Jan. 10, 2023 – It might appear that we’re back to some semblance of “normal” at this point in the COVID-19 pandemic. But many people remain at higher risk for serious outcomes like hospitalization and death, especially older Americans.
Legula Estiloz was diagnosed with COVID-19 at age 104, for example. “She and I both came down with COVID at the same time, a few days after Christmas of 2020,” her son Tim Estiloz says.
“I went in to wake her up for her breakfast, and she was just drenched, sopping wet – her bed clothes and her nightgown,” Tim says.
Legula, a resident of The Willows, a skilled nursing community in Oakmont, PA, owned and operated by Presbyterian SeniorCare Network, sought care at nearby Magee Hospital. Both Legula and Tim were swabbed for COVID-19 and tested positive. They had low-grade fevers and fatigue. Legula lost her appetite for months. But neither lost their sense of smell or taste or had respiratory challenges.
The COVID-19 vaccines were not available at the time. “It is all the more miraculous that she survived it at that age, and without even the benefit of the vaccine to get her through it,” he says.
Americans 65 and older are dying at disproportionately higher rates from COVID-19. For example, people ages 65 to 74 account for 22% of COVID-19 deaths, even though this age group represents less than 10% of the U.S. population, CDC figures show. The picture is more dire for those 75 to 84 – a group that accounts for 26% of deaths but less than 5% of the population.
The oldest Americans, those 85 and over, account for 27% of deaths but make up only 2% of the U.S. population.
Add to this the yet-to-be-fully appreciated impact of the latest Omicron subvariant on the rise, XBB.1.5, and the future remains anything but certain.
Legula, who survived COVID-19, went on to have a heart attack and be diagnosed with breast cancer, all before spring 2020.
Her prognosis is good now, Tim says. “She's doing quite well. I think for a period of time, she was doing better than me.” She plays notes on the piano, likes to “dance” in her wheelchair, and catches a ball thrown from 3 or 4 feet away “each and every time.”
To summarize her pandemic experience, Legula “battled breast cancer, had radiation treatment, she fell once, she survived COVID, and she survived a heart attack,” Tim says. Although the admitting doctor warned that his mother might not survive the night of her heart attack, she improved and in January 2021 celebrated her 104th birthday.
“And now, God willing, in a few days she'll celebrate her 106th.”
Bivalent Booster Buy-In
A key factor in Legula’s recovery: She also is up to date on her COVID-19 vaccinations and boosters.
The bivalent boosters – which target some Omicron strains and the original coronavirus – are 84% more effective at keeping seniors from being hospitalized, says David Gifford, MD, chief medical officer at the American Health Care Association/National Center for Assisted Living in Washington, DC.
A Jan. 3 preprint study published in the journal The Lancet backs that up. While it hasn’t been peer-reviewed, researchers studied 622,701 people ages 65 and older and found those who had received the bivalent booster were 81% less likely to be hospitalized and 86% less likely to die from COVID-19 than others who did not receive it.
But only slightly more than one-third of Americans 65 and older, 38%, have received a bivalent booster, compared to 15% of all Americans 5 years or older, CDC data shows. So there is great room for improvement, experts say.
“We have this ongoing push among our members to increase booster acceptance rate among residents,” says Lisa Sanders, director of media relations at LeadingAge, a national association of nonprofit providers and aging services, including nursing homes, retirement community settings, and affordable housing for older adults.
One of the biggest misconceptions, she says, is “the thinking that the bivalent booster is not necessary.” In addition, ongoing education and access to vaccines remain important “because there is a lot of misinformation.”
“The messaging has to be clear: You need to get the bivalent booster,” Sanders says, “especially now after the holidays and [when] new variants are emerging.”
COVID and Congregate Living
With older Americans more vulnerable to serious effects of COVID-19, a question that comes up is: What about settings where they live together, such as nursing homes, skilled nursing facilities, and other care centers? Earlier in the pandemic, these locations faced greater infection control challenges with the coronavirus.
“Long-term care professionals have known since day one that older adults with chronic conditions are most vulnerable when it comes to this virus. They have been bedside to unspeakable tragedy these past 3 years,” Gifford says.
“Unfortunately, ageism has been on full display during this pandemic, as evidenced by long term-care facilities begging public health officials for resources to no avail in the beginning,” he says.
So where are they now?
On the plus side, defenses and preventive measures have come a long way since the pandemic started, Gifford says. “While older adults are still most vulnerable, we have the tools to help protect them from serious illness and hospitalization. First and foremost, seniors need to stay up to date on their COVID vaccinations, which means getting the updated, bivalent booster.”
Florida at the Forefront
The three U.S. states with the most residents ages 65 and older are California, Florida, and Texas. As a percentage, more than 1 in 5 Floridians, or 21%, for example, are in this age group, according to 2021 U.S. Census numbers.
With one of the country’s most vulnerable older populations, the Florida Health Care Association in Tallahassee continues to promote the effectiveness of the COVID-19 vaccine and boosters. Kristen Knapp, senior director of strategy and communications for the association, says, “While the booster may not prevent infections, we know that it can help residents from becoming very sick or being hospitalized."
COVID-19 vaccination is not a requirement for resident admission or staff employment. But Knapp says that, vaccinated or not, anyone who tests positive for COVID-19 is required to follow infection control protocols.
The Feds Get Involved
On Nov. 22, the White House announced a campaign to promote boosters in older adults. The focus is on reaching seniors and other communities hardest hit by COVID-19, making it even more convenient to get vaccinated, and increasing awareness through paid media.
The initiative includes new enforcement guidance through the Centers for Medicare & Medicaid Services to ensure nursing homes are offering updated COVID-19 vaccines as well as timely treatment to their residents and staff.
Shortly thereafter, LeadingAge joined forces with American Health Care Association to create an “All Hands on Deck” initiative to help achieve the White House goals. One strategy is to get hospitals more involved. This is important, Sanders says, because about 90% of nursing home admissions involve people transferred from a hospital.
Future variants continue to be a threat, but the vaccines are incredibly effective in preventing hospitalizations and death, experts emphasize.
“We continue to monitor and prepare for anticipated surges, like this winter’s, and encourage everyone, including our residents and staff, to get their boosters,” Gifford says.
There needs to be an ongoing vigilance that this is a community issue, Sanders says. “There's a human tendency to want to push it away and say, ‘oh it's their problem.’
“Really, it's all of our problem, and if we all take steps to protect ourselves and each other, we'll be better off as a society.”