As Covid deaths soar, even seniors are skipping the latest booster

PLEASANT HILL, Calif. — Bonnie Ronk is something of a public health matriarch at the Mt. Diablo Center for Seniors in this liberal Northern California suburb.

When Ms. Ronk, a great-grandmother whose red walker has a sticker that reads “El Jefe” (The Leader), tells her peers to pull their masks up over their noses, they obey. When she received both doses of the Covid vaccine and a booster and told others to do the same, they did.

But Ms Ronk, 79, hasn’t gotten the latest Covid booster either, which has been updated to protect against the Omicron variant and has been available since September. She said she knew nothing about it.

In the United States, where about 94 percent of people age 65 and older received their first Covid vaccines, only 36 percent have received the updated vaccination, known as the bivalent booster shot, according to the Centers for Disease Control and Prevention. Seniors have offered a number of explanations: they were unaware of it, couldn’t find it, or weren’t convinced of its value.

As the pandemic enters its third winter and Covid hospitalizations and deaths surge again, medical experts worry there is no effective plan to update the immunizations of Americans most at risk. Two years ago, when Covid shots were first introduced, the federal government sent teams into thousands of nursing homes and community centers to vaccinate seniors, helping stem the virus’ devastation.

But so far this fall, the White House has only offered grants to community organizations to get shots in the arms of elderly people without the clear messaging strategy or logistical support they need most, many nurses and nursing home executives said in interviews.

“The government and philanthropic support seems nonexistent,” said Debbie Toth, executive director of the nonprofit Choice in Aging, which helped deliver thousands of the first vaccines to adult care facilities and residential complexes in California’s East Bay in early 2021 bring to.

The waning immunity of seniors has largely transformed the Covid pandemic in the United States from a threat to the unvaccinated to a threat to the elderly, many of whom were once well protected. People over 70 are being admitted to hospital with Covid at a rate four times higher than the general population.

The latest available death figures by age showed that nearly 90 per cent of Covid deaths were in people over the age of 65.

“The evidence is clear: even if you got the shot two years ago, your immunity has gone down. But the people who need to hear it the most have not,” said Dr. Michael Wasserman, geriatrician and chair of the California Association of Long Term Care Medicine. “If you combine pandemic fatigue with no real government plan, we have a perfect storm.”

Read more about the coronavirus pandemic

• Booster: Americans who received updated vaccinations for Covid-19 saw their risk of hospitalization reduced by about 50 percent this fall compared to certain groups who were vaccinated with the original vaccines, the Centers for Disease Control and Prevention reported.
• Vaccination mandates: After the bitter battles over Covid vaccinations over the past two years, simmering opposition to universal school vaccination requirements has increased significantly.
• Free home tests: With cases surging, the Biden administration has restarted a program that has delivered hundreds of millions of tests through the mail service.
• Infection: Like a zombie in a horror movie, the coronavirus can survive long after death in infected patients and even spread to others, according to two startling studies.

The Biden administration’s Covid plan for the winter includes $125 million in grants to two community organizations, USAging and The National Council on Aging, for programs to vaccinate older Americans — a far less direct approach than the posting by CVS and Walgreens employees in care centers after the first shots were approved. The plan also includes letters to governors calling for more admissions into nursing homes and a television advertising campaign targeting racial and ethnic minority seniors.

Mary Wall, the chief of staff for the White House Covid response team, said the government is doing what it can with the limited resources available, but acknowledged that this time the government is relying on states to shoulder more of the burden.

“We’re asking them directly instead, please go and host on-site clinics,” she said.

She called the grants “a great start,” but stressed that a more solid financial investment would require the cooperation of Congress, which has repeatedly rejected President Biden’s request for an additional $10 billion in health funds, much of it for the coronavirus response .

“Realistically,” she said, “we haven’t gotten more money for it for a while, despite repeated pleas to Congress. We have tried very hard to look at our resources with great sobriety.”

Epidemiologists agree that widespread vaccination is among the most valuable of all the pillars of a national response. They estimate that Covid vaccinations prevented 650,000 hospital admissions and 300,000 deaths among seniors and Medicare beneficiaries in 2021 alone.

But the virus has evolved since then, and the original vaccine formula no longer matches well with circulating variants, a particular risk for seniors with compromised immune systems and underlying conditions like heart disease and diabetes.

Even bivalent vaccination has limited ability to prevent infection from the latest Omicron variants, but it is very effective in preventing serious illness and death. According to CDC data, people ages 50 and older who received multiple boosters had half the risk of dying from the virus than people who received only one booster.

dr Sabine von Preyss-Friedman, a geriatric specialist and Avalon Health Care Group’s chief medical officer, said the apathy among some seniors reflected a misunderstanding about the purpose of the vaccine.

“People think, ‘I got the shot and I still have Covid, so what’s the point?’ They don’t think about the fact that they got Covid and survived.”

As part of the federal push, the Centers for Medicare and Medicaid Services also added a record about the vaccine to their 1-800 MEDICARE line and sent emails to newsletter recipients “to share information about these updated vaccines, including when.” and how to get them are you.”

But a recent poll by the Kaiser Family Foundation, a nonpartisan research organization, found that 40 percent of people aged 65 and over said they had heard little or nothing about the new refresher. According to surveys, about half of Americans over 70 going home don’t have a computer, and more than half have not used email or the Internet in the past month.

Contra Costa, the East Bay County where the Mt. Diablo Center operates, has not experienced the politicization that has turned many American communities against public health measures. Here, front yards are still littered with signs praising health workers. A 14-row parking lot has been repurposed for drive-through Covid testing.

Posters in each sidewalk encourage a distance of two meters. The center’s mascot is a stuffed pig in a rainbow cape wearing a miniature mask. “Not all heroes wear cloaks,” reads a sign, “but they do wear masks.”

Yet even at this facility, where 100 percent of participants received their first vaccines, only 40 percent received the bivalent booster. At Pleasant Hill Post Acute, four miles south, every resident received the original shots, but only one in five are now up to date. In Vacaville Convalescent and Rehab to the north, nearly 90 percent of residents were vaccinated, but 13 percent are up to date Stand. Seven residents there tested positive for Covid last week.

Ms Ronk has chronic inflammatory lung disease which puts her at serious risk of Covid. She said she’d like to stay “as healthy as possible,” country music blared as she worked out at the center and used plastic water bottles as dumbbells.

She would have been “damn glad to get it,” Ms Ronk said of the bivalent refresher had she known about it.

Alexandr Makedonsky, 84, a former dental technician who describes himself as “very science-friendly”, said he was eagerly searching for the first batch of Covid vaccines and two booster shots after a friend was hospitalized with the virus. Little did he know that the fifth shot suited Omicron better.

Part of the problem, according to Alex Stoia, a nurse at the facility, is that the eligibility criteria for the new vaccine weren’t easy.

“I can’t tell you how many people have asked if they should wait longer for the bivalent because they had just gotten another refresher in September and we didn’t know what to tell them,” she said. “Even the people who advised me couldn’t understand the recommendations.”

The logistics are also a mammoth challenge. Ms Stoia, who is in charge of caring for the elderly, said getting them to vaccination clinics can be almost impossible: they may not hear the phone ringing; there is no one to help them dress; it’s too cold to wait at the curb for the van, and when it arrives, the power chair often doesn’t fit in.

In Los Angeles County, where an estimated 500,000 residents are homebound, the health department said it dispatches just eight nurses each day to administer home vaccinations.

“You have to understand that you can’t just tell people to get the vaccine, you have to get the vaccine on their arm,” Ms Toth said. “And believe me, the last mile is the hardest.”

For many public health experts, the most difficult seniors to educate are those who doubt the value of the new vaccine. New survey data from the Kaiser Family Foundation showed about a third of adults aged 65 and over who received the original line of Covid vaccines but not the booster shot said they didn’t think they needed them, and a similar proportion said that they didn’t need it. I don’t think its benefits were worth it.

dr Noah Marco, chief medical officer for nonprofit senior care Los Angeles Jewish Health, said he “remains amazed” that the federal government hasn’t hired marketers to create “updated messages that actually work.”

“Coca-Cola has spent billions of dollars over decades convincing us that we need to buy and drink sparkling water with sugar and caramel in it. Come on, is there really no one around here who can help you?” said Dr. Marco.

At Mt. Diablo, the 51 seniors who have not yet received the updated intake could use a new seat. Two friends, Tsilya Tankover, 95, and Faina Gutkin, 77, received their first vaccines, but they are among those refusing the booster shot that Omicron is fighting.

“I’m fine,” Ms. Gutkin said, pushing the kale around on her plate while sharing her plans for a tango dance. “Why do I need this? I’m still waiting for someone to tell me that.”