Better Health While Aging

Practical information for aging health & family caregivers

COVID & Aging Adults: 2022 Updates

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Since the COVID-19 pandemic emerged in early 2020, COVID has become one of the top causes of illness and death in the US, and has especially impacted aging adults, for both health and social reasons.

Older age is one of the top risk factors for severe COVID; it’s even a stronger risk factor than vaccination status. So this is an important issue for us to follow in geriatrics.

On this page, I’ll be posting updates related to COVID and older adults, for 2022. I’ll be focusing on important developments and what I think is most important for older adults and their families to know, to be safer and manage these COVID times we are living through.

I also have a section below on general COVID safety principles for older adults, which I am pretty sure will hold true throughout this year…even as the COVID situation evolves.

Latest Updates:

Here is my most recent video update, from July 21, 2022:

In this video update, I cover the current high COVID levels, the related risks for aging adults, what to know about Omicron BA.5, the data on boosters, and the most effective ways to take sensible precautions this summer.

This update addresses many FAQs, including:

  • Is COVID on the rise again?
    • The current COVID situation and how high cases really are
  • Is BA.5 worse than previous Omicron variants?
  • What to know about COVID hospitalization numbers
  • Do vaccines and boosters still work for aging adults?
  • Should I get a second booster? Should my aging parent get one?
    • The data on first and second boosters
  • How the new Novavax COVID vaccine works
  • How to test for COVID and whether tests still work with BA.5
  • How long to isolate if you get COVID
  • What to know about Paxlovid and relapsing after Paxlovid
  • What masks I recommend and why
  • How to take reasonable precautions

Note: you can get the CO2 monitor I refer to on Amazon here: https://amzn.to/3yhDtq8. The masks that I’m currently using include 3M V-flex N95, and 3M Aura N95. These are affiliate links, so any purchases will help support Better Health While Aging, at no extra cost to you.

For all links and resources mentioned in the update, see the related podcast page here.

May 5, 2022 Update:

In this video update, I explain what to know about the current rise in COVID cases, the related risks for aging adults, what to know about the newest Omicron variants BA.2 and BA.2.12.1, and the most effective ways to take sensible precautions.

This update addresses many FAQs, including

  • Where we are at with COVID now, and the impact on aging adults
  • What do we know about the latest Omicron variants: BA.2, BA.2.12.2, BA.4, and BA.5
  • What’s changed (& hasn’t) with COVID
  • The latest on COVID vaccine efficacy during Omicron
  • What to know about first and second boosters
  • The latest on how COVID is being transmitted
  • What to do for masking to be effective
  • Ventilation & checking CO2 levels
  • Does rapid testing still work?
  • What to know about COVID treatments and possible Paxlovid relapses
  • Whether to mask on airplanes
  • My top recommendations for taking reasonable precautions right now

You can get the CO2 monitor I refer to on Amazon here: https://amzn.to/3yhDtq8. This is an affiliate link, so any purchases will help support Better Health While Aging, at no extra cost to you.

For related links, see the podcast page for this update, which is here.

March 29, 2022

The CDC approved a second COVID booster, for adults aged 50+ and for people who are moderately or severely immunocompromised.

For more information: CDC: COVID-19 Vaccine Boosters

I will discuss the data on boosters in an upcoming video update…for now, the main thing to know that getting a first booster is what is most important. Getting a second one is most likely to benefit those at highest risk (e.g. those age 80+). It’s unclear that it’s very beneficial to healthy adults in their mid-50s…especially the effect is likely to be temporary.

Feb 25, 2022:

The CDC has just released new guidance re COVID, including a revised version of calculating whether local “COVID-19 community levels” are low, medium, or high. The new method combines the number of cases in the past 7 days with hospitalization rates and hospital capacity, as the CDC explains here.

Note that their method considers whether the new cases in 7 days (per 100k population) are fewer or more than 200. 200 cases/100k/7 days corresponds to 28.5 cases/100k/day. This is not a horribly high case level, but their previous approach considered less than 10 cases/100k/day low transmission, with moderate transmission being 10-50 cases/100k/day, so we are definitely moving the goal posts here.

I also have mixed feelings about heavily relying on hospitalization rates. They are a seriously lagging indicator of COVID taking off; people get hospitalized 1-2 weeks after they catch COVID. Also, you can have pretty high levels of transmission among children and young people before you see hospitalizations moving (because the younger people are extremely unlikely to be hospitalized for COVID), and those high transmission levels are riskier for older adults than for the general public. So, I plan to keep an eye on local case counts, at least for the next few months.

Whereas yesterday we were almost all living in high transmission areas, now many parts of the US have been reclassified into moderate or low. Does it matter? Regardless of the numbers, the masks and precautions are being dialed back. In my latest video update (recorded yesterday), I explain what I think we need to focus on now, and also what we can learn from Denmark (which removed all restrictions on 2/1/22).

Personally, I think a level of 10 cases/100k/day sounds better for relaxing all the masking and precautions. (This is the level that Dr. Bob Wachter is going with, as I explain in the video.) At 30 cases/100k/day, I would still be considering rapid testing before indoor encounters with vulnerable elders, and a few other precautions.

February 24, 2022 video update:

In this video update, I discuss the tapering of the Omicron surge, what to know about the “stealth” Omicron BA.2 (it has taken over in Denmark and is growing here), how to “live with COVID” safely, and more.

This update covers:

  • Why current COVID numbers are better but still not low enough
  • What we’ve learned about vaccines & boosters during the Omicron surge
  • What we can learn from Denmark lifting all COVID restrictions
  • How to compare US COVID data to that of other countries, and why our outcomes are worse
  • What to know about the Omicron sister variant BA.2
  • What it would mean for COVID to be “endemic”
  • The ideal approach to living with COVID
  • Wastewater & other ways to monitor COVID in your local area
  • What older adults can do to keep themselves and their families safer

For related links, see the podcast page for this update, which is here.

January 6, 2022 update:

This video update covers the latest on the ongoing Omicron surge, including whether it’s milder in older adults, what’s we’ve learned about rapid testing for Omicron, what to know about the current hospital situation, how to stay safer during the surge, and more.

The update addresses these FAQs:

  • But isn’t Omicron supposedly “milder”?
  • Do COVID tests (PCR and rapid) work against Omicron?
  • Do the COVID vaccines still “work”, and will they work against Omicron?
  • Are the COVID vaccines effective in older adults?
  • Why get vaccinated/boosted if you’re just going to get COVID anyway?
  • What about those new COVID treatments?
  • Shouldn’t we just “let it rip”?
  • And if I test positive for COVID?
  • Is it safe to ….

Related links (including my favorite COVID Twitter sources) are posted on the podcast page for this update, which is here.

For my previous updates regarding COVID vaccines and other 2021 developments, see my original COVID updates page here.

General COVID principles for older adults (that won’t be changing)

COVID has been a bit challenging to cover in that things are often changing!

That said, over the past year, a few core principles have held true. Here they are:

1.The risk of being hospitalized and/or dying from COVID goes up with age.

Most people don’t get sick enough to be hospitalized from COVID, and that has been true even of nursing home patients (even before they were vaccinated).

But even though younger people have been hospitalized and even died of COVID, it’s overwhelmingly people over age 65 who have done so. Vaccines have reduced this risk for older adults, but most of the serious breakthrough infections still happen in older adults.

In fact, in the fall of 2021, the risk of death due to COVID was higher in vaccinated people aged 80+ than in unvaccinated people aged 30-49. (I discuss the data on this in-depth in my December 2021 COVID update.)

Unfortunately, this means that older adults will need to be more careful about COVID than others are, even if they are vaccinated.

The coronavirus does not care if you feel like 70 is the new 50. The average 70-year-old will have a markedly higher risk of illness from COVID than the average 50-year-old. (And that average 50-year-old has a higher risk than the average 30-year-old.)

Now, this doesn’t mean permanently restricting all activity and living in fear for the next few years. But it does mean that older adults will benefit from paying attention to what is going on with COVID, and should consider taking additional precautions when surges occur in their communities.

2. COVID is airborne and reducing your chance of catching it is about minimizing inhaling what others are exhaling.

Sure, some COVID variants are more contagious than others. But they are all airborne and mostly transmitted when people breathe in air (usually indoor air) that is carrying COVID particles.

So it’s important to be mindful of the air you are breathing in, especially if COVID rates are currently high in your local area. (Because when COVID rates are high, it’s more likely that someone breathing in the room may be exhaling COVID…and probably doesn’t know it.)

These simple approaches reduce the chance of breathing in COVID:

  • Wearing a mask. The better the mask, the better your protection. The best masks are N95s, followed by KN95s and KF94s. After that, probably safest is to double mask (a surgical mask covered by a cloth mask). A well-fitting cloth mask does provide some protection, but it’s good to up one’s mask game when there’s a big surge or very contagious variant going around. (Or if you are immunocompromised or at particularly high risk of severe COVID.)
  • Ventilating indoor spaces. Airborne COVID can definitely float further than 6 feet and can linger suspended in a non-ventilated room for some time. (Think of it like cigarette smoke in a room; it hangs around even after the smoker has left the room.) Opening doors/windows or using a good quality HEPA air filter helps clear the air.
  • Others wearing masks when they are indoors with you. You will be protected by your own mask, but you get additional protection when others in the room are wearing a mask as well. (Because their mask helps catch any COVID particles or other germs they might be unintentionally emitting.) For public indoors spaces, this often comes down to local rules. For your own home, you get to set the rules and you may want to ask others to remain masked indoors when a surge is going on.
  • Socializing, eating, and meeting outside when possible. Outside is always safer in that there is way more ventilation and air circulation outdoors, compared to indoors. In many cases, it will be reasonably safe to be unmasked outside. (But of course, it’s safer if you are masked, especially if you are close to someone who is speaking unmasked, or eating.)
  • Minimizing your time indoors with other unmasked people who are not part of your immediate household. This means minimizing things like indoor dining and other indoor activities in which people are unmasked. Again, this is most important when COVID rates in your community are high. If you must be inside unmasked with others, the fewer the people, the better.

It has slightly surprised me that US public health authorities have not made ventilation and indoor air quality more of a priority. In some countries, such as Japan, carbon dioxide concentrations are posted in public spaces such as movie theaters. (Humans exhale carbon dioxide, so concentrations go up when ventilation isn’t adequate.)

Now, early on in the pandemic, many relied on “pandemic pods” and socialized indoors with a select small group of people. The trouble with this approach, however, is that unless you are going to be very strict about the rules and make sure no one in the pod is getting exposed to others, pods tend to be less secure than people realize, as shown here:

3. If you catch COVID, significant protection against hospitalization and death comes from vaccination.

We now have lots of data. This has held true for all variants so far.

It’s also true for all age groups, but it makes the biggest difference in people who are over age 50, and makes a bigger difference as people get older.

Now yes, the protection against severe COVID is a little better with some vaccines than others (Moderna has been a little better than Pfizer; both have been a fair bit better than Johnson&Johnson). And, we see some waning after several months, which is why boosters are currently recommended.

But really. What we are seeing the most variability in — depending on how long since vaccination and the variant — is vaccine effectiveness against catching COVID and passing it along. (This is why it’s not safe to assume that if you and everyone else in the room is “fully vaccinated”, you are COVID-proof. Because you are not.)

Over 2022, we will undoubtedly learn more about boosters. And it’s possible that researchers will even develop some new type of “pan-coronavirus” vaccine, or nasal vaccine.

But the general principle will remain: older adults who are vaccinated will have a significantly lower risk of hospitalization and death due to COVID than those who are not. (I support COVID vaccines for the rest of us because that helps protect older adults, the immunocompromised, and other vulnerable people among us. Plus reduces our own small risk of severe COVID to virtually nil.)

4. Take more precautions when COVID rates are high or going up. 

We don’t want to live constantly in fear, and it’s very costly to live a very restricted life long-term.

So instead, I recommend being ready to take more precautions when the conditions warrant it, such as when COVID rates are going up or are very high.

This potentially requires a psychological shift, if you’ve been waiting for COVID to be “over” so that we can all return to “normal life.”

I would really love for us to return to pre-pandemic life, but no one yet knows whether it will be possible or when. I’m starting to doubt this virus will “go away” entirely, and instead think it’s most likely that over the next few years, it will become something a little closer to influenza: something we live with, that’s maybe a little worse certain times of year, but doesn’t devastate large swaths of society or overwhelm the healthcare system.

In the meantime: take more precautions when COVID rates are high, and relax a bit when they are lower.

5. Safety from COVID is not the only thing that is important in life.

Yes, COVID is risky, especially for vulnerable older adults. But the costs of trying to be as safe as possible from COVID can be very high.

We have seen this play out especially in nursing homes, where residents experienced devastating consequences from social and physical isolation during the first part of the pandemic. (It’s also an issue for schools, young adults, and others.)

So as we navigate COVID, let’s keep in mind that safety from COVID is just one of many things to consider. We still need to connect and come together, and we should not let COVID prevent that altogether.

And that’s it for now! Please take care and stay reasonably safe, especially during surges.

 

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Comments

  1. I am 73 and my husband is 76 (he has some well-controlled heart issues). I flew from San Francisco to Southern CA Dec 26. The airport was crowded and some of the relatives I saw had had Covid exposures. My husband and I are vaccinated and boosted, but now we have Covid-seems mild- no fever and oxygen levels are good- kind of like a bad cold. We are isolating now. The county (San Mateo) contact tracing called my husband and mentioned referring him for monoclonal antibodies at Stanford. Would this be beneficial at this point?

    Reply

    • Sorry you got COVID and I’m glad to hear that your symptoms are mild.

      My understanding of monoclonal antibodies is that they seem to be of most benefit in those with very early (within 7 days) symptoms, and in those who may be partially vaccinated, unvaccinated, or immunocompromised. It seems that the antibody infusions are safe, but any treatment can have potential side effects.

      It might be reasonable to talk to the team at Stanford to discuss the pros and cons in your husband’s particular case. Best of luck and feel better soon.

      Reply

  2. The political jurisdiction in which my wife and I live is geographically VERY large. Unfortunately, although COVID infection rates are reported daily they are virtually useless as a method of determining the actual rate of COVID infection in the community we live in (or any other community for that matter). We know that infection rates are climbing rapidly and take all recommended precautions but often wonder if we should be isolating even more than we are but cannot make that decision based on any information supplied by the reporting authorities

    Reply

    • I understand the frustration related to making sense of the COVID numbers being reported. It is hard to translate infection rates into a personal risk index. Throughout this pandemic, there have been many individual decision points, and all I can suggest is doing what you need to do for peace of mind. Other factors to take into account include your personal vaccination status and risk of severe illness if you did contract COVID. Best of luck.

      Reply

  3. Thanks for your common sense advice. I love what you say about 70 not being the new 50. Age the biggest risk factor means let’s protect our elders, and immune compromised, by getting vaccinated.

    Reply

  5. I think #5 should be much closer to the top of the list! As the director of a senior center, I’ve watched members of my center return with negative changes in weight, blood pressure, physical condition, etc., I think socializing face-to-face is far more important than anyone ever thought. It’s taken months to return them to something like normal! And I continue to push against children who, with mostly good intentions, are trying to keep the their parent(s) isolated. And meeting via social media proved not to be anything close to a viable solution. (We’re in a lower-income, remote, rural area.) Taking the stance that they didn’t get this old being stupid, my encouraging seniors to be safe, but come to the center and interact with others, is like Sisyphus pushing the boulder up the mountain.
    Thank you for your hard work educating and informing us! I sincerely appreciate all of it!

    Reply

  6. Dear Leslie
    Thank you so much for your very comprehensive update.

    We are seeing much the same picture here in Australia (Victoria for me) but of course on a smaller scale PCR test queues are impossibly long and working conditions for those conducting them are very uncomfortable to put it mildly. RA test kits are now unobtainable and/or expensive.

    I am 85 years of age and can relate to everything you are saying.
    I can’t find anyone here who speaks specifically to my age group so I look forward to your weekly message.

    Thanks again
    Kind regards

    Reply

    • Thank you for sharing your experience in Australia and I hope it improves soon.

      I’m glad you find the updates to be informative and filling a gap in the current COVID-related media. Stay tuned for more and thanks for leaving a comment.

      Reply

  7. Hi Dr. K., I am vaxxed and currently have COVID–I’ve been in bed two days. My second shot was end of November.

    Have the first two shots changed over time? Is the serum the same now as it always was? If so, why hasn’t it improved? What about the boosters-are they all the same?

    Is the current model for everyone to get boosted every couple of months forever? (that just doesn’t seem to be sustainable)

    Why not follow the “flu shot” model of one shot each year?

    Thank you for sharing this information!

    Reply

    • I’m sorry to hear that you have COVID and I hope you feel better soon.

      The boosters are the same as the original shots, as you can read about here: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/booster-shot.html. I can understand that seems odd, especially as we’re hearing about new COVID strains, but from what we can tell, the vaccine still confers some protection against severe COVID related illness.

      It seems unlikely that we’ll continue to need quarterly shots forever, although it might feel like it. You raise a good point about getting an annual shot, based on the strain of coronavirus that seems to be prevalent. I think it’s too soon to predict if that will be the case.

      I’m so glad you found the article helpfuL!

      Reply

  8. Dear Doctor:
    I listened to your video, and I found that the topic of “boosters” was barely touched upon. Assuming one has had one booster to the original vaccine, is another advisable? Is it possible to be ‘over-vaccinated’ and not let the body’s immune system do “”some”” of it’s work?
    Laurence

    Reply

    • At this time, only one booster is recommended in the US. (So 3 vaccine doses for most adults.) Israel has been administering a 4th dose, but so far it’s unclear that it’s providing a lot of extra benefit. Probably it will not significant improve the protection against hospitalization, and the protection against catching COVID (vaccine efficacy against infection) will be only temporarily improved.

      The body’s immune system does do its work in response to the vaccines. So far, I have not seen anything to cause me concern that repeat boosters might be unsafe. But it’s not clear that repeat boosting with the original vaccine formulation will bring much benefit.

      I think it’s quite possible that we’ll eventually end up with something similar to the flu vaccine: an annual vaccine against coronavirus. But we’ll see…things continue to change quickly.

      Reply

      • Thank you for a most thoughtful reply.
        In my case, with the J & J vaccine, a booster and original vaccine come to TWO shots.

        One more question if I may: is the covering of one’s nose important as you state that the virus is transmitted by way of the mouth?

        Respectfully,
        Laurence

        Reply

  9. Thanks so much for this great Covid update!

    I have a question about swabbing the throat then the nose in a Rapid Test. Would there be a concern that swabbing the throat first could spread the virus to the nose?

    Reply

  10. Thanks for this. I so appreciate your in-depth overview with the focus on older age groups(mine). Very informative. I read several national news sources and podcasts and follow medical sources, as a retired nurse practitioner. But you are my favorite.

    Reply

  11. Thank you for the article. So frustrating, a 96 year old friend is in assisted living in San Francisco, I am 79. I want to visit her but she does not wear a mask and cannot hear well enough when I keep mine on. Both of us vaccinated and boosted. Hoping we can spend time outside.

    Reply

  12. I’m trusting my God given immunity system after losing two friends to strokes a week after boosting. I’m not being a guinea pig for a flu shot that hasn’t been tested. It’s not a vaccine as vaccines stop you from getting a disease. It’s merely a flu shot. I’ve also seen a severe decline in my 96 year old father after he was given the shot. No thanks.

    Reply

    • I’m so sorry to hear about your friends and the decline in your father, and I’m glad you have a faith tradition to draw on.

      Both the “flu shot” and the COVID vaccine ae considered vaccines. Overall, so many more older adults have derived benefit from the COVID vaccine than harm. I recommend the COVID boosters for older adults who don’t have an allergy or other reason not to get them.

      Reply

      • Three doses of polio vaccine provides 99% effective immunity against polio.

        The yellow fever vaccine is greater than 99% effective.

        One dose of MMR vaccine is 97% effective against rubella. Two doses of MMR vaccine is 97% effective against measles.

        The covid “vaccine” starts out at 65% efficacy against omicron and drops to 8% efficacy after 6 months.

        Reply

  13. Hi. My elderly father (83) with dementia lives with us. My 3 children and I recently came down with covid 19. My wife and father have been testing negative with no symptoms. My wife needs to go back to work and I’m wondering when it is safe for me to have some masked contact with my father just to make and give him food and to help him with cleaning up his part of the house. Tomorrow will be 7 days since my first symptom and 5 days after my positive test. Thank you.

    Reply

  14. What’re your latest thoughts on 2nd boosters? There seems to be a lot of debate over getting a 2nd booster now or waiting until later in the fall, possibly with a more effective vaccine against the latest Omicron variants.

    Reply

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