening their immune defenses, the researchers say. their translation.

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

The Omicron variant is better than previous versions of the virus at dodging viruses that already weaken immune defenses, reducing the vaccine’s effectiveness against infections and more serious diseases. . That’s especially true for older people, whose immune systems are less responsive to vaccines in the first place.

For some people, even three doses of the vaccine seem to become less protective over time against Omicron-related hospitalizations. Research recently published in The Lancet Respiratory Medicine found that trend was consistent with people with weakened immune systems, a group that older Americans are more likely to fall into. About 9% of people 65 and older in the study were immunocompromised, compared with 2.5% of adults, said Sara Tartof, lead author of the study and an epidemiologist at Kaiser Permanente in Southern California. under 50 years old.

During the Omicron wave, Covid mortality rates were again significantly higher in older Americans than in younger people, Dr. Stokes said. Older people also make up a high percentage of those who die excessively – the difference between the number of people actually dying and the number of people expected to die if the pandemic had never occurred.

Dr. Jeremy Faust, an emergency physician at Brigham and Women’s Hospital in Boston, was found in a recent research that excess mortality was more concentrated among people 65 years of age and older during the Omicron surge than during the Delta surge. Overall, the study found, there were more excess deaths in Massachusetts in the first eight weeks of Omicron than there were during the 23-week period when Delta dominated.

As older people begin to die at a higher rate, Covid’s death rate also includes a higher proportion of vaccinated people. In March, about 40% of those who died from Covid had been vaccinated, according to an analysis of figures from the Centers for Disease Control and Prevention.

Fewer elderly Americans have also been infected during the pandemic than younger people, leading to lower levels of natural immunity. As of February, about one-third of people aged 65 and older had evidence of previous infections, compared with about two-thirds of adults under age 50.

Cases of Covid have long not prevented future infections, but people who are reinfected are less at risk of becoming seriously ill.

This winter’s drop in Covid precautions, combined with Omicron’s high transmissibility, has exposed older adults more, scientists say know. It is unclear how their own behavior may have changed. One previous researchfrom scientists at Marquette University, suggest that although older adults in Wisconsin used to wear masks at a higher rate than younger adults, that gap has effectively disappeared in the middle year 2021.

Antiviral drugs are currently available manage with larger numbers, but it is difficult to know who is benefiting from them. A winter spike in Covid deaths among older Americans calls for a more urgent policy response, scientists say.

Dr Inouye, of Harvard Medical School, said she had been waiting for notification from her mother’s assisted living facility about the rollout of second booster shots even as staff members began to become infected. However, the director of the facility said that a second round of increased fire could not be carried out without state guidance.

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

“It seems that now the responsibility is placed entirely on the individual,” she said. “It’s not like it makes it easy for you.”



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