Covid’s Risk to Older Adults
Ready to give up on the pandemic? Spare a moment to think about older people.
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By now, you’ve probably heard someone say it, or maybe you’ve said it yourself: We’re all getting Covid.
“Yes, you’ll get the virus,” Dr. James Hamblin wrote in his newsletter. “I think we all have a date with Covid at some point,” Helen Branswell, a health reporter at Stat News, said. “People are starting to give up,” my colleague Tara Parker-Pope told me.
It’s an understandable feeling given Omicron’s intense contagiousness, even among the vaccinated. A surge that began in the Northeast is now spreading to the Midwest, South and beyond:
Some of the country’s new Covid acceptance — or fatalism — stems from frustration with the costs of pandemic precautions: the loss of learning from closed schools; the isolation from social distancing; the nationwide rise in blood pressure, drug overdoses, mental health problems and more.
And some of the new attitude stems from the reality that contracting Covid will not be a big deal for most people. Hospitalization rates for children and for vaccinated people under 50 years old remain minuscule.
But I do want to raise one major point of caution. Covid in recent months has continued to present a meaningful amount of risk to older people, despite vaccination. It’s too soon to know whether Omicron will change the situation, but the safest assumption — absent more data — is that Covid will remain dangerous for the elderly.
“There is good reason for older adults to continue to try to avoid becoming infected, because the risk for hospitalization in that age group is still significant,” Dr. Shelli Farhadian of Yale University told me.
Today’s newsletter will walk through the data and then consider its implications.
The risks
A team of British researchers, led by Dr. Julia Hippisley-Cox at the University of Oxford, has conducted some of the most detailed research on Covid risks for different groups of people. The BMJ, a peer-reviewed journal, published the work, and it is available in an online calculator. The research was done before Omicron emerged and covers only residents of Britain, but it is still instructive.
Here are estimated post-infection death rates for several hypothetical people, all vaccinated.
The risks here for older people are frightening: A rate of 0.45 percent, for instance, translates into roughly a 1 in 220 chance of death for a vaccinated 75-year-old woman who contracts Covid. If the risks remain near these levels with Omicron, they could lead to tens of thousands of U.S. deaths, and many more hospitalizations.
Encouragingly, there are reasons to believe that Omicron’s death rate may be lower. Three new studies released yesterday suggested that Omicron causes milder illness on average than earlier versions of the virus. “I would guess that the mortality risk with Omicron is much smaller” than with earlier variants, Dr. George Rutherford of the University of California, San Francisco, told me yesterday.
One reassuring comparison is to a normal seasonal flu. The average death rate among Americans over age 65 who contract the flu has ranged between 1 in 75 and 1 in 160 in recent years, according to the C.D.C. Pre-Omicron versions of Covid, in other words, seem to present risks of a similar order of magnitude to vaccinated people as a typical flu. Some years, a flu infection may be more dangerous.
With Omicron, “I think the risk is not super high for relatively healthy and boosted people in their 70s,” Janet Baseman, an epidemiologist at the University of Washington, told me. “I think it’s moderate at most.”
Still, Baseman and other experts recommend vigilance, for several reasons. First, the flu kills tens of thousands of Americans a year, and we should probably pay more attention to it. (After declining last year during social distancing, flu infections are rising again now, as these Times charts show.)
Second, Omicron is so contagious that it has the potential to swamp hospitals and cause many otherwise preventable deaths even if only a small share of infections are severe. “We’re not at a place to treat this as a cold,” Azra Ghani of Imperial College London said.
Baseman said that if she were in her 70s, her primary worry would be getting moderately ill, needing standard medical care and not being able to get it at an overwhelmed hospital. Dr. Aaron Richterman of the University of Pennsylvania told me, “There is a strong rationale for reasonable efforts to mitigate transmission, particularly over the next four weeks.”
Remember that these efforts do not need to last forever. In South Africa, the number of new Covid cases is already falling, suggesting that the initial Omicron surge may be sharper and shorter than previous surges. Again, though, nobody knows what the next few weeks will bring.
In the meantime, it makes sense for many people — not just those over 65 — to think about which risky activities are easy to cut out. It also makes sense to wear N95 or KN95 masks, which are more effective than most. Above all, scientists say, get boosted now if you are eligible.
There are also some steps that individuals cannot take but that society could: Requiring people to be vaccinated to enter restaurants (as New York City has and Washington, D.C., soon will) and fly on airplanes; expanding access to walk-in vaccine clinics, rapid tests and post-infection treatments (as the Biden administration has begun doing); and improving ventilation in public indoor spaces.
I have focused on vaccinated people today’s, because they are already trying to protect themselves and their communities. Here is a different version of the chart above, this time adding the death risk for an unvaccinated, otherwise healthy 75-year-old woman who contracts Covid:
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