Reprint: Covid Vaccines Essential for Elders

 

COVID-19 vaccines: CDC says people ages 65 and up should get a shot this spring – a geriatrician explains why it’s vitally important

Even if you got a COVID-19 shot last fall, the spring shot is still essential for the 65 and up age group. whyframestudio/iStock via Getty Images Plus

Laurie Archbald-Pannone, University of Virginia

In my mind, the spring season will always be associated with COVID-19.

In spring 2020, the federal government declared a nationwide emergency, and life drastically changed. Schools and businesses closed, and masks and social distancing were mandated across much of the nation.

In spring 2021, after the vaccine rollout, the Centers for Disease Control and Prevention said those who were fully vaccinated against COVID-19 could safely gather with others who were vaccinated without masks or social distancing.

In spring 2022, with the increased rates of vaccination across the U.S., the universal indoor mask mandate came to an end.

In spring 2023, the federal declaration of COVID-19 as a public health emergency ended.

Now, as spring 2024 fast approaches, the CDC reminds Americans that even though the public health emergency is over, the risks associated with COVID-19 are not. But those risks are higher in some groups than others. Therefore, the agency recommends that adults age 65 and older receive an additional COVID-19 vaccine, which is updated to protect against a recently dominant variant and is effective against the current dominant strain.

You have a 54% less chance of being hospitalized with severe COVID-19 if you’ve had the vaccine.

Increased age means increased risk

The shot is covered by Medicare. But do you really need yet another COVID-19 shot?

As a geriatrician who exclusively cares for people over 65 years of age, this is a question I’ve been asked many times over the past few years.

In early 2024, the short answer is yes.

Compared with other age groups, older adults have the worst outcomes with a COVID-19 infection. Increased age is, simply put, a major risk factor.

In January 2024, the average death rate from COVID-19 for all ages was just under 3 in 100,000 people. But for those ages 65 to 74, it was higher – about 5 for every 100,000. And for people 75 and older, the rate jumped to nearly 30 in 100,000.

Even now, four years after the start of the pandemic, people 65 years old and up are about twice as likely to die from COVID-19 than the rest of the population. People 75 years old and up are 10 times more likely to die from COVID-19.

Vaccination is still essential

These numbers are scary. But the No. 1 action people can take to decrease their risk is to get vaccinated and keep up to date on vaccinations to ensure top immune response. Being appropriately vaccinated is as critical in 2024 as it was in 2021 to help prevent infection, hospitalization and death from COVID-19.

The updated COVID-19 vaccine has been shown to be safe and effective, with the benefits of vaccination continuing to outweigh the potential risks of infection.

The CDC has been observing side effects on the more than 230 million Americans who are considered fully vaccinated with what it calls the “most intense safety monitoring in U.S. history.” Common side effects soon after receiving the vaccine include discomfort at the injection site, transient muscle or joint aches, and fever.

These symptoms can be alleviated with over-the-counter pain medicines or a cold compress to the site after receiving the vaccine. Side effects are less likely if you are well hydrated when you get your vaccine.

Getting vaccinated is at the top of the list of the new recommendations from the CDC.

Long COVID and your immune system

Repeat infections carry increased risk, not just from the infection itself, but also for developing long COVID as well as other illnesses. Recent evidence shows that even mild to moderate COVID-19 infection can negatively affect cognition, with changes similar to seven years of brain aging. But being up to date with COVID-19 immunization has a fourfold decrease in risk of developing long COVID symptoms if you do get infected.

Known as immunosenescence, this puts people at higher risk of infection, including severe infection, and decreased ability to maintain immune response to vaccination as they get older. The older one gets – over 75, or over 65 with other medical conditions – the more immunosenescence takes effect.

All this is why, if you’re in this age group, even if you received your last COVID-19 vaccine in fall 2023, the spring 2024 shot is still essential to boost your immune system so it can act quickly if you are exposed to the virus.

The bottom line: If you’re 65 or older, it’s time for another COVID-19 shot.

Laurie Archbald-Pannone, Associate Professor of Medicine and Geriatrics, University of Virginia

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Reprint: Preventing Another Pandemic

 From the NY Times Opinion newsletter:

The Covid-19 pandemic exploited a narrow gap in humanity’s outbreak prevention barriers. As the world now knows, SARS-CoV-2 spreads through the air via respiratory transmission. Spread can occur even before people develop symptoms. Our modern, mostly indoor lifestyles constructed the optimal environment for a fast-moving respiratory pandemic. Clean water, clean hands, clean food and clean surfaces did not stop the virus from hitching a ride on airplanes or spreading at packed concerts, bars and restaurants.

As in the past, we need to develop technologies that will fundamentally change our environment. In the United States, all modern buildings are built with fire prevention in mind, despite the last city-burning fire occurring over a generation ago. We provide piped water and sewer systems, electricity to boil water and refrigerate food, and window screens to stop pests. The goal today should be to take respiratory pandemics entirely off the table.

This starts with cleaning the air. The most ambitious version of clean indoor air technology would be capable of rapidly suppressing transmission for even the most contagious pathogens, like measles, at a cost affordable enough to install in all the places people gather and cross paths. Accomplishing this will require innovation beyond better ventilation and ways to filter air. ‌This could include light bulbs that also emit germ-killing wavelengths that are still safe for humans. With this type of innovation, society can reduce transmission and maybe even make the common cold a relic. The Biden administration has declared improving ventilation a priority, but simply upgrading out-of-date filtration systems to the current standard probably won’t be enough to prevent pandemics.

Researchers have made ‌progress toward‌‌ other advanced pandemic-fighting capabilities. It is now possible to take any type of sample from a possibly infected person and sequence the genome of every microorganism in that sample ‌‌ — bacteria, viruses, fungi and all. All pathogens have genomic material, and sequencing allows us to read that material. This method, metagenomic sequencing, functions as a universal pathogen detector. It is beginning to be used to monitor patients for known pathogens, as well as bugs we have never seen before.

Vaccines are, of course, a mainstay of prevention, and even these have seen incredible improvements with the advent of mRNA vaccines. Work is ongoing to deliver pandemic vaccines within 100 days. Efforts toward‌‌ making vaccines effective against entire groups of viruses, such as all coronaviruses, are underway. But for modern vaccines to truly prevent rapid respiratory pandemics, they must be deployed widely and quickly and, when possible, in advance.

The U.S. government‌‌ is investing in microneedle vaccine patches and nasal spray vaccines that can be self-administered. These could be quickly mailed to every household, eliminating the need for clinic- and pharmacy-based administration by trained health care workers. Scientists think that skin patches and nasal vaccines may be able to elicit mucosal immunity, something current injectable vaccines don’t do very well. Mucosal immunity prevents viruses that land on our mucus membranes — in the nose, mouth and lungs — from causing an infection entirely.

A COVID loss: anger, grief, and healing

The COVID-19 pandemic has been raging for many months now, marked from the onset by lies about the disease, its origins, its treatment, and its prevention. No aspect of the pandemic has been free from controversy and misinformation. In the middle of flame wars and whack-a-mole efforts to squelch anti-vaccine, anti-mask internet sites lies the confusion and grief of those who have lost loved ones to this disease (over 700,000 in the US and 4,800,000 worldwide).

Like many others who believe in science, I was first puzzled and then appalled by the cloud of outright falsehoods that grew up around vaccination. Refusing the vaccines based on illogical and unfounded internet rumors struck me as downright suicidal. Equally troubling were the friends who bought into those lies.

One was a long-time, very dear friend, who had supported me through dark times and whom I had supported in turn. Early in 2020, L told me that she didn’t trust the mRNA vaccines and besides, she thought she’d had a mild case of COVID-19, although she was never tested. But she was diligently wearing a mask at work, and it was clear that further discussion would only be confrontational, so I backed off. For the next year, all appeared to be going well. Then she moved to another part of the country, one with low vaccination and mask-wearing rates. I heard from her while she was waiting at an urgent care center for a persistent cough. Her COVID-19 test was positive. A few days later, she was admitted to the ICU. We talked and texted frequently as her condition deteriorated. After a week and a half, she was placed on a ventilator. She died two weeks later. Her last text to me was, “I love you.”

During her hospitalization, I felt not only growing concern for her, but anger. Anger at so many things. After her diagnosis, I wanted to scream at her, “How could you fall for that conspiracy nonsense?” Then my fury spread to everyone who spread those lies, manipulated statistics, and otherwise terrified people into refusing the one thing proven to save their lives. Anger at the last administration and the former president, who failed to take action at the onset of the pandemic. Anger at the officials in her state for their lax measures and cavalier attitudes to the virus. Anger at everyone who touted ineffective remedies in order to make a profit. And most of all, guilt that I hadn’t pressed the vaccine issue harder and been persuasive enough to save my friend’s life.

Grief mixed with anger and guilt isn’t logical. Nor is it simple.

[personal rant] Another Rant About Vaccination

Back in April, 2019, I posted a personal rant, Why I Am Adamant About Vaccination. This was way before Covid-19 and the more than half million American deaths. The issue was childhood vaccination against measles, mumps, rubella, and the like. I shared a deeply personal story:

During my first pregnancy, an antibody titer that revealed I’d had rubella as a child. A series of conversations with my mother and sister put together the pieces of my own family tragedy due to contagious disease. In most cases, rubella is a mild infection, except when a woman is pregnant. Contracted in the first 12 weeks of pregnancy, babies have an 85% chance of Congenital Rubella Syndrome, including deafness, cataracts, heart defects, neurological issues, and other significant problems. The risk goes down as pregnancy progresses.

This is what happened to my baby sister.

My mother had been mildly ill, and I had been, as well. My sister Madeleine was born blind and with heart defects. She lived only 6 months.

At the time (1950) there was no vaccine, but there is now. Today this loss would have been completely preventable by vaccination, not just for the mother but for all the people around her. This is a public health issue that involves us all.

So when I hear the anti-scientific justifications for refusing to vaccinate children, I think of the baby that could have lived and the grief that haunted my mother the rest of her life. I don’t care about personal choice or fears of governmental conspiracies. None of them count in my mind against the lives of my baby sister, and everyone’s sisters and brothers.

I honestly do not care what their reasons are. This is not a “tomaytoe, tomahtoe” discussion where understanding through respectful dialog is the goal. This is about whether we as human beings are capable of acting for our common good (which in this case includes protecting our most vulnerable from preventable severe disability and death itself), at the cost of a much smaller risk and a little inconvenience. Do not ever try to convince me that this area of public health is an infringement on civil liberties, or is a plot on the part of Big Pharma. My sister’s life was more precious than your conspiracy theories.

 

Fast forward to 2020. People are dying or suffering chronic, debilitating effects from Covid-19.

[personal rant] Why I Am Adamant About Vaccination

I remember a time when there was no question about vaccination. It was a modern miracle, a triumph of science over disease. I grew up reading Paul de Kruif’s Microbe Hunters, thrilling to the discoveries first of microbes, then of the microbial causes of contagious diseases, and most importantly, the development of vaccines that used the body’s natural immune systems to confer resistance. Terrible diseases like smallpox and polio would soon become a thing of the past, museum relics.

In the years of my childhood, everyone expected kids to get round after round of communicable diseases, most of them viral. This happened to me, too. Before I hit adolescence, I’d had measles, mumps, chickenpox, and rubella (German measles – more about that below). I have vivid memories of losing weeks of school but also of my mother nursing me through each round. I never got diphtheria or pertussis (whooping cough), although the kids down the street got it, or polio. I did know kids who got polio, and everyone knew someone who knew someone who’d died of it. So when the Salk (injected/inactivated) vaccine came along, I got it, and then later the Sabin (oral/live). I was in high school when the Sabin vaccine was made widely available, and my service club helped to administer it on sugar cubes.

I’m diligent about tetanus (TDap, with diphtheria) boosters, and received the shingles and pneumonia vaccines on schedule. I also get a yearly flu vaccine, although the one year I didn’t try hard enough in the face of limited supply for my age group, I came down with it: a month-long bout of H1N1 was no fun at all. So in terms of understanding how vaccination contributes to my personal health, I practice what I preach.

But there’s more to the story than just whether I as an individual am protecting myself. Those who scoff at the value of herd immunity receive its benefits while opening the door to exposing not just themselves but those who cannot be vaccinated for medical reasons (babies too young, people of any age who are immunocompromised, etc.) One of the consequences is that when adults contract “childhood” diseases, they are often much sicker and at much greater risk of complications. I saw this when my first husband came down with measles at age 24. His fever spiked above 105^o F, leaving him delirious. I spent a night coaxing him into and out of a lukewarm bath, which effectively brought down his temperature to a safer level, over and over again. He was much, much sicker than I’d been at age 10 with the same illness. It took him weeks to fully recover, and thankfully he did not suffer pneumonia or encephalitis, which are more likely in adults over 20 (and children under 5), according to the CDC.