COronavirus-related hospitalizations are on the rise again in the United States, with older adults accounting for a growing share of U.S. deaths and less than half of nursing home residents knowing about COVID-19 vaccinations.
These alarming signs portend a difficult winter for seniors, worrying 81-year-old nursing home resident Bartley O’Hara. , but stay flat for younger people.
“The sense of urgency is not universal,” said O’Hara of Washington, DC. But “when you’re 21, you should probably be worried about your grandma. We’re all in this together.”
A worrying indicator for seniors: Hospital admissions for people with COVID-19 rose by more than 30% in two weeks. Much of the increase is driven by older people and those with existing health conditions, said Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention. The numbers include everyone who tests positive, regardless of why they’re included.
When it comes to protecting seniors, “we’re doing a terrible job in this country,” said Dr. Eric Topol, head of Scripps Research Translational Institute.
As nursing home leaders redouble their efforts to boost staff and residents with the new vaccine version, now recommended for children 6 months and older, they face complacency, misinformation and COVID-19 fatigue. They are calling on the White House for help with an “all hands on deck” approach.
Clear messages about what the vaccine can do — and what it can’t — are needed, said Katie Smith Sloan, president of LeadingAge, which represents nonprofit nursing homes.
Breakthrough infections don’t mean the vaccine has failed, she said, but that false perception has been hard to combat.
“We need to change our messaging to be accurate about what it does, which is prevent serious illness and hospitalization and death,” Sloan said. “This virus is insidious and it keeps popping up everywhere. We just have to be realistic about that.”
Issues include the unwarranted hesitation to quickly prescribe the antiviral pill Paxlovid to the elderly, prompting five major medical associations to conduct a web-based educational session for physicians, “Vax & Pax: How to Keep Your Patients Safe This Winter.” “
Easing restrictions, broader immunity in the general population and mixed messages about whether the pandemic is over have softened the sense of threat among younger adults. That may be a welcome development for most, but the attitude has seeped into nursing homes in a disturbing way.
Getting family consent to vaccinate nursing home residents has become more difficult, nursing home leaders say. Some residents who can give their own consent reject the injections. Only 23% of nursing home staff are aware of COVID-19 vaccinations.
Cissy Sanders of Austin, Texas, faced multiple obstacles when trying to get a booster for her 73-year-old mother, who is in a nursing home. There was no booster clinic on the schedule. The facility told her they couldn’t find a vaccinator. So she made plans to go to Walgreens with her mom later this month.
“I am concerned about the increase in hospitalizations and deaths among senior citizens, and concerned about the lack of urgency at my mother’s nursing home to get residents and staff vaccinated,” she said with the latest booster.
Staff and visitors are potential gateways to 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 learned during COVID is that the rate of spread depends on the rate of spread in the community,” said Tina Sandri, CEO of Forest Hills of DC, a nursing home in the nation’s capital. “I feel safer in my building than anywhere else, including the supermarket.”
Meanwhile, hospitals across the country are seeing an influx of elderly patients that Topol calls “pretty alarming.” Nationally, the rate of daily hospitalizations for those age 70 and older with confirmed or suspected COVID-19 rose from 8.8 per 100,000 people on Nov. 15 to 12.1 per 100,000 people on Dec. 6, according to statistics from the Department of Health and Human Services. services. In California and New York, Topol said, hospitalizations for seniors with COVID-19 are already higher than those during the spring and summer omicron waves.
At NYU Langone Health, chief hospital epidemiologist Dr. Michael Phillips that a growing number of seniors are being hospitalized with COVID-19. But the biggest increase he sees 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 — and many of the patients are seniors with other health conditions. Some are admitted for various illnesses and test positive for COVID-19 in the hospital. The good news? “We haven’t seen an increase in ICU admissions,” he said.
The novel booster-injection combination, which targets both omicron and the original coronavirus, offers protection against one of the main omicron variants driving cases up lately: BQ.1.1, which is especially adept at escaping immunity.
“But our booster rates among seniors are pitifully low,” Topol said, with only about a third getting the shot.
Long said healthcare providers at Houston Methodist are promoting the booster “every chance we get.” But they don’t administer it to people hospitalized with COVID-19, who are generally told to wait three months after becoming infected to get it.
Phillips also urges people to get their boosters, especially if they’re at risk for serious illness or plan to spend time with someone who is. He said they’re seeing a lot more hospitalizations among people who haven’t been vaccinated.
Deaths, such as hospitalizations, are now on the rise.
The ultimate concern is that more seniors will die. Last spring and summer, mortality rates generally fell as more people gained protection from vaccination and previous infection. But the share of COVID-19-related deaths among the oldest elderly — adults aged 85 and over, who make up 2% of the population — grew to 40%.
Over the course of the pandemic, 1 in 5 COVID-19 deaths have been among those in a long-term care facility.
Dr. Walid Michelen, chief medical officer of seven nonprofit nursing homes operated by the Archdiocese of New York, said Americans should continue to take the pandemic seriously.
“It’s not going away. It’s here to stay,” he said. “We are getting a new variant, and who knows how aggressive that variant will be? That keeps me up at night.”
Associated Press writer Nicky Forster contributed from New York.
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