Age is the strongest predictor of COVID-19 severe disease and death. Even though those aged 65+ are the leaders in vaccination rates, they continue to lead hospitalizations in the U.S. and across the globe. But… why? An onslaught of scientific information can tell us why this may be the case. I worked with
Professor Jetelina — Thank you for this and for your other posts. You're a stellar, an absolutely stellar, public health communicator. This from a former senior consultant to CDC and national foundations and a former state senior public health official.
I have been looking for this well laid out data for a long time and a simple explanation of how the immunization system works and possibly why older people are so much at risk- including on the CDC website. I've found it so difficult to put together that I'd pretty much given up. Thank you very, very much, Katelynn.
Thanks. My wife and I are both in our early 70s and got mild cases of COVID-19 (despite being completely up to date on vaccinations) as a result of letting our guard down and not keeping our masks on during sit down dinners on a recent river cruise. Lesson learned. Mine was VERY mild (basically a head cold) while my wife basically spent an entire week on the couch reading because she didn't have energy for much more. We both recovered without resorting to the ER, but we are now very cautious. Masks everywhere in public enclosed spaces.
Of course, folks like us would be a lot better off if other people would do the same, but we have apparently become a nation of sociopaths that regards the elderly and otherwise immunocompromised as annoyances. Saving our lives is apparently not worth the horrible oppression of keeping vaccinations up to date and wearing masks. The national attitude now seems to be (to borrow a phrase from the Brits) "I'm alright Jack."
My wife and I are both 65+ and have heart problems. We got our 2nd COVID-19 booster in February. Should we get our 3rd booster now or wait for the promised new version this Fall?
p.s. Thanks for your layman’s language information; you’ve been most helpful for those of us older folks in our community.
This is a very good overview of immunologic senescence. Still, I am surprised that the role of the innate immune system was not discussed. We see senescence in this important arm of our immunity as well.
I want to take this opportunity to thank YLE for her outstanding work throughout the pandemic.
I would very much appreciate your addressing an issue or two to those of us who have solid organ transplants and are thus severely immunocompromised. We are a neglected group of between 2 and three percent of the population, and it would be wonderful to get your take on how we should address safety and the possibility of travel.
Thank you, Dr Jetelina, for explaining the different components of the immune system and how they work.
When you say "older people vaccinated with one booster dose have 4 times the risk of dying compared to people with two booster doses" - for how long after the second booster does this hold true - weeks or years? The supporting chart shows only 4 weeks of benefit.
When the CDC makes statements like this without specifying a timeframe, they are implying the benefit lasts indefinitely, when in fact it probably lasts only a month or two at best before waning. Also, is it possible that people who get two boosters are more likely to mask on airplanes and avoid indoor dining (i.e., the second booster doesn't deserve all the credit)?
The CDC has recently admitted that sometimes their communications to the public are confusing. But when the CDC omits an important caveat such as "the benefit only lasts X weeks," they are feeding us a narrative that is only half-true in an attempt to encourage/manipulate the public in to doing what the CDC deems to be the desired action, which removes fully informed personal choice. The result, unfortunately, is an erosion of public trust in the CDC.
My understanding is there a line of defense before the antibodies that are COVID focused. What Omicron was able to do was bypass this. Age is a simple / convenient proxy for the estimating the current level of immune system effectiveness in a person. Frankly, it is the lazy way out of thoughtful data collection. Why do some 65 year old have little problem with COVID and some struggle – even with the same vaccine pattern. Second, what is the value of a booster for old variants of COVID to handle new variants. This is an open question and begs we push old stuff simply because we don’t have anything else and pharm company’s have an investment. I am not saying this is true, but it is a common and reasonable question. Third, if a person gets another booster (say they 3rd or 4th) how long does it last and does it reduce the value of future vaccines. There is some investigation that says this is true.
The recommendation at the end for old folks (I fit this at 68), is vaccinate. I would suggest the better recommendation is avoid situations where COVID could spread. To start, remask on airplanes, spend funds to improve ventilation, and put in policies that enable folks that are sick to have paid time off. Again, saying vaccinate without these other clear actions provides ammunition to folks opposed to vaccination – that vaccination is just “path of easy non action”. Again I am vaccinated and find MRNA technology fascinating. Failing to understand how a message is received is what got CDC into a jam.
Ok, can we also have real talk about the fact that simply being male adds about 4 years of "age" and use that to inform policy?
Also, I really wish we didn't have these arbitrary cutoffs based on the accident of our decimal number system (which in turn is simply due to having 5 fingers). There is nothing sacred about the numbers 65 or 50. Older is older. There are no magic phase changes, we just happen to sort data into arbitrary buckets.
Age is clearly a factor. Actuarial tables, showing the probability of dying in a given year, would be a sound way to prioritize vaccinations and boosters. We should have a dynamic scheduling/rescheduling system where you can go ahead and schedule a booster (if you're five months from the last one) and if someone else comes along and wants your spot at least 48 hours before your appointment, you get rescheduled. Less than half of American adults have had their first boosters, slightly more than 10% of Americans over 50 have had their 4th shots, tens of millions of doses have gone in the garbage, we know that boosting confers breadth to antibody responses, and yet we are stuck on this idea that we are all supposed to "wait our turn." It's stupid and cruel, and if I'd stuck to the script I would have gotten Covid long ago.
Thank you for sharing the ongoing insight! As a 60plus person, I'm wondering about "staying up to date" on boosters. It seems you've said that 2 boosters are up to date. It's been 5 months since my second booster and I'm planning to travel and be in large populations from airports to concert halls. Is a 3rd booster recommended?
I have two questions about boosters for older people. First, do you know, theoretically, how long the second booster (4th shot) lasts? Second, for immunocompromised people who have recently gotten their 5th shot, can they get the new booster when it comes out, or do they have to wait 4 months?
Very good summary. I wonder if data are available for immunocompromised elderly, such chemo patients in their 70s. (Like my wife, who has had to discontinue chemo due to low neutrophils that stubbornly won’t rebound). If data are available, it would be great if you could do a piece focused on this population, who are the ones we most need to protect.
Question for health care professionals: would you write a note getting someone out of, say, work, school or jury duty if they scored low on a spike antibody test?
Although I am now over 65, can I take any comfort in always having excellent immunity, very rarely catching colds and flu, and I haven't been sick at all since before 2019? And how would I find out? It would be so helpful in determining my COVID risk calculation.
Why older people are at higher risk for severe COVID-19
Professor Jetelina — Thank you for this and for your other posts. You're a stellar, an absolutely stellar, public health communicator. This from a former senior consultant to CDC and national foundations and a former state senior public health official.
I have been looking for this well laid out data for a long time and a simple explanation of how the immunization system works and possibly why older people are so much at risk- including on the CDC website. I've found it so difficult to put together that I'd pretty much given up. Thank you very, very much, Katelynn.
Thanks. My wife and I are both in our early 70s and got mild cases of COVID-19 (despite being completely up to date on vaccinations) as a result of letting our guard down and not keeping our masks on during sit down dinners on a recent river cruise. Lesson learned. Mine was VERY mild (basically a head cold) while my wife basically spent an entire week on the couch reading because she didn't have energy for much more. We both recovered without resorting to the ER, but we are now very cautious. Masks everywhere in public enclosed spaces.
Of course, folks like us would be a lot better off if other people would do the same, but we have apparently become a nation of sociopaths that regards the elderly and otherwise immunocompromised as annoyances. Saving our lives is apparently not worth the horrible oppression of keeping vaccinations up to date and wearing masks. The national attitude now seems to be (to borrow a phrase from the Brits) "I'm alright Jack."
Thank you. Excellent and very useful information presented. You deserve a national audience.
My wife and I are both 65+ and have heart problems. We got our 2nd COVID-19 booster in February. Should we get our 3rd booster now or wait for the promised new version this Fall?
p.s. Thanks for your layman’s language information; you’ve been most helpful for those of us older folks in our community.
This is a very good overview of immunologic senescence. Still, I am surprised that the role of the innate immune system was not discussed. We see senescence in this important arm of our immunity as well.
I want to take this opportunity to thank YLE for her outstanding work throughout the pandemic.
I would very much appreciate your addressing an issue or two to those of us who have solid organ transplants and are thus severely immunocompromised. We are a neglected group of between 2 and three percent of the population, and it would be wonderful to get your take on how we should address safety and the possibility of travel.
If T cells rapidly decline at 40, why is the 2nd booster recommendation for 50+ ?
Thank you, Dr Jetelina, for explaining the different components of the immune system and how they work.
When you say "older people vaccinated with one booster dose have 4 times the risk of dying compared to people with two booster doses" - for how long after the second booster does this hold true - weeks or years? The supporting chart shows only 4 weeks of benefit.
When the CDC makes statements like this without specifying a timeframe, they are implying the benefit lasts indefinitely, when in fact it probably lasts only a month or two at best before waning. Also, is it possible that people who get two boosters are more likely to mask on airplanes and avoid indoor dining (i.e., the second booster doesn't deserve all the credit)?
The CDC has recently admitted that sometimes their communications to the public are confusing. But when the CDC omits an important caveat such as "the benefit only lasts X weeks," they are feeding us a narrative that is only half-true in an attempt to encourage/manipulate the public in to doing what the CDC deems to be the desired action, which removes fully informed personal choice. The result, unfortunately, is an erosion of public trust in the CDC.
Thank you very helpful.
My understanding is there a line of defense before the antibodies that are COVID focused. What Omicron was able to do was bypass this. Age is a simple / convenient proxy for the estimating the current level of immune system effectiveness in a person. Frankly, it is the lazy way out of thoughtful data collection. Why do some 65 year old have little problem with COVID and some struggle – even with the same vaccine pattern. Second, what is the value of a booster for old variants of COVID to handle new variants. This is an open question and begs we push old stuff simply because we don’t have anything else and pharm company’s have an investment. I am not saying this is true, but it is a common and reasonable question. Third, if a person gets another booster (say they 3rd or 4th) how long does it last and does it reduce the value of future vaccines. There is some investigation that says this is true.
The recommendation at the end for old folks (I fit this at 68), is vaccinate. I would suggest the better recommendation is avoid situations where COVID could spread. To start, remask on airplanes, spend funds to improve ventilation, and put in policies that enable folks that are sick to have paid time off. Again, saying vaccinate without these other clear actions provides ammunition to folks opposed to vaccination – that vaccination is just “path of easy non action”. Again I am vaccinated and find MRNA technology fascinating. Failing to understand how a message is received is what got CDC into a jam.
Ok, can we also have real talk about the fact that simply being male adds about 4 years of "age" and use that to inform policy?
Also, I really wish we didn't have these arbitrary cutoffs based on the accident of our decimal number system (which in turn is simply due to having 5 fingers). There is nothing sacred about the numbers 65 or 50. Older is older. There are no magic phase changes, we just happen to sort data into arbitrary buckets.
Age is clearly a factor. Actuarial tables, showing the probability of dying in a given year, would be a sound way to prioritize vaccinations and boosters. We should have a dynamic scheduling/rescheduling system where you can go ahead and schedule a booster (if you're five months from the last one) and if someone else comes along and wants your spot at least 48 hours before your appointment, you get rescheduled. Less than half of American adults have had their first boosters, slightly more than 10% of Americans over 50 have had their 4th shots, tens of millions of doses have gone in the garbage, we know that boosting confers breadth to antibody responses, and yet we are stuck on this idea that we are all supposed to "wait our turn." It's stupid and cruel, and if I'd stuck to the script I would have gotten Covid long ago.
Thank you for sharing the ongoing insight! As a 60plus person, I'm wondering about "staying up to date" on boosters. It seems you've said that 2 boosters are up to date. It's been 5 months since my second booster and I'm planning to travel and be in large populations from airports to concert halls. Is a 3rd booster recommended?
Thanks, Katelyn!
I have two questions about boosters for older people. First, do you know, theoretically, how long the second booster (4th shot) lasts? Second, for immunocompromised people who have recently gotten their 5th shot, can they get the new booster when it comes out, or do they have to wait 4 months?
You're the best!
Very good summary. I wonder if data are available for immunocompromised elderly, such chemo patients in their 70s. (Like my wife, who has had to discontinue chemo due to low neutrophils that stubbornly won’t rebound). If data are available, it would be great if you could do a piece focused on this population, who are the ones we most need to protect.
Question for health care professionals: would you write a note getting someone out of, say, work, school or jury duty if they scored low on a spike antibody test?
Although I am now over 65, can I take any comfort in always having excellent immunity, very rarely catching colds and flu, and I haven't been sick at all since before 2019? And how would I find out? It would be so helpful in determining my COVID risk calculation.