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COVID Strategy America hasn’t actually tried

 


COVID risk is common sense Go up with ageHowever, how rapidly it rises is still astounding, even after living and dying for two years with this coronavirus. Compared to people in their 20sAlthough people over the age of 65 are not slightly more likely to die of COVID At least 65 times You are more likely to die from COVID. Beyond the age of 75, you are 140 times more likely to die. Beyond the age of 85, you are 340 times more likely to die.

No other basic fact of life is as dramatically important as the age of COVID. Other common risk-related factors —Race, Diabetes, cancer, immunosuppression— Makes the disease fatal with a factor of “only” 2-4. These are important differences that affect how doctors care for COVID. However, age increases risk by orders of magnitude. It’s just in its own league.

This is why the vaccination and boost rates in the United States look better in the older group than in the younger group, but they are still too low. As a result, the death toll in the United States remains too high. Unvaccinated older people die at an incredibly high rate, but even unvaccinated and unboosted older people die from COVID four times as often as unvaccinated adults under the age of 49. doing. Boosters dramatically reduce that risk.This is based on details CDC data in early December, The latest available. Age, however, continues to be the driving force behind COVID’s brutal mathematics with Omicron: by 2022, so far. COVID death in the United States It is found in people over the age of 65 and is 93 percent of people over the age of 50.

Graph showing relative risk of COVID-19 mortality by vaccination status and age group

“Vaccination rates and booster utilization for people over the age of 60 or 65 are very low, exposing them to a great many vulnerabilities to severe illness, hospitalization and death,” said Scripps Research’s director. One Eric Topol says. Translational Institute. “This is one of the most serious disappointments in our performance.”

It is difficult to convince the elderly to vaccinate at this time, but the COVID risk for this group is so high that it is very worth trying. In contrast, boosting what has already been vaccinated should be very feasible, as the group does. Obviously open to vaccines.. In the sputtering of American vaccination campaigns, this is where efforts are likely to bring the greatest rewards. Hospitalization and death are so concentrated in the elderly that, in fact, a single vaccination of a person over the age of 65 can have the same effect as dozens of people given to adolescents. Fortunately, there are enough vaccine doses in the United States, so you don’t have to choose who to vaccinate. However, as the immunity of unboosted people continues to weaken and it becomes difficult to immunize new people, focusing on vaccination and boosting for the elderly will be the next COVID wave. It can have a significant impact on hospitalization and prevention of death. The most serious COVID consequences are not only worth preventing, but the most urgent consequences if you don’t want the hospital or morgue to fill up again.


Consider the current Omicron wave. This is far more deadly in the United States than in other highly vaccinated and boosted countries. The United States has reached 80% of its pre-vaccination peak with daily mortality, compared to only 20-30% of the peak reached in other countries. Not only is the overall immunization rate low in the United States, but the elderly vaccination rate is also low. England, for example, has achieved a complete vaccination rate of 96% for people over the age of 65. In the United StatesThis figure is 88.5 percent, with significant geographic variability from 79 percent in Arkansas to 95 percent in Vermont.

All of these percentages may seem high, but the remaining risk levels are very different. “People think 90 percent and 95 percent aren’t that different,” said Adam Kucharski, an infectious disease modeler at the London School of Hygiene and Tropical Medicine. He likes to reverse the numbers. “Think of it as follows: 5% are unprotected or 10% are unprotected.” This doubles the pool of people over the age of 65 who are at high risk of hospitalization and death. increase. In large epidemic waves like Omicron, hospitalizations and deaths can spread very rapidly.

In addition, the United States is a booster for people over the age of 65, far behind other wealthy countries. The UK has boosted 92% of the elderly population, while the United States has 65%. Even highly vaccinated Vermont accounts for only 78 percent of the boosted older people. Booster immunity is required as weakened immunity and new mutants erode the spectacular efficacy seen in the 2020 vaccine trial. Two mRNA doses for at least 6 months after vaccination will alleviate hospitalization with Omicron. Only 57 percent Over all ages. The booster returns it to 90 percent. This additional protection is very important, especially for the elderly, as the elderly’s immune system tends to have a weaker initial response to the vaccine. Effect of the third dose May eventually decline That too; if there is a group that will need regular boosters in the future, it is again the elderly, not just the oldest.

How old are you when it comes to COVID risk? The CDC has used this threshold for many vaccination data and has focused on age 65 to represent the highest risk group. But other countries are more ambitious. Denmark, Removed coronavirus restrictions In the case of Omicron high in the sky, it was able to do so because it has excellent booster coverage 50 years old..95% of this group is fully vaccinated and over 90% are vaccinated 3 doses.. As a result, Omicron “wasn’t too bad in terms of health effects,” says Lone Simonsen, an epidemiologist at the University of Roskilde in Denmark. The case has fallen a little from its peak in Denmark, Mortality displacement It has already returned to almost zero. To minimize hospitalization in addition to death, Simonsen states that vaccination rates over the age of 40 are also important because the median age of COVID hospitalization is lower than the median age of death. increase. ((((Hospitalization risk It also rises sharply with age, but not as sharply as the risk of death. ) Vaccination rates are not universal among Danes in their 40s, but they are still very good. 90% will be fully vaccinated and three quarters will be boosted. Vaccination rates for Americans aged 40-65 are even slower, even at full vaccination rates. 70’s..


How can the United States maximize vaccine and booster uptake for older Americans? I asked this question to some health policy professionals with a more conservative threshold at age 65. Given the even lower uptake among middle-aged Americans, this seemed more achievable. .. England and Denmark have achieved such high immunization rates due to their centralized national health system. Healthcare in the United States is incredibly fragmented, but Medicare reaches most people at least 65 years and older. DecemberIn fact, the Biden administration has announced that it will mail a letter encouraging COVID boosters to all 63 million people in Medicare. The White House advertised this as “the first time in more than four years” that Medicare sent such a universal notice.and at the same timeThe Medicare & Medicaid Service Center (CMS), the agency that oversees Medicare, has developed a series of other outreach activities to promote COVID boosters.

According to experts, CMS may add more direct incentives. Most Americans who use Medicare use traditional Medicare. This is a service fee program that pays invoices but does not strictly control patient care. However, CMS has a way to influence healthcare providers. For example, a patient’s COVID vaccination rate and booster immunity rate can be incentives for the patient by making them a “quality standard” that helps determine the amount to be refunded to the donor.Medicare is already doing this Streptococcus pneumoniae vaccine Regarding pneumonia, Mark McClellan, a former CMS administrator and now a professor of health policy at Duke University, said.

A little less than half Many Medicare recipients are enrolled in a Medicare Advantage plan operated through private insurance companies such as Kaiser Permanente and Humana, which provide greater control over patient care. Again, the CMS can make COVID vaccination part of the quality criteria of the plan. And these private insurance companies are “close to the patient,” says Robert Field, a medical policy expert at Drexel University. This means that we have better data for patients who are still in need of the vaccine. “They can use their billing data to follow people up and say,’You got only one shot,’ or’You got two shots, so you need a booster,'” he said. Told me.

Nursing homes are another potential focus of COVID vaccination. Residents are at particular risk of COVID because they live nearby, as well as their age and underlying health.not yet Nursing home vaccination rate It is not better than the entire elderly population. 87% of residents are fully vaccinated and only 69% are boosted. In general, vaccination rates tend to be lower in commercial and chain facilities, facilities with high staff turnover, and communities with low vaccination rates. According to a study published last fall.. Michael Barnett, one of the authors of the study and a professor of health policy at Harvard University, says staffing and “organizational dysfunction” probably explain why boosters weren’t prioritized.Nursing homes rotate 100% or more on average Of their staff every year.. Full staffing is a huge challenge. Burnett told me, “I just feed the residents, give them medicine, and help them use the bathroom. Basic daily life is already an overwhelming task.” “Vaccination is a one-time intervention and doesn’t necessarily take too much effort to understand, but someone needs to coordinate and organize it.”

Medicare also evaluates the quality of nursing homes, and CMS can also be added based on COVID boosters. Vaccination against influenza and pneumococcus.. Barnett believes this may not be a sufficient incentive, given that there is already a long list of metrics. But money can be a stronger temptation, and states can also play a role. “There’s nothing to prevent the state from providing direct financial incentives,” Barnett said, whether it’s a per-booster payment or a cash bonus when the threshold is reached. .. “For me, that’s pretty easy.”

These changes are individual and step-by-step and may take longer than necessary to implement. However, even step-by-step progress is worth it, as Americans over the age of 65 are so often hospitalized and killed. If the immunity of this population is weakened and older people need regular boosters, building this system now will facilitate future shot delivery. Vaccines cannot completely eliminate the risk of COVID in the elderly, as everything is at risk with age, such as colds and falls. COVID pills help reduce hospitalization and mortality when supply becomes more adequately available, but this relies on timely testing and access. Vaccines are still our most powerful preventive tool. To avoid the worst consequences of overwhelming hospitals and high mortality in future COVID waves, we need to get more doses to those who need them most. It was and is still the oldest.

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