As the death toll from Covid mounts, even the elders are skipping the last boost

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

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

But even Ms. Ronk, 79, has not received the latest Covid booster, which was updated to protect against the Omicron variant and has been available since September. She said she didn’t know about it.

In the United States, where about 94 percent of people 65 and older had their initial Covid shots, only 36 percent have received the updated vaccine, known as a bivalent booster, according to data from the Centers for Disease Control and Prevention. Older people have offered a number of explanations: they didn’t know about it, couldn’t find it, or weren’t convinced of its value.

As the pandemic enters its third winter and hospitalizations and deaths from Covid rise once again, medical experts worry that there is no effective plan to update the immunizations of the most vulnerable Americans. Two years ago, when Covid vaccinations were first introduced, the federal government sent teams to thousands of nursing homes and community centers to vaccinate the elderly, slowing the virus’s devastation.

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

“Government and philanthropic support seems nonexistent,” said Debbie Toth, executive director of the nonprofit Choice in Aging, which helped bring thousands of initial vaccines to senior care centers and housing complexes. in California’s East Bay in early 2021.

Declining immunity in the elderly has largely transformed the Covid pandemic in the United States from a threat against the unvaccinated to one against the elderly, many of whom were previously well protected. People over the age of 70 are admitted to hospital with Covid at a rate four times higher than the general population.

The most recent available death counts by age showed that nearly 90 percent of Covid fatalities occurred among people over 65.

“The evidence is clear: even if you shot yourself two years ago, your immunity has waned. But the people who need to hear it the most haven’t,” said Dr. Michael Wasserman, geriatrician and public policy chair of the California Long-Term Care Medicine Association. “When you combine pandemic fatigue with no real government plan together, what we have is a perfect storm.”

The Biden administration’s winter Covid plan includes $125 million in grants to two community organizations, USAging and The National Council on Aging, for programs to vaccinate older Americans, a much less direct approach than when he sent CVS and Walgreens workers to care centers. then the first shots were authorized. The plan also includes letters to governors encouraging more shots at nursing homes and a television advertising campaign targeting seniors from racial and ethnic minority groups.

Mary Wall, the chief of staff on the White House’s Covid response team, said the administration was doing what it could with the limited resources available, but acknowledged that this time, the administration was relying on the states to shoulder more of the burden.

“Instead, we are asking them directly, please go and host on-site clinics,” he said.

He said the grants are “a great start,” but stressed that stronger financial investment would require the cooperation of Congress, which has repeatedly rejected President Biden’s request for an additional $10 billion in health care funding, the big majority for the response to the coronavirus. .

“Realistically,” he said, “this is not something we’ve gotten more money for, for a while, despite repeated requests to Congress. We’ve tried very hard to look very soberly at our resources.”

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

But the virus has evolved since then, and the original vaccine formula is no longer a good match for circulating variants, a particular danger for older people with weakened immune systems and underlying conditions such as heart disease and diabetes .

Even the bivalent shot has limited ability to prevent infections from the latest Omicron variants, but is very effective at preventing serious illness and death. According to CDC data, people age 50 and older who received multiple boosters had half the risk of dying from the virus than people who received just one booster.

Dr. Sabine von Preyss-Friedman, a geriatric specialist and medical director of Avalon Health Care Group, said apathy among some older people reflected a misconception about the vaccine’s purpose.

“People are thinking, ‘I got the vaccine and I still have Covid, so what’s the point?’ They’re not thinking about the fact that they had Covid and lived.”

As part of the federal push, the Centers for Medicare and Medicaid Services also added a recording about the vaccine to its 1-800-MEDICARE hotline and sent emails to newsletter recipients “to share information about these vaccines updated, including when and how to get it.” they.”

But a recent survey by the Kaiser Family Foundation, a nonpartisan research organization, found that 40 percent of people 65 and older said they had heard little or nothing about the new booster. About half of homebound Americans 70 and older don’t have a computer, according to surveys, and more than half haven’t used email or the Internet in the past month.

Contra Costa, East Bay County where Mt. Diablo Center works, it has not experienced the politicization that has caused many American communities to oppose public health measures. Here, front yards are still dotted with posters praising healthcare workers. A 14-row car park has been repurposed for Covid-19 testing.

Signs at each walkway encourage six feet of distance. The center mascot is a stuffed pig in a rainbow cape wearing a miniature mask. “Not all heroes wear capes,” declares one poster, “but they do wear masks.”

However, even at this facility, where 100 percent of participants received their initial vaccinations, only 40 percent received the bivalent booster. At Pleasant Hill Post Acute, four miles south, all residents received the original photos, but only one in five is updated. At Vacaville Convalescent and Rehab, to the north, nearly 90 percent of residents were vaccinated, but 13 percent are up to date. Seven residents there tested positive for Covid last week.

Ms. Ronk has a chronic inflammatory lung disease that puts her at risk of severe Covid. He said he liked to stay “as healthy as I can” as he worked out at the center, using plastic water bottles as dumbbells.

She would have been “very happy to get it,” Ms. Ronk said about bivalent reinforcement, if he knew.

Alexandr Makedonsky, 84, a former prosthetics technician who considers himself “very pro-science”, said he eagerly sought the initial round of Covid vaccines and two boosters after a friend was hospitalized with the virus. I didn’t know that the fifth shot was more suitable for Omicron.

Part of the problem, according to Alex Stoia, a nurse at the facility, is that the eligibility criteria for the new vaccine were not straightforward.

“I can’t tell you the number of people who asked if they should wait longer for the bivalent because they had just received a different booster in September and we didn’t know what to tell them,” he said. “Even the people advising me couldn’t figure out the recommendations.”

Logistics is also a mammoth challenge. Ms. Stoia, who manages care for homebound seniors, said getting them to vaccination clinics can be nearly impossible: They may not hear the phone ring; there is no one to help them dress; it’s too cold to wait on the curb for the van, and when it arrives, the power wheelchair often won’t fit.

In Los Angeles County, where an estimated 500,000 residents are confined to their homes, the public health department said it was sending only eight nurses to provide home vaccinations each day.

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

For many public health experts, the most difficult seniors to teach are those who doubt the value of the new vaccine. New survey data from the Kaiser Family Foundation showed that about a third of adults 65 and older who received the original series of Covid vaccines but not the booster said they didn’t think they needed it, and a similar party said no. believes its benefits were worth it.

Dr. Noah Marco, chief medical officer of the nonprofit Los Angeles Jewish Health, said he “continues to be amazed” that the federal government hasn’t hired marketing experts to “create updated messages that actually work.”

“Coca-Cola spent billions of dollars for decades to convince us that we should buy and drink sugary, caramel-flavored sparkling water. Come on, is there really no one around to lend a hand here?” Dr. Marco said.

At Mt. Diablo, the senior 51s who haven’t yet received the updated shot could use a fresh shot. Two friends, Tsilia Tankover, 95, and Faina Gutkin, 77, received their initial shots but are among those refusing the Omicron-fighting booster.

“I’m fine,” Mrs. Gutkin said, pushing herself around the cabbages on her plate as she shared plans to go tango. “Why do I need it? I’m still waiting for someone to tell me.”

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