COVID & Aging Adults: 2022 Updates

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 May 5, 2022:

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.

Here is my most recent video update, from February 24, 2022:

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:

And by “this” I mean this.
Everybody in your bubble is part of other bubbles.
h/t @busycactus & @KellyMDoran https://t.co/9XA6NWr8Gd pic.twitter.com/fY9uVlN31M

— Helen Branswell (@HelenBranswell) January 2, 2022

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.