COVID was really bad when it first came on the scene, especially for older adults, who made up the vast majority of people who were hospitalized or died from the virus.
Things are now much better. This is partly because most of us have now had exposure to COVID, either through having it, being vaccinated, or both. This provides most people with significant protection from the worst effects of COVID.
However, as people get older, their immune system ages and works less well.
This means that even if an older person has had COVID before, it can hit them harder than a few years ago (especially if their health has declined).
So COVID will continue to be an important health issue in geriatrics. Fortunately, the vaccine does significantly reduce the risk of hospitalization or death from COVID.
On this page, I’ll be posting updates related to COVID and older adults. I’ll be focusing on important developments and what I think is most important for older adults and their families to know.
I also have a section below on general COVID safety principles for older adults.
Covid & Aging Adults:
Update October 2025: COVID & Fall Vaccines for 2025-2026
In this update, I cover:
- COVID so far in 2025
- Why fall vaccines matter
- COVID vaccines for 2025-26
- Moderna mNEXSPIKE and other options
- Flu vaccines for 2025-26
- What to know about RSV vaccines
- How to reduce your chances of getting sick
Related CDC resources:
- COVID-19 Surveillance Data in the United States
- Severe Viral Respiratory Illness – Updates
- Respiratory Virus Activity Levels – Updates
- Moderna mNEXSPIKE Safety & Effectiveness
Also recommended:
- Your Local Epidemiologist: Covid-19 vaccine changes: What it means for you
General COVID principles for older adults (that won’t be changing)
Since the pandemic started, a few core principles regarding COVID and aging 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.)
3. If you catch COVID, significant protection against hospitalization and death comes from vaccination. If you are older, you will lose protection unless you stay up-to-date on COVID vaccines.
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.
The thing is, the protection from vaccination and boosters does wane, especially when people are older. Protection against catching COVID wanes first (usually within 2-3 months) and protection against severe hospitalization wanes within 6 months.
Hence, it’s essential for older adults to stay up-to-date on their COVID vaccines. (You can learn about the latest COVID vaccine by watching my most recent video update above.)
Also: even shortly after boosting, the vaccine effectiveness against catching COVID may be only 30-40% for older adults. (So far it has been much higher — 70% or more — against hospitalization and severe COVID.)
So you should never assume that if you and everyone else in the room is “fully vaccinated”, or even up-to-date on boosters, that means you are COVID-proof. (Because you are not.)
But the general principle will remain: older adults who are vaccinated and up-to-date on boosters 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.
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 COVID waves.
Note: For my previous updates regarding COVID vaccines and other developments from the first years of the pandemic, see my original COVID updates page here.
Jenelle Fleck says
Thanks for this. I so appreciate your in-depth overview with the focus on older age groups(mine). Very informative. I read several national news sources and podcasts and follow medical sources, as a retired nurse practitioner. But you are my favorite.
Nicole Didyk, MD says
Thank you for your kind feedback – it means so much coming from another health professional. Stay tuned for more updates and stay well.
Roger Eastep says
Thanks so much for this great Covid update!
I have a question about swabbing the throat then the nose in a Rapid Test. Would there be a concern that swabbing the throat first could spread the virus to the nose?
Nicole Didyk, MD says
If a person is infected with COVID, the virus is likely through the body and can’t be “spread” to another body part. I’m so glad you enjoyed the update!
Laurence Alter says
Dear Doctor:
I listened to your video, and I found that the topic of “boosters” was barely touched upon. Assuming one has had one booster to the original vaccine, is another advisable? Is it possible to be ‘over-vaccinated’ and not let the body’s immune system do “”some”” of it’s work?
Laurence
Leslie Kernisan, MD MPH says
At this time, only one booster is recommended in the US. (So 3 vaccine doses for most adults.) Israel has been administering a 4th dose, but so far it’s unclear that it’s providing a lot of extra benefit. Probably it will not significant improve the protection against hospitalization, and the protection against catching COVID (vaccine efficacy against infection) will be only temporarily improved.
The body’s immune system does do its work in response to the vaccines. So far, I have not seen anything to cause me concern that repeat boosters might be unsafe. But it’s not clear that repeat boosting with the original vaccine formulation will bring much benefit.
I think it’s quite possible that we’ll eventually end up with something similar to the flu vaccine: an annual vaccine against coronavirus. But we’ll see…things continue to change quickly.
Laurence Alter says
Thank you for a most thoughtful reply.
In my case, with the J & J vaccine, a booster and original vaccine come to TWO shots.
One more question if I may: is the covering of one’s nose important as you state that the virus is transmitted by way of the mouth?
Respectfully,
Laurence
learningasigo says
Hi Dr. K., I am vaxxed and currently have COVID–I’ve been in bed two days. My second shot was end of November.
Have the first two shots changed over time? Is the serum the same now as it always was? If so, why hasn’t it improved? What about the boosters-are they all the same?
Is the current model for everyone to get boosted every couple of months forever? (that just doesn’t seem to be sustainable)
Why not follow the “flu shot” model of one shot each year?
Thank you for sharing this information!
Nicole Didyk, MD says
I’m sorry to hear that you have COVID and I hope you feel better soon.
The boosters are the same as the original shots, as you can read about here: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/booster-shot.html. I can understand that seems odd, especially as we’re hearing about new COVID strains, but from what we can tell, the vaccine still confers some protection against severe COVID related illness.
It seems unlikely that we’ll continue to need quarterly shots forever, although it might feel like it. You raise a good point about getting an annual shot, based on the strain of coronavirus that seems to be prevalent. I think it’s too soon to predict if that will be the case.
I’m so glad you found the article helpfuL!
Doug Saunderson says
Dear Leslie
Thank you so much for your very comprehensive update.
We are seeing much the same picture here in Australia (Victoria for me) but of course on a smaller scale PCR test queues are impossibly long and working conditions for those conducting them are very uncomfortable to put it mildly. RA test kits are now unobtainable and/or expensive.
I am 85 years of age and can relate to everything you are saying.
I can’t find anyone here who speaks specifically to my age group so I look forward to your weekly message.
Thanks again
Kind regards
Nicole Didyk, MD says
Thank you for sharing your experience in Australia and I hope it improves soon.
I’m glad you find the updates to be informative and filling a gap in the current COVID-related media. Stay tuned for more and thanks for leaving a comment.
Sandy Brown says
I think #5 should be much closer to the top of the list! As the director of a senior center, I’ve watched members of my center return with negative changes in weight, blood pressure, physical condition, etc., I think socializing face-to-face is far more important than anyone ever thought. It’s taken months to return them to something like normal! And I continue to push against children who, with mostly good intentions, are trying to keep the their parent(s) isolated. And meeting via social media proved not to be anything close to a viable solution. (We’re in a lower-income, remote, rural area.) Taking the stance that they didn’t get this old being stupid, my encouraging seniors to be safe, but come to the center and interact with others, is like Sisyphus pushing the boulder up the mountain.
Thank you for your hard work educating and informing us! I sincerely appreciate all of it!
DB says
Thank you Dr. Kernisan for these updates. They are helpful and encouraging.
Nicole Didyk, MD says
I’m so glad that you like the updates!
Barbara DeCoursey Roy says
Thanks for your common sense advice. I love what you say about 70 not being the new 50. Age the biggest risk factor means let’s protect our elders, and immune compromised, by getting vaccinated.
Nicole Didyk, MD says
Common sense advice is usually the best. I’m glad you like the updates and thanks so much for taking the time to comment!
John Farquhar says
The political jurisdiction in which my wife and I live is geographically VERY large. Unfortunately, although COVID infection rates are reported daily they are virtually useless as a method of determining the actual rate of COVID infection in the community we live in (or any other community for that matter). We know that infection rates are climbing rapidly and take all recommended precautions but often wonder if we should be isolating even more than we are but cannot make that decision based on any information supplied by the reporting authorities
Nicole Didyk, MD says
I understand the frustration related to making sense of the COVID numbers being reported. It is hard to translate infection rates into a personal risk index. Throughout this pandemic, there have been many individual decision points, and all I can suggest is doing what you need to do for peace of mind. Other factors to take into account include your personal vaccination status and risk of severe illness if you did contract COVID. Best of luck.
Susan G says
I am 73 and my husband is 76 (he has some well-controlled heart issues). I flew from San Francisco to Southern CA Dec 26. The airport was crowded and some of the relatives I saw had had Covid exposures. My husband and I are vaccinated and boosted, but now we have Covid-seems mild- no fever and oxygen levels are good- kind of like a bad cold. We are isolating now. The county (San Mateo) contact tracing called my husband and mentioned referring him for monoclonal antibodies at Stanford. Would this be beneficial at this point?
Nicole Didyk, MD says
Sorry you got COVID and I’m glad to hear that your symptoms are mild.
My understanding of monoclonal antibodies is that they seem to be of most benefit in those with very early (within 7 days) symptoms, and in those who may be partially vaccinated, unvaccinated, or immunocompromised. It seems that the antibody infusions are safe, but any treatment can have potential side effects.
It might be reasonable to talk to the team at Stanford to discuss the pros and cons in your husband’s particular case. Best of luck and feel better soon.
Noreen says
Never will do vaccines, period. Age 81 and mind is clear as a bell. We were fed a load of crap about flu and other vaccines. Have never had flu shot. Just avoid doctors and you will live longer.