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, 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 relative lightness of the Omicron variant. Almost as many Americans 65 and older died in the Omicron surgeon as did the 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 simply not a pandemic of the unvaccinated,” said Andrew Stokes, an assistant professor of global health at Boston University who studies age patterns of Covid deaths. “There is still exceptionally high risk among older adults, even those with the primary vaccine series.”
Covid deaths, though always concentrated in older people, have skewed toward older people in 2022 more than they did at any point since vaccines have become widely available.
That swing in the pandemic has intensified pressure on the Biden administration to protect older Americans, with health officials encouraging everyone in recent weeks to get a second booster and distribute new models of antiviral pills.
In much of the country, though, the booster campaign is currently listless and disorganized, said older people and their doctors. Patients, many of whom struggle to drive or get online, have to maneuver through a 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 proportion of pandemic deaths last summer and fall, are now benefiting from new stores in immune protection as the population revolves around Covid deaths once again. people.
And the new wave of Omicron subvariants may create additional threats: While hospitalizations in younger age groups remain relatively low, admission rates among people 70 and older in the Northeast have climbed one-third to the winter’s Omicron wave’s towering peak.
“I think we’re going to see the death rates rise,” said Dr. Sharon Inouye, a geriatrician and a professor of medicine at Harvard Medical School. “It’s 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 is making them “convenient” by administering shots at his apartment community for older people. But he didn’t know any such effort for booster doses. On the contrary, he remembered a state official publicly boasting about casting doubt as he became available.
“The government was not sure about the booster shot,” he said. “If they weren’t sure about it, and they were 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 rising 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 is now targeted at that age group.
But scientists warn that many older Americans remain 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 economic and medical ills that affected especially nonwhite older Americans, lest Covid continue to cut off many of their lives.
“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 extremely 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, Dr. Stokes and his collaborators found 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 was 65 and older was roughly 20 percentage points higher than 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 did before vaccines became available. Among people 85 and older, the death rate last fall was roughly 75 percent lower than it was in the winter of 2020, Dr. Stokes’ 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 tripled in the late 30s more than last fall. Mortality rates for Black people in the same age group are 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 in 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 the study and a demographer at the University of Oxford.
By the time the highly contagious Omicron variant took over, researchers said, more older Americans have had 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 haven’t been given a shot in the last six months.
The Omicron variant was better than previous versions of the virus 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 responded less aggressively to vaccines in the first place.
For some people, even three vaccine doses appear to be less protective over time against Omicron-related hospital admissions. A study published recently in The Lancet Respiratory Medicine found that the trend held for people with weakened immune systems, a category that older Americans were likely 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 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 than younger Americans, Stokes said. Older people also made up an overwhelming share of excessive 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. A recent study by Jeremy Faust, an emergency physician at Brigham and Women’s Hospital in Boston, found that overdose deaths were more heavily concentrated in people 65 and older during the Omicron wave than the Delta surgeon. Overall, the study found, there were more deaths in Massachusetts during the first eight weeks than during the 23-week period when Delta dominated.
As older people started 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 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.
Covid warnings 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 were once wearing masks at rates higher than those 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 say 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 the second booster shots even as reports began arriving that staff members were infected. But still, the facility’s director said a second booster shot drive was impossible without state guidance.
Eventually, her family had a trip to a pharmacy on their own for a second booster.
“It just seems that the onus is now completely on the individual,” she said. “It’s not like it made easy for you.”