Better Health While Aging

Practical information for aging health & family caregivers

COVID Vaccination for Aging Adults:
What to Know & Do

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As everyone knows, the COVID-19 pandemic has caused a public health — and societal — crisis of epic proportions. The impact has been especially severe on older adults, who are more likely to be severely affected by COVID, and who represent a distressingly high proportion of the U.S.’s COVID deaths.

But, in an amazing feat of scientific achievement, COVID vaccines were developed in truly record time, and in 2021, a large-scale vaccination campaign has been rolled out in the U.S.

This doesn’t mean everything will be back to normal very soon. But vaccination is key to reducing the dangers of COVID, because to date, the Pfizer and Moderna vaccines have proven to be extremely effective in preventing hospitalizations and deaths due to COVID. They have also been shown to be safe.

Although it’s exciting that we benefit from the significant protection of COVID vaccines, these vaccines have also raised a lot of questions for people. This article summarizes what I think is most important for older adults and families to know about coronavirus vaccination.

In particular, I want to offer science-based information to help with common questions, such as “Which COVID vaccine is better for seniors?” or “Which COVID vaccine for a 90-year-old?”

I’ll also cover vaccine safety, and what we know so far about how effective these COVID vaccines are in older adults. And in 2021, I am adding information related to the Delta variant and boosters.

Latest Updates:

11/22/21 update: Since my 10/28/21 video update:

  • As of 11/19/21, the FDA and CDC have now approved the vaccine booster for all adults (age 18 and older), and it’s especially recommended for adults over age 50.
  • A pediatric dose of the Pfizer vaccine has been approved for children ages 5-11.
  • COVID case numbers are surging in Europe and in certain parts of the US; it looks like a winter surge is underway.

I continue to recommend boosters for the reasons I explained in my latest video update, and I’m glad that now it will be easier for any adult coming into contact with elders to get a vaccine booster.

Please note that it takes two weeks for the booster to take effect (and probably even longer for people over age 80), so if you get a booster a few days before a holiday gathering, that’s not enough time for it to provide protection for that upcoming gathering.

See the video update for my suggestions on using rapid tests and other methods to stay safer during the holidays.

Here is my most recent video update, from October 28, 2021:

This video update covers COVID boosters, recent research on the efficacy of COVID vaccination in older adults over the last six months, why we are seeing breakthrough infections, and more. I also cover my recommendations for how aging adults and their families can be safer during the holidays, and using rapid antigen tests.

The update addresses these FAQs:

  • Should I get vaccinated against COVID?
  • Should my 90-year-old mother get the COVID vaccine?
  • How well does the vaccine work in older adults? How well does it work over time, and against Delta?
  • Which vaccine is best for older adults? Which vaccine is safest?
  • Should I worry that the vaccine might harm me (or my frail older parent)?
  • Who should get a COVID booster and why?

For related links specific to this update, see the related podcast show notes page.

What’s Most Important to Know About COVID Vaccination

As of October 28, 2021, what is most important to know is:

    • The COVID vaccines are safe and very effective at preventing hospitalization or death from COVID (especially the mRNA vaccines from Pfizer and Moderna). Even after 5-6 months, the vaccines continue to provide excellent protection against hospitalization and death due to COVID, even in older age groups.
    • After several months, the vaccines do become less effective at preventing mild COVID infections and breakthrough infections can happen. These are unlikely to become serious.
      • The small number of breakthrough infections that become very serious are mostly in people who are older or have serious chronic medical conditions. (Note: General Colin Powell, who died of a breakthrough COVID infection, was 84 and had a very serious blood cancer.)
    • The Delta variant is extremely contagious and is being spread mostly by unvaccinated people, but also by some vaccinated people. Unvaccinated people are contagious for longer.
    • Delta is causing symptoms and (usually) mild COVID illness in fully vaccinated people. There is also evidence that fully vaccinated people can transmit the Delta COVID variant to others. Many COVID cases in vaccinated people are asymptomatic, as well.
      • This means you should not assume that you can’t get COVID from a fully vaccinated person.
      • If you are vaccinated, you should be careful about the possibility you could transmit COVID to another vulnerable person, such as an unvaccinated child or frail older person.
    • Getting vaccinated is safe, will protect you personally from serious illness due to COVID, and helps reduce the impact of COVID in our communities. I recommend vaccination for all adults. I have personally vaccinated my own 13-year-old child, and will vaccinate my 11-year-old, when it becomes available, to reduce risk to our family members who are in their 90s.
    • I also recommend resuming wearing masks indoors and taking COVID exposure precautions (ventilation, minimize time indoors with people outside your household), at least until COVID case rates decline.
    • Getting a booster dose of the vaccine does seem to reduce the risk of a vaccinated person getting a breakthrough infection.  I recommend older adults and other eligible persons get a COVID vaccine booster.

What COVID vaccines are currently available?

You can see which COVID vaccines have been approved for use in the U.S. on the FDA’s COVID-19 Vaccines page: FDA COVID-19 Vaccines.

As of March 26, 2021, in the U.S., three COVID-19 vaccines have received an Emergency Use Authorization (EUA) from the FDA: Pfizer, Moderna, and Janssen (which is the pharmaceutical branch of Johnson & Johnson).

On December 11, 2020, the FDA granted an emergency use authorization (EUA) to Pfizer’s COVID-19 vaccine. Moderna was granted a similar EUA on December 18, 2020.

On February 27, 2021, the FDA granted emergency use authorization to Johnson & Johnson’s COVID vaccine. Unlike the Pfizer and Moderna vaccines, which require two injections spaced about a month apart, the J&J vaccine only requires one injection.

On August 21, 2021, the FDA authorized an additional dose of COVID vaccine for people who are moderately to severely immunocompromised.

On August 23, 2021, the FDA granted full authorization to Pfizer’s vaccine.

On Sept 22, 2021, the FDA authorized a single booster dose for Pfizer COVID vaccine recipients who are age 65 or older, plus for a few other select groups.

On October 20, 2021, the FDA authorized a booster dose for older Moderna COVID vaccine recipients (plus for a few other at-risk groups) and for Johnson & Johnson vaccine recipients (all).

Dozens of other vaccines are under development worldwide. A few have been approved in countries other than the US, including the Oxford AstraZeneca vaccine, and many others are in “Phase 3,” in which the vaccine is given to thousands of people to test it for efficacy and safety. You can see a list of COVID vaccines on the NYTimes Coronavirus Vaccine Tracker page, which also includes a helpful summary of the vaccine approval process.

Vaccines were initially prioritized for frontline health workers and nursing home residents, and then were prioritized in most areas for older adults. As of May 2021, vaccinations are available in most parts of the US to all adults who wish to be vaccinated, and as of May 13, 2021, the Pfizer vaccine is also available to children ages 12 and older.

About the mRNA COVID Vaccines (Pfizer and Moderna)

How the Pfizer and Moderna COVID vaccines work

The Pfizer and Moderna vaccines use a new approach for vaccination: messenger RNA (“mRNA”). This technology has never before been used in a licensed vaccine. But it seems to offer several advantages over pre-existing vaccine technology.

Whereas most vaccines work by injecting a person with a killed virus or portion of virus, mRNA vaccines use a totally different approach: they contain limited instructions that prompt the body’s cells to create copies of the COVID spike protein component (but not the whole virus).

The body’s immune system then recognizes the COVID spike protein as foreign, and builds up immunity. This means that when the body later encounters the complete COVID virus during an infection, it can ramp up quickly and defeat the virus before the person feels ill, or becomes seriously ill.

So, it’s impossible to get COVID from the mRNA COVID vaccines, because they don’t inject killed or weakened COVID, and the injected instructions cannot cause the body to create complete functioning COVID virus.

Another advantage of the new mRNA technology is that vaccine doses can be manufactured much more quickly.

You can learn more about these mRNA vaccines here: CDC: Understanding mRNA COVID-19 Vaccines

Unfortunately, there has been a lot of misinformation spread about the mRNA COVID vaccines. An excellent article debunking the false claims is here: Irish Professor Makes Unfounded Claims About Long-Term Effects of mRNA Vaccines

For the Pfizer and Moderna vaccines, two doses are required (3 and 4 weeks apart, respectively).

mRNA COVID Vaccine Efficacy in Older Adults: What we know so far

What we know about how well these vaccines work is based on two types of information: randomized trial data submitted to the FDA to get emergency use authorization, and then observational analyses conducted over the past several months.

Although relatively few observational analyses have been published in peer-reviewed journals, CDC data indicates that since vaccination began, COVID case rates and death rates have fallen dramatically in nursing home residents and among people aged 85+. A UK study also noted a significant drop in COVID hospitalizations among older adults after their vaccine rollout. (See the video here for an explanation of where to find this data.)

Also, in May 2021, researchers published an updated study of the Pfizer vaccine efficacy in Israel. This found a real-world overall vaccine efficacy of 94% (93% in over 65 age group). Table 3 of this study report also reported vaccine efficacy in 3 older age groups (over 65, over 75, and over 85). (I explain this data in my COVID update video from 5/14/21.)

This data found that vaccine efficacy dropped in the older age groups for asymptomatic infection (83% in people over age 85) but remained around 97% for symptomatic COVID and severe COVID, with no drop seen in the older age groups. This suggests that although the risk of passing on COVID or having a breakthrough infection may go up as people get older, even those over age 85 should expect to get excellent vaccine protection from serious COVID illness.

A CDC report published in early May of 2021 found that getting either the Pfizer or Moderna vaccine was 94% effective against COVID-19 hospitalization among fully vaccinated adults aged 65 and older.

At this time, research and observational data overall supports the efficacy of the mRNA vaccines, even in the very old. The main group that seems to be an exception is those with significant immunocompromise, such as those taking certain immune medications, those who’ve had transplants, and those with a history of hematological malignancies (“blood cancers”) or other conditions affecting their B cells and T cells. For more on this, see Researchers Tie Severe Immunosuppression to Chronic COVID-19 and Virus Variants.

The CDC recently began reporting COVID cases and deaths based on vaccination status. This NY Times article includes graphics based on the CDC data, showing how vaccination reduces cases (and deaths) for every age group: Who Had Covid-19 Vaccine Breakthrough Cases?

For these reasons, I highly encourage COVID vaccination for adults of all ages, and especially for older adults.

What we know about COVID vaccine protection weakening over time

Several observational studies indicate that the three COVID vaccines become less good at preventing mild infection after a few months. However, so far they have continued to provide excellent protection against hospitalization, especially in people under age 65.

Most studies show that after several months, Moderna remains more effective than Pfizer, and both are more effective than Johnson and Johnson.

For this reason, COVID boosters are now being recommended for older adults, Johnson & Johnson recipients, and certain select high-risk groups. For more on COVID boosters:  CDC: COVID-19 Vaccine Booster Shots

For data on how boosters increase antibody levels, see  Heterologous SARS-CoV-2 Booster Vaccinations – Preliminary Report.

Note: A COVID vaccine booster is not technically the same as getting a “third dose,” which was approved by the FDA on 8/21/21 for certain people who are immunocompromised and unlikely to mount sufficient response to the usual COVID vaccine schedule. For more on who qualifies for this type of extra dose, see CDC: COVID-19 Vaccines for Moderately to Severely Immunocompromised People.

What we know from the COVID trial data submitted to the FDA

The Pfizer phase 3 trial data was published in the New England Journal of Medicine (NEJM) on December 10, 2020, and the Moderna phase 3 trial data was published on December 30, 2020.

The Pfizer trial included about 43000 participants, who were randomized to get the Pfizer COVID vaccine or a placebo injection. During a follow-up period of a few months, there were 8 cases of Covid-19 among vaccine recipients and 162 cases among placebo recipients. The authors concluded that the vaccine was 95% effective in preventing Covid-19.

But before you assume that you — or your aging parent — will be 95% protected by vaccine trial data: it’s extremely important to take a good look at the study data, to find out: how many people like you were studied, and what were the results in that group?

Being a geriatrician, I always want to know how many older adults were included in a study, what was the age breakdown of older participants (because the average 65-year-old is medically fairly different from the average 85-year-old), and what happened with those participants.

Here is the short video presentation I recorded in December 2020, about how I assess whether the COVID vaccine (or other treatment) is effective in older adults, especially those over age 85 and those in nursing homes. I also have summarized some key vaccine information below.

In this video, I review the data for Pfizer’s vaccine, and I show you how you can assess the data on older adults when the data for upcoming vaccines is released.

(For a short tutorial on how to slow down the video or search the transcript, see here.)

Here’s what I found out, for the Pfizer trial:

      • The median age of participants was 52 years, and 42% of participants were older than 55 years of age. The age range of participants was 16-91.
      • COVID cases and vaccine efficacy results are reported for four age ranges (see Table 3):
        • 16-55 years (19852 people) –> 5 cases (vaccine) vs 114 cases (placebo) –> 95.6% efficacy (statistically likely range: 89.4–98.6%)
        • >55 years (15043 people) –> 3 cases (vaccine) vs 48 (placebo) –> 93.7% (statistically likely range: 80.6–98.8%)
        • >65 years (7728 people) –> 1 case (vaccine) vs 19 (placebo) –> 94.7% efficacy (statistically likely range: 66.7–99.9)
        • >75 years (1559 people) –> zero cases (vaccine) vs 5 cases (placebo) –> 100.0% efficacy (statistically significant range: −13.1–100.0%)

Please note that it’s not a typo: for participants aged 75 years or older, the initial Pfizer trial data reported a statistically likely efficacy range of negative 13% to 100%. (!)

Why is this? In practical terms, they didn’t have enough people aged 75+ catch COVID during the study period. (This may be because everyone in this age group was being careful to minimize their COVID exposure.)

In short, when Pfizer’s vaccine was authorized, it wasn’t clear just how effective it was in older adults aged 75+, much less those aged 85-90+. They also didn’t report just how many people aged 85+ were in the study, but probably it was a small number.

As a geriatrician, this concerned me. Most vaccines, such as the influenza vaccine, tend to work less well in older adults because of an aging immune system. (This is why vaccine makers have designed flu vaccines specifically for older adults.)

That said, in February 2021, researchers published a study of the Pfizer vaccine efficacy under real-world conditions in Israel, which noted a real-world vaccine efficacy of over 90%. The study did exclude nursing home residents from the study, and did not specify effectiveness in people over age 80. But it was excellent to see the vaccine demonstrating such good results overall.

Also, as noted earlier in this article, in May 2021, researchers published an updated study of the Pfizer vaccine efficacy in Israel, which reported vaccine efficacy in 3 older age groups (over 65, over 75, and over 85).

This data found that vaccine efficacy dropped in the older age groups for asymptomatic infection (83% in people over age 85) but remained around 97% for symptomatic COVID and severe COVID, with no drop seen in the older age groups. This suggests that although the risk of passing on COVID or having a breakthrough infection may go up as people get older, even those over age 85 should expect to get excellent vaccine protection from serious COVID illness.

For the most recent information on what data from Israel shows (including why they decided to give boosters), see my latest video update.

What about the efficacy of the Moderna vaccine?

The Moderna phase 3 trial data was overall similar to the Pfizer data. They also had a limited number of participants over age 75, and so could not draw statistically significant conclusions regarding the efficacy of the vaccine in people over age 75.  The peer-reviewed Moderna vaccine study results published in the New England Journal are here.

The data that Moderna submitted to the FDA when requesting emergency approval can be viewed here.

      • In Table 17 (page 29), you can see that in people aged 65+, the point estimate for vaccine efficacy was 86.4% (95% likely range of 61.4 – 95.5%), compared to an efficacy of 95.6% (range 90.6%, 97.9%) in people age 18 to under 65.
        • This is overall excellent vaccine efficacy.
      • You can see the number of participants aged 75+ and the vaccine efficacy results in Table 10 (page 24).
        • The number of people over age 75 was quite small (about 1300 overall) and there were only 3 COVID cases in the vaccinated group.
        • So the posted efficacy rate of 100% is not statistically significant (which is why they don’t provide a range).

Needless to say, the participants in the vaccine trials who were aged 75+ are overall much younger and healthier than people in nursing homes, and should be assumed to have a better immune system response to vaccines than even a healthy 90 year old will have.

If you are wondering why there weren’t more people aged 75+ in the trials, see this interview with geriatrician Dr. Sharon Inouye, of Harvard: Why Aren’t Highest-Risk People Better Represented in COVID Vaccine Trials?

When the Pfizer and Moderna vaccine were released, my concern was that the biggest risk in vaccinating frail older adults is that people may overestimate the associated protection and then take fewer precautions around these older adults. So even if all residents of a nursing home are vaccinated, it’s important for staff to be vaccinated as well, and that everyone continues to take precautions until the levels of COVID community transmission finally drop down.

For the latest information on the efficacy of the Moderna vaccine (which in many studies appears to be more effective than the Pfizer vaccine), see my latest video update above.

Do the Pfizer and Moderna vaccines protect against the new variants of COVID?

The CDC is monitoring several COVID variants, some of which appear to be more contagious than usual. These seem to have originated overseas but appear to be circulating in the United States. The variants include:

      • Alpha, (B.1.1.7, first identified in the U.K.)
      • Beta (B.1.351, first identified in South Africa)
      • Gamma (P.1., first identified in Brazil)
      • Delta (B.1.617, first identified in India) — As of October, 2021, this has proven to be extremely transmissible . It was implicated in a breakthrough cluster of cases among vaccinated airport workers in Singapore and has become the dominant COVID variant in many parts of the world.

The vaccine makers are actively studying how well their vaccines protect again these variants. In July 2021, a study published in the New England Journal of Medicine concluded that the Pfizer vaccine and AstraZeneca vaccines were effective against the Delta variant, provided two doses were administered.

To date, no COVID boosters have been designed specifically for any COVID variants, but it is possible that this will be developed in the future.

To find out if the COVID variants are causing cases near you, see this CDC page: US COVID-19 Cases Caused by Variants.

Are the Pfizer and Moderna COVID vaccines safe?

In general, they appear to be quite safe and there were very few true severe problems noted in the study.

As of March 26, 2021, over 130 million doses of these vaccines have been administered. To date, the primary safety issue that has emerged is the possibility of severe allergic reactions. However, these are uncommon and only affect a handful of people per every million doses administered. For more on this, see this CDC page.

Now, it’s important to note that it was quite common for vaccine recipients to feel unwell after vaccination, especially after the second dose. The most common symptoms were fatigue and headache, and some people experienced fever, as well.

These are signs that the immune system is responding to the vaccine! (Which is why they occurred less often in older participants than younger ones.) So these should not be taken as a sign that the vaccine is dangerous, or not worthwhile.

About the Johnson & Johnson COVID Vaccine

The Johnson & Johnson vaccine requires only a single injection. A good summary of the J&J vaccine, including how it’s different from the Pfizer and Moderna vaccines, is here: How does the Johnson & Johnson vaccine work? When is it available? What to know about the new shot.

Reviewing the J&J vaccine data is more complicated in that the Phase 3 trial was conducted in three regions (the US, South Africa, and 6 Latin American countries), and also took place in the winter of 2020-2021, when some areas had COVID variants spreading.

The trial data submitted to the FDA can be viewed here:  FDA Briefing Document: Janssen Ad26.COV2.S Vaccine for the Prevention of COVID-19.

In reviewing the J&J data, I noted:

      • Vaccine effectiveness (VE) overall, by region was:
        • US: 72% (95% confidence interval 58-82%)
        • Latin America 61% (95% confidence interval 47-72%)
        • South Africa 64% (95% confidence interval 41-79%)
      • 35% of participants were over age 60
        • 3.7% over age 75
      • VE after 28 days against moderate-severe COVID:
        • Age 18-59: 66% (95% CI 53-76%); 64% if comorbidities
        • Age 60+: 66% (95% CI 37-83%); 42% if comorbidities
      • VE after 28 days against hospitalization/ICU/death
        • No cases were noted among vaccine recipients; VE 100% (31-100%)

The bottom line is that although the posted overall efficacy rate appears to be lower (72% in the US) than that of the mRNA vaccines, the J&J vaccine is still quite effective overall and after 28 days, it had good efficacy (83%; see table 16) in preventing severe/critical COVID.

It is perhaps a little bit concerning that it was less effective among older adults with comorbidities, but it is still better than being unvaccinated.

There was no very detailed data on the vaccine efficacy in people over age 75; they are mentioned in some results tables (e.g. table 12) but there does not seem to be enough data to draw an efficacy conclusion.

The vaccine also appeared to be safe overall. Similar to the previously approved COVID vaccines, many vaccine recipients did experience side effects such as headache, fatigue, and body aches, and these were more common in younger recipients.

There has been some concern about a rare but serious side effect involving clots: as of May 13, 2021, 28 people (of which 6 were men) have experienced clots associated with the J&J vaccine. These all occurred in people under the age of 59. Given 9 million doses have been administered, this appears to be a very rare side-effect.

For the latest on J&J efficacy and why an mRNA booster is now recommended, will be needed, see the 10.28.21 video update (above).

COVID Vaccination and Nursing Homes:

CDC data indicates that since vaccinations began in nursing homes in December 2020, COVID case rates and death rates have fallen dramatically in nursing home residents and among people aged 85+. A UK study also noted a significant drop in COVID hospitalizations after their vaccine rollout.

You can view current counts for COVID cases and COVID deaths in nursing homes here:
CDC: Nursing Home Covid-19 Data Dashboard

The numbers have improved a lot since the winter. However, in April 2021, there were still 900-1100 cases per week in nursing homes nationwide, along with 400-500 deaths per week.

Recent investigations suggest that some nursing homes are experiencing outbreaks related to unvaccinated staff members, and “breakthrough” COVID cases in vaccinated residents are occurring. Most of these breakthrough cases are mild or asymptomatic, fortunately.

To date, vaccination rates are much higher among nursing home residents than among the staff who work in the facilities.

The CDC’s Advisory Committee on Immunization Practices (ACIP) reviewed COVID vaccine safety data in a meeting on January 27, 2021.  You can view the meeting slides and safety data here. This meeting included data on the immunization of nursing home residents (slides 39-41). These vaccinations used Pfizer and Moderna vaccines.

The safety data so far, for nursing home residents, is reassuring. As the slides explain, so far it doesn’t look like people in nursing homes are more likely to die within after vaccination, compared to nursing home residents who are not vaccinated.

Especially given the risk of COVID exposure due to those staff members who have chosen to not be vaccinated, I highly recommend COVID vaccination for all nursing home residents. I also recommend vaccination for visiting family members, as this helps protect nursing home residents, who may be more vulnerable to breakthrough COVID cases after vaccination.

I also recommend a booster dose for older adults and especially for nursing home residents, since recently published CDC data finds that the mRNA vaccines efficacy against COVID infection has dropped over the past few months:
Effectiveness of Pfizer-BioNTech and Moderna Vaccines in Preventing SARS-CoV-2 Infection Among Nursing Home Residents Before and During Widespread Circulation of the SARS-CoV-2 B.1.617.2 (Delta) Variant — National Healthcare Safety Network, March 1–August 1, 2021.

Who shouldn’t be vaccinated against COVID?

At this time, there are not many specifics on who should not be vaccinated, provided a vaccine is approved for your age group. (None of the available vaccines have an emergency authorization for children.)

As of May 2021, there have been a relatively small number of severe allergic reactions, which the FDA is investigating. So people with a history of anaphylactic allergic reactions should probably check with their health providers before pursuing vaccination. There have also been some very rare cases (28 out of 9 million doses given) of serious clots in people who receive the Johnson and Johnson vaccine, as noted above.

That said, with millions of vaccine doses being distributed over the next several months, guidelines are likely to rapidly evolve, regarding who should not be vaccinated, or who should be vaccinated with caution. For accurate information on this topic, I recommend reputable information sources, such as the FDA and the CDC’s COVID information pages. (See Resources, below.)

My current recommendation for COVID vaccination

As of October 28, 2021, I am urging all adults to get vaccinated for COVID, unless your own health provider advises you otherwise. Although any vaccine is better than no vaccine, as of September 2021, the mRNA vaccines appear to be more effective than Johnson & Johnson, so I would recommend one of those. There is also evidence that the Moderna vaccine is a little “stronger” and more effective, which can be good for aging immune systems.

That’s because:

  • The Pfizer and Moderna vaccines appear to be quite effective in preventing hospitalization, even in older adults.
    • Data from Israel suggests good effectiveness in people over age 85, as well. Although there does seem to be some recent waning of vaccine protection against breakthrough infections (esp in older adults), vaccine protection against hospitalization remains quite good.
  • Even though it’s unclear exactly how effective these vaccines are in people over age 75, COVID case numbers and deaths in this age group have fallen as older adults have been vaccinated.
  • So far there is no reason to believe these vaccine are unsafe or likely to cause lasting harm.
  • Until COVID rates drop way, way, down, the risks of catching and transmitting COVID should vastly outweigh the potential discomfort of vaccination or very small risk of an adverse reaction.

I also recommend that previously vaccinated older adults get a booster COVID vaccine dose.

What is an older person’s risk of dying from COVID?

To get an estimated answer to this question, in March 2021, queried the CDC’s COVID-19 Case Surveillance Public Use Data set, which is available online.

In reviewing available data for COVID cases from 9/1/20 to 3/25/21, I calculated the following:

      • For people aged 80+
        • 16.4% mortality overall
        • 43% mortality if hospitalized
        • 67% mortality if admitted to the ICU
      • For ages 70-79
        • 6% mortality
      • For ages 60-69
        • 2% mortality

Note that these figures are pre-Delta. The Delta variant does seem to cause more severe illness, so the risk of serious COVID illness in the unvaccinated is probably higher now.

What to remember if you — or your loved one — is over age 75:

I strongly urge you to get vaccinated! Moderna is likely better for older adults, but Pfizer is good too. Studies are finding that both mRNA vaccines offer superior protection compared to the Johnson & Johnson vaccine, and so I would recommend getting an mRNA two-dose vaccine if at all possible.

I also recommend that previously vaccinated older adults get a booster COVID vaccine dose.

Please note that vaccination will make you much safer from COVID, but it often does not make you 95% safer and I especially urge caution for those who are frail, immuno-compromised, or over age 85.

Although most breakthough COVID infections in older adults are not severe, some are. Most deaths due to breakthrough COVID infections have been in people over age 65. It is hoped that boosters will reduce serious COVID breakthroughs in older adults.

There continues to be relatively little research published on vaccine efficacy in people over 85, which makes it challenging to know just how effective these vaccines are for our most vulnerable older adults. That said, the nursing home outbreaks we’ve had since residents were vaccinated show that although breakthrough infections can definitely happen, vaccinated nursing home residents are MUCH less likely to die of COVID.

COVID is also mutating and although so far the current vaccines appear protective against variants, that could change.

So I recommend erring on the side of taking precautions, such as being careful about crowded indoor spaces, especially if COVID cases are going up in your community.

Outdoor activity is in general low-risk for COVID exposure and transmission, and I believe that in most cases, it shouldn’t be necessary to wear a mask while outdoors.

You can find the CDC latest recommendations for fully vaccinated people here: CDC: When You’ve Been Fully Vaccinated

We can also protect nursing home residents and other vulnerable older adults by encouraging all younger adults around them to accept vaccination.

Please take care, stay safe, and I hope you’ll get vaccinated once it’s available to you! 

And if it’s been more than six months since you were vaccinated and you are an older adult or otherwise eligible, please get a COVID booster soon!

You can view my past COVID vaccine video updates here: Sept 2021, July 2021, May 2021, March 2021, Dec 2020.

Resources:

This article was first published on Dec 18, 2020, and was last updated by Dr. Kernisan on September 10, 2021.

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Comments

      • 288668834622325 Your answer (and the CDC’s) appears to be based upon information from nearly a year ago. Current studies all show that natural immunity is MORE robust and more broad (more protective against new variants) than the mRNA or Adenovirus-based injections. Why would you be as slow as the bureaucracy has been to acknowledge this? This is not like you, and could lead to a lack of trust in your advice.

        Your posts are usually up to date and quite evidence based, so I was surprised that you didn’t mention anything on this post about people who have already gotten Covid-19 having strong natural immunity. Why would you want them to suffer the discomfort of the mRNA shots, especially because Norway found that a certain percentage of the frail elderly reach a tipping point from the stress of the short term side effects and die, and even more have long term negative side effects?

        Shouldn’t you limit your recommendation to those who would actually benefit from increased antibodies against the SARS-CoV-2 spike protein?

        Reply

        • Thanks for taking the time to watch the video and leave a comment.

          Like the vaccine, the protection from re-infection afforded by having recovered from a COVID-19 infection depends on many factors. Host immune response, other health issues, age, and genetic factors can all affect the degree of protection that a person has after recovering from COVID. I found this article to be an interesting in-depth description of how T cells can help confer immunity after infection: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7584424/

          I wasn’t able to find any definitive, well reviewed data that indicates that a person who’s had COVID is “more immune” than a person who’s been vaccinated, nor did I find that Norwegian study, so please share that information if you have it.

          Reply

      • I’m curious why if someone has had covid and tests positive for antibodies, why can’t they just get a booster after 6-12 months…like a flu shot? I’m not interested in a double dose of mRNA and have been cautioned by my PCP to consider waiting until more data is issued. That was almost a year ago now. It seems very odd this hasn’t been being studied with some level of results yet.

        Reply

        • I think you raise a good question and one that’s on the minds of many who’ve recovered from COVID, as well as the providers who care for them.

          It sounds like you have a good relationship with your primary care provider and I would work with them to decide what’s best for you. I’m hoping that we’ll learn more about whether those who’ve had COVID can be spared the initial series or go straight to a booster shot.

          Reply

  2. What is your commentary on the debate from Dr. Wolfgang Wodarg and Dr. Michael Yeadon about how the vaccine can cause permanent infertility?

    Reply

    • I haven’t delved into this debate in detail, but there is definitely a lot of discussion about vaccine safety. The consensus from leading experts in health is that the vaccine is safe and is an important part of promoting public health during the pandemic.

      Reply

  5. Thank you Dr. Kernisan. Very Helpful! I agree with you, that there needs to be much more done to study these vaccines in older adults.

    I also agree, that it is the staff of long term care facilities and family caregivers who really need to be vaccinated, since this is who has been exposing most seniors, especially those in congregate care, where visitors have been severely restricted since mid March.

    It would have been so helpful if the researchers had recruited participants living in congregate senior communities, such as Independent and Assisted Living facilities, since those residents are all over the age of 65. I am sure that many would have willingly participated in the research trials, had they been asked.

    Relieved, there are vaccines being rapidly developed and deployed, (Michigan is now being shorted 24,000 doses of the Pfizer vaccine, why?), but saddened that we may not know for quite sometime, if they are actually “effective” in a larger senior population.

    Sad, since restrictions on family visitors to long term care facilities, and extended family gatherings will most likely continue for months and months more, until the general public can get vaccinated…prolonging the severe isolation seniors have been enduring.

    When it is available, I will sign off for my soon to be 85 yrs old mom, to get the vaccine despite already having had Covid-19. Although she survived Covid-19, she is forever changed by the lasting/permanent effects of the virus, the effects of severe isolation imposed by restrictions to family visitors and group meals/activities at her Assisted Living facility…or both!

    Many seniors have survived having Covid-19, but we haven’t even begun to process the lasting effects they may be dealing with afterward. I know seniors aren’t alone in being “long haulers”, but it’s my hunch that they are disproportionately effected.

    Reply

    • Thank you so much for sharing your thoughts about the vaccine. You highlight the challenges and limitations of testing a new vaccine very well in your comment.

      I also appreciate you sharing how hard the pandemic restrictions have been for your family. That echoes what I’m hearing from many patients and families right now. There will definitely be a reckoning when all of this has passed, and it has prompted us to take a long, hard look at how we treat our elders in society. I know there is a lot of research going on in this area right now and I’m looking forward to learning more.

      Thanks again for your comment and for reading the article!

      Reply

  6. Apparently the vaccine does not prevent people from catching the virus. Instead, the vaccine stimulates the immune response to the virus, so that when the person does catch the virus, their symptoms will be less severe, or they may even have no symptoms at all, but still be capable of transmitting the virus.

    My mother and all 10 other people in her secured memory care building caught the virus in June.

    Science now says that a second infection is extremely unlikely. There have been about 20 recorded cases of a true second infection, among the tens of millions around the world who have already survived the virus.

    Given these facts, why should my mother and the other residents in her building receive the vaccine? It certainly doesn’t seem medically necessary, especially since they all already survived the virus.

    thanks!

    Reply

    • You are correct that a person who’s been vaccinated could still get COVID, and could potentially transmit it, although would do so at a much lower rate than a non-vaccinated person with COVID exposure. That’s part of the reason we need to remain vigilant with other infection control measures like handwashing and social distancing.

      The question about vaccination in someone who has had COVID is touched on on the CDC FAQ page about the vaccine, here https://www.cdc.gov/coronavirus/2019-ncov/vaccines/faq.html.
      Right now, it’s not clear how long natural immunity will last after having coronavirus infection, so there is no clear recommendation about whether those individuals need a vaccination yet. I hope we have more information soon.

      Reply

  7. I wish that those of us who are over the age of 80 would not have to wait until all the essential workers are vaccinated. But it appears that reopening the economy is more important than saving lives.

    Reply

    • I understand your concerns about having to wait to be vaccinated. It’s such an unprecedented situation with vaccine supply being limited and need being universal, and it’s hard to imagine that there wouldn’t be some delay in getting everyone vaccinated.

      Here in Canada, those who live and work in long-term care will be first, followed by those over 80, those over 70, healthcare workers and persons in Indigenous communities. Next will be other health workers and essential workers.

      There may be a great deal of regional variation in vaccine prioritization, so I would check with your local public health unit for more information.

      Reply

  8. Thank you for such excellent information!
    I am 73 years old and have been diagnosed with ME/CFS. At this point my varies from moderate to moderate/severe. Is it okay to proceed with the vaccine when it becomes available to me? (Most doctors here know very little about ME/CFS, so can’t discuss with them.

    Reply

    • I’m so glad that you enjoyed the article!

      A person with a diagnosis of ME/CFS (Myalgic encephalomyelitis/chronic fatigue syndrome) is still eligible for a COVID vaccine, unless they have an allergy to the vaccine components.

      Having said that, many of the symptoms of ME/CFS can be mistaken for vaccine side effects, and I would be careful about that if possible. That is, if there’s a symptom after the first dose of the vaccine, I would carefully consider if it is related to the vaccine or to the ME/CFS, and not avoid the second dose of the vaccine which is necessary for immunity to develop.

      Reply

      • Thanks for reply to this question and acknowledging ME/CFS. I have something like that (definitely, fibromyalgia, along with arthritis). I had both Pfizer vaccines by the last day of February, and have been sick ever since (ie., for about 2 weeks, now). It’s as though all my other symptoms have been magnified, viz. migraines, fatigue and joint pain. Perhaps all this is separate, but I have no way of telling. I am hoping this doesn’t last much longer. Are there any reports of Covid vaccine side effects lasting 2 weeks or longer in those who are already ill with other things? And how does one tell whether it’s an illness flareup, or an extended vaccine effect? Thanks.

        Reply

        • I’m sorry to hear you’re not feeling well, Linette. I’m so glad you got the vaccine, though and I’m encouraging everyone to do the same.

          Most vaccine side effects resolve within a few days at most, but a small percentage of people will have them for weeks or longer. If you’re not sure if it’s vaccine-related or a flare that needs attention, I’d talk it over with your primary care provider if you can. In the meantime, listen to your body and rest if you need to, try to get some light exercise outdoors and stay hydrated. Hope you feel better soon.

          Reply

  9. What is your opinion now that we have some information about the frail seniors passing in Norway after their Pfizer booster?

    Reply

    • I don’t have all of the details about this story, but from what I’ve read, it sounds like this could have been a coincidence that these frail individuals, who resided in nursing homes, passed away after getting immunized (and I believe it was after their first shot). Right now, there’s no indication that we’re being told to not offer the vaccine to frail adults.

      Reply

  10. What about taking tylenol before or after the Covid vaccination? I understand that anti-inflammatory medications (NSAIDs) should not be taken before, because they may blunt the effects. But what about non-anti-inflammatory drugs, such as acetaminophen?

    Reply

  11. Your thoughtful analysis of how much we can rely on the test results from the Pfizer data is extremely helpful in putting things into context. Thank you.

    Now that the Moderna vaccine is out, what do we know about it’s efficacy in older adults? The headline is that the test results show it’s only 86% effective in those over 65. But your analysis shows how difficult it is to actually get statistically significant results given the size of the test groups.

    Can you please analyze the Moderna results the same way you’ve analyzed the Pfizer data?

    Reply

    • Thanks for your comments and I’m glad the article was helpful. Based on my quick review, it looks like the Moderna vaccine, also an mRNA vaccine had a similar
      lack of older adults in its trials. But their report on a small group of about 40 individuals over the age of 56 seemed to have immune responses similar to younger adults so that bodes well. It will probably be about the same as the Pfizer vaccine. Let’s all just get one when we can!

      Reply

  12. My mom is 99 years old. She has COPD, congestive heart failure, Asthma and diabetes. We have questions about whether she should get the vaccine. In light of these underlying conditions and her age what are the risks in her receiving the vaccine.

    Reply

  13. I had an anaphylaxis reaction years ago with non-ionic iodine injected for a radiological test. As you probably know, non-ionic is supposed to be very safe, only containing 5% iodine, yet my reaction was rather severe. Does this qualify for concern with the new CDC guidelines? It doesn’t seem like a reason to avoid the vaccination but I wondered your thoughts? Thanks.

    Reply

  15. Thank you for this summary, it was very helpful. Do you believe I should get the Pfizer or Moderna vaccine for my 87 and 88 years old Dad based the information that we have so far. I have heard that the Moderna say offer more efficacy after just one dose of the Pfizer vaccine. I want the best efficacy is the long run, but also would like to get them some protection between the doses at this point?

    Reply

    • I’m glad you’re getting informed about the vaccine and plan to get your dad immunized.

      Well, I don’t know if we will ever be in a position to choose which vaccine we prefer, given the current challenges with vaccine supply, but the evidence we have is that there is not a major difference between these two compounds. It takes 2 shots for full efficacy and I would encourage everyone to continue to use good infection control practices even after the first and second shot.

      Reply

  17. Great article.

    My father is 97, lives at home, and had his first Moderna vaccine a month ago. He is scheduled to get his second shot this Friday, but our other sibling says he should not get it because she is panicking he will get so weak and die from the second vaccine. He did fine with the first vaccine with no reactions or side effects.

    Our questions are: How safe is the second Moderna vaccine for a relatively healthy 97 year-old,and will it make him so weak, he won’t even be able to walk?

    What data do you have on the second Moderna shot for people in their 90’s? Has anyone this age group not in a nursing home had severe after effects?

    How long will the first vaccine be effective to protect him? How long can we wait to get a second vaccine if she refuses to take him To get it?

    Thank you

    Reply

    • Hi Kathy, those are all reasonable questions about the vaccine. We have very limited data on how the Moderna (or Pfizer) vaccine works in adults over age 90, and unfortunately, that’s not likely to change in the short term.

      I can tell you that from what I have seen on the CDC and Health Canada websites, most reactions (whether local or systemic) are happening in those under 65. In those over 65, milder adverse reactions are common, and less than one tenth of one percent of those vaccinated got ill enough after the second vaccine dose to seek help in a hospital or emergency room.

      Having said that, it appears that about 70% of individuals got some kind of reactions, such as fever, chills, body aches, fatigue or nausea (compared to 30% of those in the placebo group).

      As far as I know, one dose of COVID-19 vaccine is not enough to confer any protection. Current recommendations are that the second dose should be given within 42 days of the first, and that immunity might occur about 2 weeks after that second dose.

      Many are asking me whether the vaccine id right for their older relative, and in general, the only reason to not vaccinate is if the person has had an anaphylactic (severely allergic) reaction to a vaccine in the past. If a family member is worried about how their relative will be able to tolerate the vaccine, I would suggest they talk to their doctor or primary care provider about it.

      Reply

    • I completely agree with Dr. Didyk’s comments above. There is basically no published data on vaccine efficacy or side-effect on 97 year olds who are outside the long-term care system, as your father is.

      The CDC is collecting COVID vaccine safety data through vsafe.cdc.gov (an optional smartphone-based program) and also their usual vaccine surveillance systems, but I don’t believe that data is easily accessible to the public.

      We also don’t know how much protection is conferred by a single Moderna dose in someone your father’s age. There is some evidence suggesting that a single dose of Pfizer or Moderna provides some protection from COVID, but no one knows for how long, and most of that evidence is in people much younger than your father.

      We do know how vaccines work in general: they need to stimulate the immune system, and the immune system ages and gets harder to stimulate as people get older. So for the influenza vaccine, we have developed “stronger” vaccines for older adults: they either have more antigen, or include an extra substance (an “adjuvant”) meant to goose the immune system.

      Because of what we know about vaccines in older adults, I think that the older people get, the more likely it is that they really need that second dose, to get whatever protection is possible from the vaccine. Multi-dose vaccines in general work under the premise that you get better (meaning stronger and/or more durable immunity) when you give the immune system more than one exposure to the antigen.

      With millions of people getting vaccinated, there will surely be someone somewhere in their late 90s who has a reaction or health crisis after their second vaccination. It will be hard to say whether it’s likely due to the vaccine or just random (very old people are prone to health crises in general).

      I would reassure your sister that because of your father’s age and the fact that he did fine after the first vaccine dose, it’s very unlikely that the second Moderna dose would cause a serious health crisis in him. He is overall at higher risk of harm from COVID. So I hope he’ll get his second dose…even if the vaccine is only 50% effective in him rather than 95%, that’s much better than not being vaccinated at all.

      Oh and, no one knows how long he can wait…it has not been studied…and of course no one knows yet just what is happening in the immune systems of 97 year olds in regards to this vaccine.

      Sorry we don’t have better answers for you! We are all in uncharted waters, especially when it comes to people 85+.

      Reply

      • This relates to my questions. I have a 97 year old healthy mother who lives by herself in her own home. Takes no medicines. Exercises daily. The challenge is we are in Texas which is hell bent on opening up March 10th even though we are 48th out of 50 states in terms of vaccination rate. Right now, it’s just about impossible to get her an appointment, has been for two months, and it anytime appointments become available, thousands (ten times the number of available appointments) jump in line and they never tell you the time the appointments go live beforehand. On top of that there is a fight in the family between those who want her to get it pronto and those who don’t want her to get it (yes, basically we have some in the family that believe the conspiracy theories and think the vaccine is unsafe and will kill her, they have heard stories from their “doctor” that two unrelated otherwise healthy 90+ year old mothers of his patients had heart attacks and died within days of getting the first shot. I have to wonder why that medical professional is spreading stories he has heard from his other patients, but it certainly is causing conflict in our family). So given the sketchiness of the data for those over 90. Given she can isolate in her home, and wear masks on once a week grocery shopping and that the local store has promised to still require masks. How hard to push to try to find a vaccine appointment? Is it irresponsible to take a wait and see attitude, look for more data to come in ? She decided to stop driving herself this past year, so there is logistics problems as any of these appointments are more than 30-40 miles away and someone will need to drive her, most likely me and I live hours away, not in the same city.

        Reply

        • Hi Gary and thanks for sharing your story which I am sure is a common one! Even after vaccination, I think it’s a good idea to use precautions like mask wearing, handwashing and avoiding crowds until this pandemic is truly over. I wish it were easier to get a vaccine in your area and I understand your frustration. I would make a reasonable effort to get an appointment and I hope they get easier to obtain as more people have their dose. I don’t think we need more data to tell us that the vaccines we have available will provide some protection, even in those over 90, but every family has to make a decision about how much risk is worth the benefit.

          Reply

        • My uncle is 95. We were banned from their house (my cousin is a doctor) up until he got the vaccine. Believe it or not, someone was with him when he got his second dose. We all felt he was going to get one or all the symptoms the second dose brings. WRONG!!!, he was well all the time…He had none of the symptoms all of us have. Is this an everyday fact? I am a MPH and believes there should be more studies regarding this fact…

          Reply

          • I agree that we would benefit from more studies, Maria-Luisa! You can watch my video about that here:https://youtu.be/2G5LZDYiiCs It does seem that, in general, older adults have fewer vaccine side effects from the COVID shots than younger ones. This may be related to the dampened response of the aging immune system, but doesn’t necessarily mean that the vaccine will not be effective. I’m so glad your uncle got his immunization!

          • Hello Patti and I completely understand how you’re feeling. We’ve been making sacrifices for the sake of our health for over a year and it’s frightening to think about what happens now. Not having side effects after a vaccine doesn’t necessarily mean it’s not working, and I don’t recommend an antibody test (see my answer to previous comments).

            Vaccines reduce our risk of getting very ill with COVID, but no vaccine is 100% effective. There’s no way to tell how “immune” a person is after getting immunized, but almost certainly, they will be much safer if they happen to get in contact with someone with COVID.

            On the other hand, continuing to avoid social contact could have serious health consequences for many. I am advising my patients to be sensible with handwashing, masking in public and staying home if they’re ill, and to move towards a more relaxed way of moving around as they feel comfortable. I hope you get back to seeing your grandchildren very soon!

  18. I just got my first shot of Moderna and am 70 years old. I’m reading that the antibodies drop off for people 65 and older between 50 and 75 percent after 3 months and am now wishing I had waited for a Pfizer vaccine. Will I be able to get booster shots after 3 months? How often will I need them? and can I change vaccines to one that will provide longer efficacy?

    Reply

    • Hi Teresa and I’m glad to hear you got your first vaccination. I’m not sure what source you are reading to get those stats about the “antibodies dropping off”, but right now, there is no need for a booster (except for your second shot in about 28 days ). From what I have read about the vaccines, the efficacy is similar, so waiting for a particular brand (Pfizer or Moderna) is not advisable. Right now, it’s not clear that getting 2 different brands of vaccine would be as effective as getting the same one, so I would think that getting a second dose of the Moderna would be the way to go if one has already received the first dose with that brand.

      I’m glad you got your vaccine and I would encourage you to keep up your good infection control practices and get that second shot when you can!

      Reply

  19. Terrific article, best I’ve seen out there on possible studies for advanced aged. We are in Dallas, still unsure whether it’s in best interest of a homebound and home-based 95 year old mother with heart issues and on max. blood pressure meds—to receive vaccine. thanks thanks for any additional info you might receive since Jan 2021—–concerning frail, heart issues, over 90 year olds. thanks thanks

    Reply

    • Thanks for your kind comment and I hope you’re safe and well in Dallas. I am fielding a lot of questions about COVID vaccine safety for older adults, and you can hear what I surmised from the data we have so far in this video.

      Officially, there’s no absolute reason to avoid the vaccine unless a person has had a severe allergic reaction to a an immunization in the past, and frail older individuals seem to be at higher risk for complications of COVID compared to younger adults. So it’s a balance between the risk of a vaccine versus the risk of getting ill with COVID. IT also seems that older adults have milder or fewer side effects after vaccination compared to younger folks. I’m tending to lean towards vaccination for my frail patients in almost all cases.

      I understand being worried and I am advising individuals in your situation to have a chat with their PCP to help make this tough decision.

      Reply

  20. I agree that this article was extremely informative which has now stimulated more questions. What’s being shared on the news is the overall efficacy of the vaccines, not what was discussed in this article. As a result, people who do receive the vaccine feel they are fully protected and are totally unaware they may have minimal or reduced protection if they are older. The CDC just issued initial guidelines for vaccinated people. Should the older population follow these guidelines given the lack of knowledge surrounding the actual efficacy of this group? My parents are 99 and 105 and have received both doses of Moderna and did well with the vaccine (my Dad was tired the second day). They live in a senior community with my brother who is their caregiver. I’m around them 4 days a week. We’ve been keeping them isolated in their apartment except when they are at my home twice a week. We have not had them around their grandchildren (late thirties) and their great-grandchildren (8 and under). Do we continue with what we are doing or should we feel more comfortable having them around the rest of the family? Should they wear masks or follow the new CDC guidelines that they may see families at low risk for severe infection indoors without a mask? Can we sit outside at a restaurant not knowing who may be at the next table? Since I am around my parents, should I feel comfortable seeing vaccinated friends and my family indoors following the new CDC guidelines or should I continue doing what I’ve been doing for another couple of months? Do we wait to see how the new variants affect our numbers and the spread of the virus? (My husband, 78, and I, 71, have both been vaccinated.) Part of me wonders if the new CDC guidelines are to just to give people reasons to get vaccinated. If there are no “benefits” to getting vaccinated (ie seeing family and socializing again), why get vaccinated? Are these guidelines truly safe and reasonable especially for the elderly population? Any feedback would be greatly appreciated. Thank you.

    Reply

    • Those are all great questions and I’m not sure we have all the answers. There’s no question that the vaccine will confer some immunity from contracting COVID, even in the very elderly, and will also reduce the risk of getting extremely ill even if a COVID infection happens, so I think it’s reasonable to relax some of the physical distancing we’ve all been practicing.

      Nothing will reduce the risk to zero, and every decision involves some trade offs and compromises. If you’re able to ask your parents what they prefer, then follow their lead. They may be willing to accept some (reduced, now that they’re vaccinated) risk in order to return to a more family-filled lifestyle.

      Reply

      • I am 75 and have had the two doses of the Moderna vaccine. Four weeks after the second dose, I had an antibody test, and it was negative. I am a blood cancer patient on a clinical trial of a bispecific antibody drug and reached remission recently. Like most blood cancer patients, I have somewhat suppressed immune response, but it is not drastic, and I am not neutropenic. Are the results of the antibody test reliable? Is there any additional step I should take? Meanwhile, I am following all recommended precautions, but I fear I will never see my grandchildren again since they live 3000 miles away.

        Reply

        • I’m so glad you had your vaccine.

          Antibody tests may not be useful in determining if your vaccine has been effective. Even in those who’ve had COVID, an antibody test may be falsely negative if it’s done before or after the antibody levels have risen. Also, remember that your immune system has other responses than just forming antibodies, that an antibody test won’t reveal.

          I wouldn’t wait for a positive antibody test result before doing the activities that you planned to do when you were “immune”, but I would continue to use sensible precautions when you’re out and about. I hope you get to see your grandchildren soon.

          Reply

  21. Many, many thanks for this great information. Do you think it is, or will be, possible to be tested post-Moderna-vaccinations to see how my immune system has responded?
    I had no reaction at all, other than slightly sore arm, to either 1st or 2nd vaccine. My PCP assures me that each immune system is different and that my lack of reaction does not mean my immune response is low. I wish I were a scientist so I could understand that!
    I’ve read, for example, of a home-test product being developed at Univ of Alabama and now at spin-off co. P3 Diagnostics which says “…rather than using widely available antigens to capture antibodies, [we] map exactly where a patient’s antibodies bind to COVID19.”
    Thank you so much for your attention.

    Reply

  22. Excellent and timely article, most informative summary I’ve read anywhere and I greatly appreciate Dr Kernisan taking the time and making the effort to research and publish it. For those wondering about 2nd dose effects, my wife and I, both 71, got the Moderna and Pfizer vaccinations. After the second, we both experienced low grade fever (99-100.4) late that night, with chills, shakes, aches, took two extra strength tylenol, and the next day were both tired, lethargic, dragging, etc., just a little tired the third day and completely ok that night. The article reinforces our decision to continue to wear masks when out in public, avoid crowded venues, especially indoors, limit proximity and duration of contact with others unless we know their social behavior.

    Reply

    • Thank you for sharing you and your wife’s experiences with the COVID vaccines, and I’m so glad that you got your shots! I completely agree with your decision to continue to use sensible precautions when out of the house, and I’m glad you found the article helpful. Please share it, and check out my take on vaccines, here: https://youtu.be/Q6e9hPcG_6Q

      Reply

  23. Hello, this is a big concern for many of us who have received two vaccines of either the Moderna or Pfizer and experienced no side effects at all. I’ve read every review I possibly can get my hands on here, with no answers. Some of my age group (around 70 y/o) had reactions but most of us did not. This is perplexing. We worry. Should we now feel safe to go to the grocery store? See our children, grandchildren? Are we no better off than we were prior to the vaccine OR do you just not know our exact situation if we had no reaction to the vaccine? This is something that should be made very clear so we can proceed correctly. Should we go back into our homes and not venture out? Is that best? This is information we need and want. For all intent and purpose it appears if you did not have a reaction to the vaccine, your body did not recognize it. Old immune systems; sad, but we need the truth. We want to be here next year.

    Can we be tested to see if we now have adequate antibodies?

    Respectfully,

    Patti

    Reply

  25. Thank for this informative article on Covid vaccinations in older people. Do you know of any research about side effects of mental fog and extreme memory loss in people over 90 after the first Moderna shot. My father in law has dementia since several years but since his first shot yesterday he is not sleeping, agitated and keeps on saying he does not understand anything?! Just curious if you have heard about this kind if side effect.

    Reply

    • I haven’t seen this in my patients or heard about it in the scientific studies and media that I follow, but that doesn’t mean it couldn’t be a side effect. Common side effects include fatigue and headache, so it could be that he’s having typical side effects but responding to them in an atypical way.

      It could also be a coincidence, or due to something else, so if it persists or gets worse, I would advise someone in your situation to seek medical advice.

      Reply

  26. Thanks you Dr. Kernisan for all this information. I had seen the studies on Pfizer and Moderna vaccines but watching your slides made it much easier to read the statistics. I have had my first shot of Moderna and only felt a sore arm after I slept on it that night. I will be 70 years old next month. I too am concerned over the large range in protection for my age group. It looks like I could only have protection of 61% after the first shot which really worries me because in Canada they have decided to extend the second dose for up to 4 months later. Even though I am not in the Health field nor mathematical field I have estimated that my protection after the second shot of Moderna would only be about 78%. For Pfizer, after the second shot it would be maybe 83.5%. That’s not ideal and I really want to be able to go back to the carefree life we use to have. It is also scary that people are being given a false sense of hope that they will be 96% protected. It’s a bit of a relief to hear you say that the stats don’t mean you have less protection. Instead, it’s because of very few people got covid in that age group. I live alone and it has been very hard to live in this isolation. I hope more studies are done on people over the age of 65 and they find out we are more protected than first estimated. It’s hard to wait for these studies to be done. Thank you again. You have provided the best information I have come across on this pandemic.

    Reply

    • Hi Sue and I’m so glad you got your first shot. I’m glad that the article was helpful in making sense of the numbers, and I agree with you that there should be more older adults in these vaccine studies.

      I hope that being vaccinated doesn’t lead folks to become complacent and stop handwashing and staying home if they’re sick. along with other infection control measures. But, the more vaccines we get in arms, the closer we’ll get to herd immunity, which will be a great thing!

      I have a few videos about COVID on my YouTube channel, if you’re interested. Stay well and take good care.

      Reply

  27. Hello, Dr. Didyk,
    Thanks very much for the informative article. I am a 73 y.o. female and I am scheduled to get my second Moderna vaccine in two days. This will be 12 weeks after my first shot, and I am wondering how the length of time between doses will affect the possibility of side effects after this second dose. After the first dose, I only had a sore arm and very slight fatigue. Thank you.

    Reply

    • Congratulations on getting your vaccine!

      In the studies of Moderna, the interval between the two doses was 28 days, and there did seem to be more side effects after the 2nd dose. I’m not sure if a longer interval between doses will reduce the chance of getting adverse side effects, but it may. Remember, even if you don’t get side effects, it doesn’t mean the vaccine isn’t working.

      Good luck and thanks for getting immunized!

      Reply

  28. hello, I want my mom to have a BioNtech vaccine too. Only my mom has Shingles (Zona), which is not active now, but my mom is afraid that it will be active after vaccine as we heard news that happened and also there were people who died in Norway or something in Iran because of the vaccine. And countries such as France, Dubai and America said that those who do not want to vaccinate can do an immunization test. Then my mother really said if the vaccine is necessary .. She does not know what to do because she is afraid of the vaccine. We live in Turkey and in the Eastern regions of Turkey there is death in the elderly who are vaccinated. My mother is 56 years old but her immunity is strong. I don’t know what to do or say.. what should we do?

    Reply

    • I can understand being concerned about the safety of the vaccine, and there has been some frightening information in the news. As Dr. K points out in her video and article, the risks of COVID for older adults greatly outweighs the risk of the vaccine.

      In younger folks in good health (in their 50’s for example), the risk of severe illness from COVID is relatively lower, but is still higher than the risk associated with the vaccine. When we younger individuals get ourselves immunized, we help to protect everyone in the community, including those at higher risk for serious COVID illness.

      I’m glad you’re turning to a reputable source like Better Health While Aging for information, and maybe sharing the video with your mom will help her to decide what to do.

      Reply

  29. Thanks for your analysis. It’s an important information for me, but I wonder about the data of Asian elders. Is there any information about Asian?

    Reply

    • From what I’ve read, we don’t have specific information about how the vaccine may work differently in those with Asian, African, Caucasian, Indigenous, or other racial ethnicities. I would assume that the vaccine will work similarly in elders of any race.

      Reply

  30. When presenting stats, the average is reported. That’s the best guess at the truth. The average is the answer. But good reports also provide an indication of how loosey-goosey that might be. If the results were all over the map, then the range of confidence is large. But the average is still the best guess, not the range of confidence.

    The range of confidence interval means there’s there’s good confidence the true answer falls inside the band but still a quite small chance if it outside that band. Pay no attention to that small chance because the average that was found is the best guess.

    Reply

  32. Thank you so much for continuing to keep us “oldsters” informed! The data from the CDC and the media is so confusing!
    I had both Moderna shots (back in January and February) and am now worried about what I should do about breakthrough cases and booster shots. I have fibromyalgia and have never been able to figure out if I’m “immunocompromised”. I do know, from following hundreds of comments on the National Fibromyalgia Association website, that many, many fibromites had bad side effects from the shots, even after four weeks. Me, too.
    Thanks again for your insightful information.

    Reply

    • I’m sorry to hear that you had side effects from the vaccine, and I understand that it’s information overload out there about COVID, and I get it about breakthrough cases and boosters.

      I think Dr. K’s podcasts are excellent, evidence-based and timely updates about the latest COIVD news, and are a great resource. Talking to your own health care providers about what to do is important as well.

      Thanks so much for taking the time to comment, and I hope you’ll be able to find the answers you need when you need them.

      Reply

  33. Thanks for the professional information. I have a question. From browsing the Internet I learned that T cells are “aging” too etc. The efficiansy of the “protecting shield” weakens as we grow older. So is the third jab of Pfiser may strengthen the immunity system?
    Thank you

    Reply

    • T cells are a type of lymphocyte – a white blood cell that helps the immune system to function correctly. T cell numbers stay about the same with age, but in older adults, T cell function can be less efficient than in younger people.

      Vaccines don’t “strengthen” the immune system, but they use the immune system machinery to provide protection against getting an infection, or a more severe form of illness from an infection, as in the case of a COVID vaccine booster.

      I would think of the booster shot as boosting a person’s prior vaccine efficacy, rather than boosting the immune system. In fact, a stronger immune system could be hazardous to your health (for example, causing autoimmune disease). We want to optimize (not boost) our immune systems through healthy eating exercise, and stress reduction.

      Thanks for taking the time to comment and for following the COVID news.

      Reply

  34. Many are jumping the line and getting Covid boosters now – ahead of the proposed 9/20 beginning of the booster program. For healthy seniors over 75, such as myself, who received Moderna in Jan and Feb 2021, do you recommend waiting until 8 months (Oct) after 2nd shot, or is it advisable to get the 3rd shot ASAP, especially in an area where cases and transmissions are very high? Thank you!

    Reply

    • That’s a great question! The latest info seems to be that booster shots are a way to enhance protection from coronavirus, and it’s expected that the roll out of booster shots will be prioritized to those at highest risk (such as long-term care home residents and the oldest adults).

      Waiting until October might be ethically right – it will allow access to those who are at higher risk in the case of a limited vaccine supply. It might also mean that if a newly engineered vaccine becomes available (for example one that’s more tailored to delta or another new variant of concern), it might be worth waiting for.

      Things are continuing to change rapidly in this COVID world, so I would advise my patients to get a booster dose as soon as they can, according to their regional public health guidelines. Checking in with your primary care provider is a good idea too, and they’ll probably have a sense of what’s best in your region.

      In the meantime, don’t let up on handwashing and following other infection control practices, and try to get enough sleep, good nutrition, and regular exercise.

      Reply

  35. Very informative and helpful. Dr K addresses the different mRNA vaccines, but what are thoughts regarding getting Moderna “booster” after initial Phizer 2 dose series?

    Reply

    • That’s a good question and one that’s still being mulled by experts in the field of COVID vaccine research. It appears that it will most likely be acceptable, maybe even preferable to have the Moderna shot after a Pfizer series, as they are both mRNA vaccines.

      Sorry I don’t have a more up to date answer, but stay tuned to Better Health While Aging as we get more information.

      Reply

  36. Thank you for spreading more fear with this article. Dr Fauci, several years ago, stated masks do not work as particles are too small when it comes to Covid virus.
    Also, you presented no alternative facts regarding Covid and survival rates. I assume you must be paid off in some capacity to write such a lopsided article.
    This is no longer conspiracy junk. This is real life and the perpetuation of fear. CDC has said the survival rate, over all age groups, is 99% give or take. Obviously if you are compromised or unhealthy , it affects you differently.
    The vaccines have side effects known about and published by the FDA in 2020. Also, you should let people know the dangers of Remdisivir. That is the drug of death for people. People died in hospitals because of Remdisivir…. read side effects. As well, Remdisivir is not approved for Covid treatment by FDA, in is an investigational drug. But I digress.
    Please stopping telling elderly to go get shot. I have two, 98 and 99, grandparents. They had the shot and both went to the hospital after them. One had fluid on the heart, no sign of it before, as well as a couple other issues. Now she weighs herself daily to make sure she isn’t 2.5 pounds heavier. She is also on new medication to control these new issues. The other had onset of heart problems and problems breathing. But, there doctors told them to get the shot. Stop with the madness. VEARS is full of side effects. Death is occurring. Quit pushing this on the elderly!

    Reply

    • Your points are ones that I hear from some of my patients and neighbours, and I certainly respect that there are opposing views regarding COVID infection, treatment, and vaccination.

      I disagree that Dr. Kernisan is “pushing” any recommendations, and I can attest that she is absolutely not “paid off” to share any particular point of view. The article and video clearly reference sources that are widely considered to be evidence based and as free from bias as possible, including original research papers when those are available.

      I’m so sorry that your grandparents were ill, and I hope they’re doing better. It can be very difficult to sort out the cause of health issues, and sometimes there can be a temporal relationship with an event like a vaccine, so I can understand assuming that the vaccine caused the illness. I feel reassured that vaccine adverse event data is being gathered so that we can get long-term information about the safety of the vaccines. Having a family member get ill after a vaccination is tragic, but the data seems to point to overall safety and benefit, even in the very old.

      Thanks for taking the time to leave a comment and share your perspective.

      Reply

  37. I am one of those who probably should get a booster. Pfizer vaccine in January and February 2021. 85 years old in good health except for diagnosis of rheumatoid arthritis in October 2020. Symptoms well controlled with Methotrexate symptoms (6 x 2.5mg weekly) and Hydroxychloroquine (1 x 200mg/daily). I believe that these medications affect the immune system in ways that make me “immunocompromised”. Do these medications suppress T cells? B cells? Other components of the immune system? What is known or thought about the effects of such medications on the immune response to vaccines. And would there be any benefit (in terms of response to the vaccine) to temporarily suspending taking such medications?

    Reply

    • Methotrexate is used in the treatment of various conditions, including rheumatoid arthritis, psoriasis and after an organ transplant. It acts by affecting folate metabolism, which inhibits DNA synthesis, repair, and cellular replication.

      Hydroxychloroquine is used as a treatment for malaria, but also for lupus and other autoimmune conditions. It affects the movement of white blood ceils, and interferes with the complement system (another part of the immune system).

      Neither medication has a specific effect on T or B cells, but they can reduce vaccine efficacy, and are considered immunosuppressants.

      It’s likely that a person on immunosuppressant drugs would be a good candidate for a booster shot, at least according to current CDC information.

      Whether or not to stop a certain medication to increase the chance that a vaccine is effective is an individual decision, best made with a doctor who knows the whole medical history. It may be that the risk of getting a flare of arthritis outweighs that benefit of enhanced vaccine efficacy. Stay tuned as we get clearer guidance on boosters.

      Reply

  38. Dr. Leslie,
    Thank you so much for the updated video commentary dated 9/9/2021; great info! We appreciate you keeping us informed and sharing with us what is important to know! You are awesome! Take care.

    Reply

  39. I note very little being addressed regarding natural immunity post-covid infection either in your article, the CDC, NIH, and WHO…specifically concerning those of us in the “aging-health community”. I am 6-months out from a definite covid infection, live on my own with little, if any residual effects of that infection. Other than being well over 75, female, I have no underlying co-morbidities. I have recently had both qualitative and quantitative lab studies done that show natural infection with SARS-cov-2. I am EXTREMELY hesitant to have any of the “vaccines” for Covid given their politicization and low track record for any age group. Nor are we being advised of reported adverse reactions (how many are NOT being reported). VAERS does have those reported numbers but the public is not being given the information that that information IS out there. Informed consent? Not really!! I am not truly an anti-vaxxer but have had many negative reactions to “required” vaccinations in the past. SO I am basically UNvaccinated for several major diseases, polio aside. So now what…

    Reply

    • I’m so glad to hear that your COVID infection has resolved with few to no residual effects. I can understand questioning if you need a vaccine after you’ve recovered from COVID, and many people have this query.

      You’re correct that having had COVID confers natural immunity, although it’s not clear what the duration of that immunity will be. In addition, there’s some evidence that those who have had COVID and don’t get vaccinated may be more likely to get it again. You can check out that study here. I think the track record of the vaccines for preventing serious illness and hospitalization from COVID is good, as Dr. K pointed out in her article, and I do recommend it for almost all of my patients, whether they’ve had COVID or not.

      Having had a serious reaction to a prior vaccine could be a reason to not get vaccinated for COVID, and then of course, it’s important to consider what the infection rates are in a person’s geographic area, whether the person has contact with unvaccinated or vulnerable individuals, and what other health issues they may have.

      We all have to make a decision about vaccination based on our local scenario, values and health issues, and with the best information we can find. I get that there are unanswered questions that make some of the choices difficult, and I hope you can do what’s best for you in collaboration with your health care team.

      Reply

  40. I have a question. Is it recommended that someone over 75 who has had the two Pfizer vaccinations and is planning to get a booster seek to have a Moderna booster, in the light of Dr. Kernisan’s comment about the two in the youtube video?

    Reply

    • Hi Robert.

      I agree that the data about the efficacy of the Moderna vaccine is encouraging, but I don’t think there’s enough data right now to recommend waiting for a Moderna booster, which may be available a little later than the Pfizer one.

      So if you or a family member need a booster shot and the Pfizer one is available, it isn’t recommended to wait for a Moderna shot.

      Reply

  41. I am 78, had my second Moderna shot in February 2021. Since we do not yet know how long we will have to wait Moderna boosters (which are 50mcg, one- half the original dose) for the Moderna boosters to be available, is it better to: get Pfizer booster, wait for 50mcg Moderna booster to become available; OR – do what almost everyone I know has already done: go get the 100 mcg Moderna third dose (since the qualification to be immunocompromised is not being required). Thank you.

    Reply

    • You voice a question that is on a lot of people’s minds – that of whether to wait for a Moderna booster. I’m not sure that we have a clear answer, but I know that when the vaccine was first available, our advice was that if you need a shot, to get one that is most available to you right now. So that’s what my advice would be currently.

      Reply

  42. I am 63 and have had both Moderna shots, the last one on April 6th. My wife (over 65) has had both Pfizer shots, and three days ago received a third (booster). We have a grandson in Florida who will be 1 year old on October 31 (Halloween) and we have not yet seen him (we live in upstate NY). Our son has been asking us to come visit now that covid infections in his area have come down recently. We very much want to go visit but our concern is what are the chances of us getting a breakthrough infection and passing it to our new grandson (particularly myself without a booster yet). Our son and his fiancee both have had the J&J shot. We would be traveling by car with two overnight stops on the way to Florida. It doesn’t look like a Moderna booster for me will be available very soon. Thank you.

    Reply

    • Congratulations on your little grandson!

      Every decision like this involves considering your values and goals, and what trade offs make sense for you and your family. Vaccination is something we’re all so grateful for, but it’s just one component of preventing COVID. In addition to being vaccinated you can continue to wash your hands, disinfect surfaces, sleep and eat well and exercise, and avoid contact with others if you feel ill.

      It seems that very young children are less likely to get seriously ill from COVID, as I read here: https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/coronavirus-in-babies-and-children/art-20484405. If rates of infection with COVID are lower in the area where your grandson lives, that’s another encouraging factor.

      My advice would be to continue to monitor the infection rates and use your best judgement, and check with your doctor about whether the Pfizer booster is worth getting before you travel. Right now, there’s no clear consensus about that.

      Reply

  43. I am an 80 year old woman, fully vaccinated with Pfizer over 6 months ago. I have no pre-existing co-morbidities that I know of ,and take no meds. I feel blessed to be quite healthy for my age! I still work as a clinical social worker/ psychotherapist ( remotely through Zoom or phone). I am quite concerned about whether to get a booster, since the day after my second dose of Pfizer ( Feb. 28th) I began to experience significant tinnitus in both ears. ( I never had this symptom before) It has continued since then. The volume of the tinnitus seems to have lessened very slightly now after 7 months,, and I am finally able to get some good sleep at night. I am worried that a booster dose might cause the tinnitus to worsen again. A well know vaccinologist and research director from Mayo Clinic, Dr Gregory Poland, published a recent online article on the”HEALIO” site ( June 2021), commenting that the link between Covid vaccines and tinnitus needs to be looked into. He shares his own adverse reaction to the vaccine stating that he began to experience severe tinnitus within hours of his second Pfizer dose. He reports similar symptoms have been reported by several thousand people to Vaers.. some have also experienced other auditory issues such as sudden hearing loss & deafness. My internist shares in my dilemma, & had my antibodies tested last week. My score was 648.2. He said that test is not definitive – but it indicates that I do have some immunity still. I’m in a real quandary about what to do regarding getting a booster, since I want to spend time with family, & friends, and return to being able to travel& work in person. I would greatly appreciate your advice. Thanks much for your website – its very informative.

    Reply

    • Thanks for your kind words and for taking the time to share your experience.

      I did find some case reports of tinnitus in the literature: https://www.tandfonline.com/doi/full/10.1080/14992027.2021.1931969 and I was not aware that it was a potential reaction. It appears that the side effect is uncommon and reversible, based on the information we currently have. How the vaccine might cause ringing in the ears is unknown, but probably some type of autoimmune process.

      Nonetheless, I completely understand your concern. I can’t advise you any better than your doctors, and it is a real dilemma. If you do decide to forgo the vaccine, I would ask your MD if they can write an exemption for you so that you can still see family and travel when you need to, although there can be limited capacity for a doctor to do that.

      Meanwhile, keep up the good work with your active lifestyle and thanks for supporting the website!

      Reply

  44. Leslie, I appreciate all your updated information. Living in a retirement community with all levels of care presents many challenges but we have done very well limiting numbers of cases among residents. Our health services committee feels testing for the mobile independent living residents is still important and we do have the Healthy Davis Together saliva test readily available in the Davis community. Many take advantage of this but some are limited by mobility issues and no longer drive. Administration will not bring it into our community and there is resistance to providing transportation. There is some confusion about the appropriate frequency of testing. Is weekly adequate or is more frequent testing needed? All visitors,employees and contractors need to have proof of vaccination.
    Thank you for your input.

    Ron Cole MD

    Reply

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