(CNN) — 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’s very aware of the risks posed to her and her husband’s health by covid-19, influenza and other illnesses sweeping the United States amid a difficult season of respiratory viruses.
“I don’t want to take any risks with my health,” he said.
Throughout the pandemic, a positive covid-19 result in an older person has carried added weight.
According to data from the US Centers for Disease Control and Prevention (CDC), only 13% of all recorded cases in the country have occurred in people over the age of 65. But about half of all hospitalizations and three-quarters of all deaths have occurred in this age group.
The hospitalization rate for older adults with COVID-19 has generally risen and fallen in line with general trends, peaking last winter during the omicron surge and declining significantly in the summer. But compared to other age groups, hospitalization rates have been consistently higher among the population aged 65 and over.
This winter, covid-19 trends across the country are on the rise. So far, the increase appears to be relatively mild: Hospitalizations are rising in most states, though the overall rate is still only a fraction of what it was in other outbreaks.
But in the case of the elderly, the situation is much more serious. Elderly hospitalizations are approaching the peak of the delta variant surge and are increasing rapidly.
And the age difference has never been greater. Since October, the rate of covid-19 hospitalizations among the elderly has been at least four times higher than the average.
Even during the first winter wave of 2020, when covid-19 swept through nursing homes, the difference was never more than tripled.
Dr. Eric Topol, a physician and professor of molecular medicine at Scripps Research, has dubbed the current wave the “senior wave.”
“Right now, we have an immunity wall built against the omicron family – between vaccines and previous infections and their combinations – that seems to keep the very young in pretty good shape. But the immune system of older people doesn’t. not.re so strong,” Topol says.
Immunocompromised young adults also likely experience disproportionately severe effects from the latest wave, but there are insufficient data to clearly understand trends in this population.
According to Topol, new variants that evade immunity more easily and the relatively low use of treatments such as Paxlovid may have played a role in the increased rate of hospitalizations among the elderly.
But “the main culprit is the lack of reinforcements”, with “unfortunately insufficient” rates, he said.
“Everything points to a decrease in immunity. If more older people were vaccinated, the effect would be minimal.”
Vaccines help and boosters keep working
Stewart says she has reduced personal mitigations but remains vigilant about covid-19 trends. She’s found a balance between caution and prevention that she says works for her, but what really helps her feel more confident is getting vaccinated.
“I’m paying attention to the fact that it’s going up, so I’m paying a little more attention than six weeks ago,” he says. “With the increase I haven’t gone back to where I was a few years ago, but I’m more aware of who I am and maybe I’m wearing the mask a bit more than before.”
Stewart took an at-home test for Covid-19 which came back negative and was confirmed by another over-the-counter test from a healthcare provider, which was some relief, he says. But even if the result was positive, knowing that she was vaccinated and boosted reassured her.
“It was the idea of being so proactive with all these vaccines. There was a very strong chance that you would get sick, but not as much as someone who hadn’t been vaccinated and there were very strong chances are you are not.” end up in the hospital,” he said. “In a way, it gave me confidence that even if I got it, it wouldn’t be so bad.”
But most seniors aren’t as protected as Stewart.
According to CDC data, only a third of the population over the age of 65 has received the updated reminder, a worrying figure for public health experts.
“It’s very, very concerning,” says Dr. Preeti Malani, a physician specializing in infectious diseases and geriatric medicine at the University of Michigan.
“There are a huge number of people who have been vaccinated before and who have not yet been vaccinated, and I fear there is confusion and misinformation. So to the elderly – and everyone – I say: if you haven’t been vaccinated, do it.”
A recent Kaiser Family Foundation poll found that 60% of seniors were worried about an increase in Covid-19 cases and hospitalizations this winter, a figure well above average.
More than 40% feared becoming seriously ill, but almost the same proportion said they were not planning to get vaccinated anytime soon. Indeed, almost a quarter of older people say they do not intend to get vaccinated or that they will only do so if necessary.
A community approach to protect the most vulnerable
Vaccines, including the updated booster, continue to prove effective in preventing serious illness. But uptake of the booster shot among older people, while low, is much higher than in other age groups. According to CDC data, less than 10% of adults under 50 and less than 5% of children received the updated booster dose.
Yet experts say the difference in vaccination rates is not enough to explain the large and growing difference in hospitalization rates.
“The truth is, really, anyone can get it,” 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. On the contrary, it is family, friends and the community at large that usually transmit covid-19 to older people, who are more likely to suffer more serious consequences.
“Older people are most at risk, but we take it with them,” says Malani. “One thing unique to older adults is that a lot of them are grandparents and a lot of them are taking care of their grandkids. So sometimes they get it from their grandkids, who can also go to school or daycare.”
Many seniors live in shelters, such as nursing homes, which also pose special risks.
But the problem remains that the elderly, although more vulnerable to serious consequences, are not the main drivers of spread within the population.
A government surveillance report released earlier this month found that care home outbreaks were “strongly associated with community spread”.
And nursing homes are once again particularly vulnerable this winter. Weekly cases among residents have already surpassed all previous surges except for the initial winter surge and the omicron surge, and continue to rise. But only 47% of residents and 22% of staff are “up to date” on vaccinations, according to data from the US Centers for Medicare & Medicaid Services.
“We would all have hoped for a vaccine that would prevent transmission. We don’t have a vaccine that will, but it does reduce transmission and reduce serious consequences,” said Janet Hamilton, executive director of the Council of State and Territorial Epidemiologists. .
For this reason alone, seniors who interact with other seniors should be vaccinated to help minimize serious consequences, he said.
“But really, anyone who comes into contact with high-risk groups should be the primary target for vaccination,” he added.
The way forward is not all or nothing
Stewart plans to host her family again for Christmas this year, for the first time since the pandemic began.
“We are careful who we associate with. We don’t feel undue risk meeting the family. It’s our security group,” he says.
She and her husband also get together with small groups of friends who they trust are also vaccinated and are equally cautious, but they still plan to stay away from baseball games, even if it’s is one of their favorite hobbies.
“We love going to baseball games. We’re real fans and we support our team a lot, but there’s a lot of risk. We take the ferry and you’re very close to a lot of people on that ride. And going to the stadium , again, we’re very close to a lot of unknowns,” he said. “It’s still too risky.”
Malani, the infectious disease specialist, said she recently spoke to a friend who appeared to be asking permission to join her family over the festive period. She was eager to celebrate in person with her loved ones after years of not doing so, but eager 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,” he said. “There is always a way forward, and for now, that is through vaccination.”