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A “senior wave” of Covid-19 increases hospitalizations


When Linda Stewart felt a tickle in her throat a few weeks ago, she got worried.

She’s a 76-year-old woman, and she was well aware of the risks posed to her and her husband’s health by Covid-19, the flu and other colds sweeping the United States amid a difficult season. respiratory viruses.

“I don’t want to take any risks with my health,” she said.

So far this winter, the rise in Covid-19 appears to be relatively mild – hospitalizations are rising in most states, although the overall rate is still only a fraction of what it was during other surges .

But for older people like Stewart, the situation is much more serious. Hospitalizations among the elderly are approaching the peak of the Delta surge and are rising rapidly.

And the age gap has never been so wide. Since October, the Covid-19 hospitalization rate among seniors has been at least four times higher than the average. Even in the first winter wave in 2020, when Covid-19 swept through nursing homes, there was never more than triple the difference.

Throughout the pandemic, a positive Covid-19 test for a senior has carried additional weight. Only about 13% of all reported cases in the United States were in people 65 and older, according to data from the United States Centers for Disease Control and Prevention. But about half of all hospitalizations and three-quarters of all deaths have occurred in this age group.

The Covid-19 hospitalization rate for the elderly has generally risen and fallen in line with broader trends, peaking last winter during the Omicron surge and dropping significantly in the summer. But compared to other age groups, hospitalization rates have always been higher among those 65 and older.

Dr. Eric Topol, a physician and professor of molecular medicine at Scripps Research, called the current surge a “senior wave.”

“Right now we have a wall of immunity built against the Omicron family – between injections and previous infections and their combinations – which seems to keep the youngsters in quite a good position. But the immune system of older people is not as strong,” Topol said.

Immunocompromised young adults also likely experience disproportionately severe effects from the latest wave, he said, but there is not enough data to understand trends in this population as well.

Newer, more immune variants and relatively low use of treatments like Paxlovid may have played a role in the increased hospitalization rate among older adults, Topol said.

But “the main culprit is lack of recall” with “woefully insufficient” rates, he said. “Everything points to waning immunity. If more seniors had their recall, the effect would be minimal.

Stewart said she has relaxed personal mitigations, but is still keeping tabs on Covid-19 trends. She’s found a balance between caution and contentment that she says works for her — but getting the shot is really what helps her feel safe the most.

“I’m paying attention to it picking up, so I’m a little more cautious than I was, say, six weeks ago,” she said. “With the pickup I haven’t gone back to the way I handled it a few years ago, but I’m more aware of who I am and maybe wear my mask a bit more than before. »

A home test was negative for Covid-19 and confirmed by another drive-thru test from a healthcare provider, which brought some relief, she said. But even if it was positive, knowing that she was vaccinated and boosted reassured her.

“It was the whole idea of ​​being so proactive with all these vaccines. There was a very good chance that yes, you would get sick, but you wouldn’t get as sick as someone who didn’t get all their shots and there was a very good chance that you wouldn’t end up in the hospital. she said. “So it really gave me a sense of security in some ways that even if I got it, it wouldn’t really be bad. »

But most older people aren’t as well protected as Stewart.

According to CDC data, only about a third of the population 65 and older received an updated booster shot — a worrying number for public health experts.

“It’s very, very concerning,” said Dr. Preeti Malani, a physician at the University of Michigan Health who specializes in infectious diseases and geriatric medicine.

“There are a significant number of people who have actually received previous reminders who have not received this one and I fear there is confusion, there is misinformation. So to seniors – and everyone else – I say: if you haven’t been boosted, go get yourself boosted. »

A recent survey by the Kaiser Family Foundation found that 60% of older people were worried about an increase in Covid-19 cases and hospitalizations this winter – a far larger share than average.

More than 40 per cent were worried about getting seriously ill themselves, but almost as many said they didn’t plan to get the updated reminder anytime soon. In fact, nearly a quarter of older people say they have no intention of getting it or will only get it if necessary.

Vaccines – including the updated booster – continue to prove effective in preventing serious illness. But the use of reminders among the elderly, although low, is much higher than for other age groups. Less than 10% of adults under 50 and less than 5% of children have received their updated reminder, according to CDC data.

Yet experts say the gap in vaccination rates is not enough to explain the large and growing gap in hospitalization rates.

“The truth is, really, anyone can get this,” Malani said. “But the older you are, the more likely you are to have severe symptoms, the more likely you are to be hospitalized and the more likely you are to die. »

According to experts, infectious diseases like Covid-19 do not spread differently in older people than in younger people. Instead, family, friends and the wider community are often the ones who bring Covid-19 to older people – who are more likely to suffer more severe consequences.

“Older people are most at risk, but we bring it to them,” Malani said. “One thing unique to older people is that a lot of them are grandparents and a lot of them are looking after their grandchildren. They are therefore sometimes infected by their grandchildren, who may also go to school or daycare.

Many older people live in congregate settings like nursing homes, which also pose unique risks, she said.

But the fact remains that the elderly, although more vulnerable to severe consequences, are not the main drivers of spread in the population.

A government watchdog report released earlier this month found that outbreaks in care homes were ‘strongly associated with community spread’.

And nursing homes are still particularly vulnerable this winter. Weekly cases among residents have already exceeded all previous surges except for the initial winter wave and the Omicron wave, and they continue to rise. But only 47% of residents and 22% of staff are “up to date” with vaccines, according to data from the US Centers for Medicare and Medicaid Services.

“We would all have hoped to have a vaccine that prevents transmission. We don’t have a vaccine that does that, but it reduces transmission and reduces severe consequences,” said Janet Hamilton, executive director of the Council of State and Territorial Epidemiologists.

For that reason alone, seniors who interact with other seniors should get vaccinated to help minimize serious consequences, she said.

“But really, everyone who comes into contact with high-risk groups should be the main target to get vaccinated,” she said.

Stewart plans to host her family again for Christmas this year, for the first time since the pandemic began.

“We care about the people we interact with. There is no undue risk that we felt in coming together as a family. It’s kind of our safe group,” she said.

She and her husband also get together with small groups of friends who they trust are also vaccinated and equally cautious, but they still plan to stay away from baseball games – even if it’s one of their favorite hobbies.

“We like going to baseball games. We are real fans and we support our team a lot, but there are a lot of risks there. We take the ferry and during this trip you ride very close to a lot of other people. And going to the stadium, again, we’re very close to a lot of strangers,” she said. “It’s still too risky. »

Malani, the infectious disease specialist, said she recently spoke with a friend who appeared to be asking permission to reunite with his family this holiday season. She was eager to celebrate in person with her loved ones after years passed, but anxious to let her guard down amid a difficult respiratory virus season.

“It’s about finding a balance, because viruses are dangerous, but so is isolation,” she said. “There is always a way forward and for now, it is through vaccination. »

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