[Hac-announce] Omicron death rate among seniors was worse than Delta

[Manny Sholem Ratafia]

https://www.nytimes.com/2022/05/31/health/omicron-deaths-age-65-elderly.html?smid=tw-share

The CoronavirusPandemic <https://www.nytimes.com/news-event/coronavirus>

*Daily Covid Briefing*
<https://www.nytimes.com/live/2022/05/31/world/covid-19-mandates-vaccine-cases?action=click&pgtype=Article&module=&state=default&region=header&context=breakout_link_back_to_briefing>


  During the Omicron Wave, Death Rates Soared for Older People

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.

By Benjamin Mueller <https://www.nytimes.com/by/benjamin-mueller> and 
Eleanor Lutz <https://www.nytimes.com/by/eleanor-lutz>

May 31, 2022

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.”


    The Omicron Wave Was Deadlier Than Delta for Older People in the U.S.

Ages 12-64

Age 65+

Omicron

163% of

Delta peak

20 deaths

per 100,000

Delta

10

Omicron

69% of

Delta peak

Delta

April 2021

Aug. 2021

Jan. 2022

Note: Data is weekly and is as of April 2. Chart includes both fully 
vaccinated and unvaccinated people; those who only received a part of 
their primary vaccination series are excluded.

Source: Centers for Disease Control and Prevention 
<https://data.cdc.gov/Public-Health-Surveillance/Rates-of-COVID-19-Cases-or-Deaths-by-Age-Group-and/3rge-nu2a>

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 
<https://www.nytimes.com/2022/05/20/us/politics/cdc-second-booster.html> 
in recent weeks encouraging everyone 50 and older to get a second 
booster and introducing new models 
<https://www.nytimes.com/2022/05/26/us/politics/paxlovid-white-house-covid-deaths.html> 
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.”

Covid-19 Death Rates for People Age 65+

Unvaccinated

156 deaths

per 100,000

100 deaths

per 100,000

50

Vaccinated

24 per 100,000

With Booster

7 per 100,000

0

Oct. 2021

Jan. 2022

April 2022

Vaccination Rates for People Age 65+

100% of people

Unvaccinated

80

Vaccinated

60

40

With Booster

20

Oct. 2021

Jan. 2022

April 2022

Note: People who did not complete their primary vaccination series are 
excluded. Booster doses include additional doses given to 
immunocompromised people, a group for which vaccines can be less 
effective. Data is weekly.

Source: C.D.C. 
<https://data.cdc.gov/Public-Health-Surveillance/Rates-of-COVID-19-Cases-or-Deaths-by-Age-Group-and/d6p8-wqjm>

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 
<https://www.covidstates.org/reports/unvaccinated-older-americans> 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 
<https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2792375?resultClick=3>.

That changed last summer and fall, during the Delta surge. Older people 
were getting vaccinated more quickly than other groups: By November 
<https://www.forbes.com/sites/alisondurkee/2021/11/11/stunning-vaccine-stat-985-of-us-seniors-have-had-shot/?sh=25f582615777>, 
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 
<https://www.medrxiv.org/content/10.1101/2022.02.23.22271380v1.full.pdf> 
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.


    Vaccine Effectiveness Against Hospitalization

Two doses

Three doses

During Delta Wave

During Omicron Wave

100% vaccine effectiveness

against hospitalization

100% vaccine effectiveness

against hospitalization

80

80

60

60

40

40

20

20

0

0

Less than 2

months since

last dose

2–3

4

5+

Less than 2

months since

last dose

2–3

4

5+

Notes: Data for people with a third dose is not available for all time 
periods. People who received a Johnson & Johnson vaccine or received 
more than three doses are excluded. Hospitalizations include people with 
a confirmed Covid-19 diagnosis who had Covid-related symptoms such as 
respiratory illness, fever or vomiting. Third doses include third 
primary doses given to immunocompromised people, a group for which 
vaccines can be less effective.

Source: C.D.C. <https://www.cdc.gov/mmwr/volumes/71/wr/mm7107e2.htm>

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 
<https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(22)00170-9/fulltext> 
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 
<https://jamanetwork.com/journals/jama/fullarticle/2792738?guestAccessKey=06de6afa-b2b3-4b35-bf84-1481a93d38d4> 
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.


    Estimated Share of People in the U.S. With Antibodies From Covid-19
    Infection

0%

40

60

80

100

20

0–11 years old

12–17

18–49

50–64

65+

Note: Data is as of February 2022.

Source: C.D.C. 
<https://www.cdc.gov/mmwr/volumes/71/wr/mm7117e3.htm?s%C3%A2%C2%80%C2%94cid=mm7117e3%C3%A2%C2%80%C2%94w>

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 
<https://www.medrxiv.org/content/10.1101/2022.01.18.22269479v1.full.pdf>, 
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 
<https://endpts.com/us-sees-spike-in-paxlovid-usage-as-mercks-molnupiravir-and-astrazenecas-evusheld-are-slower-off-the-shelf/>, 
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.”


-- 
"Fight for the things that you care about, but do it
in a way that will lead others to join you."
― Ruth Bader Ginsburg

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