In the early months of the COVID pandemic, older people were at much greater risk than their younger friends, family members and neighbors. It was simple: A weaker immune system and more co-morbidities — other diseases and conditions — made COVID more dangerous for people 65 and older.
This “elderly pandemic” eased as seniors around the world rushed to get vaccinated in late 2020 and the new, more transmissible Delta and Omicron BA.2 and BA.5 variants became dominant — and the younger, fitter part of vaccinations destroyed the population.
But that was more than a year ago. Now there are signs that COVID is once again disproportionately affecting older people. It’s like 2020 again. And the elderly in one country are particularly at risk: China.
The data seems clear. Eric Topol, the founder and director of the Scripps Research Translational Institute in California, compiled the numbers from the US Centers for Disease Control and closed that in many US states, including New York and California, the rate of COVID hospitalizations for seniors “is now exceeding the BA.5, BA.2 and Delta waves.”
Anthony Alberg, an epidemiologist at the University of South Carolina, drew the same conclusion. “At this point, everyone’s share [COVID] Elderly deaths are around 90 percent, the highest since the COVID-19 pandemic began,” he told The Daily Beast.
To be clear, not every expert agrees with this interpretation. Jeffrey Klausner, an epidemiologist at the University of Southern California, pointed out that in the United States, most of the COVID testing is now happening in hospitals. Because older Americans are more likely to be hospitalized for all reasons, they are also much more likely to be tested for COVID than younger people.
In other words, the increase in COVID hospitalizations among the elderly could be an illusion, Klausner told The Daily Beast. “Counting every hospitalized patient with a positive COVID test as a ‘COVID hospitalization’ is just wrong and bad epidemiology.”
However, there are clear epidemiological reasons for an apparent recent increase in severe COVID infections among the elderly. They have to do with the potency and durability of vaccine-induced antibodies compared to natural antibodies from previous infections, as well as the catastrophic collapse in vaccine uptake in certain countries.
“The worst-off countries are those with large segments of the elderly population who are under-vaccinated and have not experienced COVID-19 disease,” Lawrence Gostin, a global health expert at Georgetown University, told The Daily Beast. The US and China in particular are in trouble.
In most countries, seniors were enthusiastically vaccinated when quality vaccines first became available in late 2020. In the US, 94 percent of seniors over the age of 65 received their main dose — two doses of messenger RNA vaccine in most cases — compared to an overall immunization rate of 69 percent for all Americans. The problem is that protection from vaccines wears off over time. And for many American seniors, it’s been almost two years since they got bitten.
Your immunity is pretty much gone. “Over 65-year-olds were vaccinated first, and given the more rapid decay of vaccine-induced immunity, this segment of the population is becoming susceptible to infection again more quickly compared to younger populations,” Edwin Michael, an epidemiologist at the Center for Global Health Infectious Disease Research at the University of South Florida, The Daily Beast said.
There are two ways to restore immunity. One is to catch COVID and survive. Previous infection produces natural antibodies that are even more potent and long-lasting than vaccine antibodies. It is a past infection – in many cases more than a past infection – that protects younger people in most countries and is responsible for the overall slow decline of COVID around the world since Omicron first peaked a year ago.
But fewer seniors have natural antibodies. “The over-65s were or are generally more compliant with social protection measures,” Michael said. Keep your distance, mask, avoid crowds. “Their naturally acquired immunity — the more robust protective and longer-lasting immunity — will also be or is lower than in the case of their younger counterpart subpopulations.”
Now more elderly people are taking off their masks and going out. The problem is that they mix with younger people who have natural antibodies. COVID is still everywhere, but it mostly infects people without strong natural immunity. “This immune vulnerability of the older population makes them more susceptible to infection compared to the rest of the population,” Michael said.
Of course, recent infection is not the only way to induce fresh antibodies. Boosters can extend the strong protection for many months. But in the US, only 34 percent of seniors got the latest refresher. To be fair, the overall uptake of this new booster for all Americans is even worse: just 13 percent.
In countries where older people do not experience increases in infections, the overall rate of increase is much higher; 78 percent of Canadians, 77 percent of Germans and 57 percent of Brazilians got their latest refresher.
China is the only big country that makes the US look good when it comes to protecting its seniors from COVID. As bad as natural immunity and booster vaccine intake are for older Americans, they are bad for older Chinese. One in five Chinese over the age of 80 is completely unvaccinated. Another 10 percent never completed their two-dose primary series.
The younger you are in China, the more likely you are to be fully vaccinated and boosted. In most other parts of the world it is the other way around. Experts attribute this reversal to two main factors: the concentration of older Chinese in underserved rural communities and widespread misinformation about the safety and effectiveness of vaccines, which older people are more likely to believe.
Worse, China as a whole lacks natural antibodies. It’s the only major country that still enforces strict limits on testing, masking, crowds and travel. Some Chinese mayors are beginning to ease some of those restrictions in response to large protests that erupted across the country last month. But greater freedom brings with it its own epidemiological risks.
Epidemiologists expect COVID cases will surge across China as more people mingle and the virus takes advantage of lack of natural immunity. “Hospitalization and death rates, especially among the elderly, could be catastrophic,” Eric Bortz, a virologist and public health expert at the University of Alaska-Anchorage, told The Daily Beast.
As COVID becomes an elderly pandemic once again, older Americans are in trouble. But older Chinese are in much greater danger. And while there are 50 million older Americans, there are 3 times like many older Chinese.