Coronavirus-related hospital admissions are rising again in the United States, with older adults accounting for a growing share of US deaths and fewer than half of nursing home residents up to date on vaccines against COVID-19.
These alarming signs herald a difficult winter for seniors, worrying 81-year-old nursing home resident Bartley O’Hara, who said he is “vaccinated to the eyeballs” and tracks coronavirus hospital trends at as they “zoom in” for older adults. , but remains flat for the younger ones.
“The sense of urgency is not universal,” said O’Hara of Washington, DC But “if you’re 21, you should probably worry about your grandmother. We are all in this together”. A worrisome indicator for seniors: Hospitalizations of people with COVID-19 increased more than 30% in two weeks.
Much of the increase is being driven by older people and those with existing health problems, said Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention. The numbers include everyone who has tested positive, regardless of why they were admitted. When it comes to protecting seniors, “we’re doing a terrible job in this country,” said Dr. Eric Topol, director of the Scripps Translational Research Institute.
As nursing home leaders redouble their efforts to get staff and residents the new version of the vaccine, now recommended for those 6 months and older, they are faced with complacency, misinformation and fatigue by COVID-19. They are asking the White House for help with an “all hands on deck” approach.
Clear messages are needed about what the vaccine can and cannot do, said Katie Smith Sloan, president of LeadingAge, which represents nonprofit nursing homes.
Emerging infections don’t mean the vaccine has failed, he said, but that misperception has been hard to combat. “We need to change our messaging to be precise about what it does, which is prevent serious illness, hospitalization and death,” Sloan said. “This virus is insidious and it keeps showing up everywhere. We just have to be realistic about it.”
Issues include unwarranted hesitation to prescribe the antiviral pill Paxlovid quickly in the elderly, prompting five major medical societies to hold a web-based educational session for physicians, “Vax & Pax: Keeping Your Patients Safe This Winter “. broader immunity in the general population and mixed messages about whether the pandemic is over have softened the sense of threat felt by younger adults. That may be a welcome development for most, but the attitude has seeped into nursing homes in worrying ways.
Getting family consent to vaccinate nursing home residents has become more difficult, nursing home leaders say. Some residents who can give their own consent are refusing the vaccines. Only 23% of nursing home staff are up to date on COVID-19 vaccinations.
Cissy Sanders of Austin, Texas, faced multiple obstacles trying to get a brace for her 73-year-old mother, who is in a nursing home. No booster clinic was scheduled. The center told her they couldn’t find a vaccinator. So she made plans to take her mom to Walgreens later this month.
“I am concerned about the increase in hospitalizations and deaths among the elderly, and concerned about the lack of urgency at my mother’s nursing home to vaccinate residents and staff” with the latest booster, she said.
Staff and visitors are potential entry points into nursing homes for the virus. The best facilities use a multi-layered approach, protecting residents with masks, screening questions, temperature checks, and enhanced infection control.
“What we have learned during COVID is that the rate of spread depends on the rate of spread in the community,” said Tina Sandri, executive director of Forest Hills of DC, a nursing home in the nation’s capital. “I feel safer in my building than anywhere else, including the grocery store.”
Meanwhile, hospitals across the country are seeing an influx of older patients that Topol calls “quite alarming.” Nationwide, the rate of daily hospital admissions for people age 70 and older with confirmed or suspected COVID-19 increased from 8.8 per 100,000 people on November 15 to 12.1 per 100,000 people on November 6. December, according to statistics from the Department of Health and Human Services. In California and New York, Topol said, hospitalizations of older people with COVID-19 have already surpassed those of the spring and summer omicron waves.
At NYU Langone Health, the hospital’s chief epidemiologist, Dr. Michael Phillips, said a growing number of older people are being admitted to his hospital with COVID-19. But the biggest increase he’s seen is in the emergency department, “which is very, very busy” with COVID-19 as well as flu patients.
Dr. Wesley Long, a pathologist at Houston Methodist in Texas, said his hospital has also seen an increase in COVID-19 admissions in recent weeks, with many of the patients being older people with other health problems. Some are admitted for different diseases and test positive for COVID-19 at the hospital. The good news? “We have not seen an increase in ICU admissions,” he said.
The new combined booster shot, which targets both omicron and the original coronavirus, provides protection against one of the main omicron variants that is increasing cases of late: BQ.1.1, which is especially adept at escaping immunity. “But our booster rates among the elderly are pathetically low,” Topol said, with only about a third getting the shot.
Long said that Houston Methodist health care providers encourage boosting “every chance we get.” But they don’t give it to people hospitalized with COVID-19, who are typically told to wait three months after becoming infected to contract it.
Phillips also urges people to get their boosters, especially if they are at risk of serious illness or plan to spend time with someone who is. He said they see a lot more hospitalizations among people who aren’t vaccinated.
Deaths, like hospitalizations, are now rising. The final concern is that more older people will die. Last spring and summer, death rates generally declined as more people gained protection from vaccination and previous infection. But the proportion of COVID-19-related deaths for older adults, adults 85 and older, who make up 2% of the population, rose to 40%.
Over the course of the pandemic, 1 in 5 deaths from COVID-19 occurred among those in a long-term care facility.Dr. Walid Michelen, medical director of seven nonprofit nursing homes operated by the Archdiocese of New York, said Americans must continue to take the pandemic seriously. “Will not go away.
It is here to stay,” he said. “We’re going to get a new variant, and who knows how aggressive that variant is going to be? That keeps me up at night.”
