COVID hospitalization levels for NC’s oldest old exceed pre-vaccine period

This story was originally published by NC Health News on Dec. 22. Story by Thomas Goldsmith, North Carolina Health News

During the first week of December, hospitals were once again admitting hundreds of North Carolinians for COVID and other respiratory diseases. 

But while much of the media coverage has focused on pitiable small children coughing and struggling for air, it turns out many of the new admissions have really white hair: Nearly three in 10 of those being checked into hospitals were older than 80. That’s beyond the shrinking life expectancy, newly announced, for U.S. women at 79.3 years, and men at 73.5. 

North Carolina’s share of grandmothers, grandfathers and other 80-pluses who needed in-patient care for COVID doesn’t just exceed the level of state residents at that age, a handful of percentage points, it’s also more than the same share of that “old old” population hospitalized for the coronavirus before vaccinations began almost exactly two years previously, a North Carolina Health News analysis shows.

The holiday-season news comes as North Carolina and the nation appear to be swimming — or drowning — in a viral sea. In what’s being called the triple-demic, we are tossed among COVID, influenza, RSV and additional respiratory-virus waves that are making life hell for patients and stressing medical facilities and practitioners.

Statistics accumulated from a range of sources paint a particularly grim picture for older people, with the state just months shy of the third anniversary of initial COVID’s arrival in North Carolina as announced March 3, 2020. 

‘Highest risk for severe illness‘

“Week to week, the percentage of people being hospitalized varies,” Summer Tonizzo, a spokeswoman at the state Department of Health and Human Services, said in an email. “However, overall, older people have consistently been at some of the highest risk for severe illness, hospitalization and death from COVID-19.”

Treatment and means of prevention have evolved, and hopes have grown and sometimes faded, since the emergence of the novel coronavirus in 2019. The vaccines that doctors recommended for patients beginning two years ago at first seemed highly potent agents toward ending the pandemic and its excessive toll on older people.

But waning immunity in older people, widespread reluctance about taking the vaccine, along with a nightmarish ability of the virus to create variants, has left North Carolina’s oldest population entering hospitals with COVID diagnoses at a higher rate than in December 2020 before vaccines.

• In the first week of this December, 28 percent of COVID hospital admissions were among people 80 or older. That’s more than one-fifth higher than in the same period in 2020, when the figure was 23 percent of admissions.  
• Previously, the rate of people 80-plus among admissions had declined to 13 percent at the 2021 midpoint. The hospitalization rate has been more closely watched since the incident of COVID deaths declined after vaccines were introduced.

Winter – with the flu season – is always a rough time for older patients, something emphasized by UNC Health pulmonologist Brad Drummond. 

“I think there’s this complacency about flu because everyone’s been screaming from the rooftops about COVID,” he told NC Health News in November. 

He said he always sees more older people in his intensive care unit at this time of year with flu infections. That’s because as people age, their immune systems aren’t as resilient, so vaccines are more important to provide them with an extra kick when the viruses start circulating. 

Fewer vaccines across the board

In part, the trends may reflect a general decline in keeping COVID vaccination and booster rates at recommended levels, among the general population as well as for long-term care residents and staff.

“Layering protection for this population is very important,” Tonizzo said. “This includes staying up to date on vaccine and boosters, having ready access to testing, and seeking treatment early after testing positive. 

“The actions are important not just for the older person, but also for people who are in close contact with older people.”

The growing threat of the triple-demic, as it’s being called, has the attention of the White House, where a senior official recently addressed reporters.

“We have the tools we need to prevent death and severe illness, and we want all nursing homes to take action now,” the source said during a Dec. 14 “background” teleconference. The source cited the need for “updated vaccinations, treatment for residents testing positive, and improving indoor air quality.”

“We’re also expanding the pool of staff members at nursing homes who can administer shots, and we’re reaching out to governors where nursing home vaccination rates are low so that we can offer our support.”

The concentration on getting vaccines and boosters to nursing homes reflects scientific studies that widely cite positive results from the medicines. A CDC study that showed a second booster provided 74 percent effectiveness against severe outcomes from the disease and 90 percent effectiveness against dying from it.

But reception of the newer booster that’s designed to resist both the original COVID strain and the Omicron variant has met with less enthusiasm. An analysis done in October by the independent Kaiser Family Foundation found long-term care residents and staff both chalked up initial strong numbers of vaccinations but have been less likely to take the new bivalent boosters.

In a subsequent KFF analysis performed in early December, 49 percent of nursing home residents in North Carolina and a mere 17 percent of staff were up to date on their vaccines. That same analysis noted that in 2021, there was an uptick in nursing home resident deaths from COVID after the holidays. 

“That spike raises concerns about the potential for a similar spike in preventable deaths among nursing home residents in the upcoming post-holiday season,” the KFF authors noted.  

Adam Sholar, of the NC Health Care Facilities Association, a nursing-home industry group, acknowledged that both residents and staff have been more reluctant to receive doses of the bivalent booster. Sholar cited the National Healthcare Safety Network vaccination data for the state’s nursing homes as 91.8 percent for staff and 86.7 percent for residents – higher rates than those among the population as a whole – for the initial series of shots.

About one in three North Carolinians older than 65 has gotten the more recent COVID booster, compared to about 13 percent of the general population, according to CDC figures.

Vaccine rates: It’s complicated

Lower figures for use of the bivalent booster among staff, at about one in five, reflect its relatively recent availability at the time of the survey, Sholar said. Residents are all offered the vaccine and boosters, but not all agree to it.

“These rates are, of course, lower than the uptake on the initial series vaccination,” he said. “One reason is that residents, family members, and staff seem to be less convinced of the vital need for the bivalent booster because they see vaccinated and boosted people continue to get COVID. We continue to educate residents and staff about the benefits of reduced disease severity, et cetera, but there is a lot of mixed messaging out there.” 

Recent studies show that increasing numbers of people who have been vaccinated are dying of COVID, to the point that death rates among the vaccinated exceed those of the unvaccinated. A Kaiser Family Health Foundation position paper suggests that the large number of people with vaccinations explains the seeming disparity in part.

“Vaccinated and boosted people are, on average, older and more likely to have underlying health conditions that put them at risk for severe COVID-19 outcomes,” according to the paper.

Killer COVID rates

For a disease that didn’t exist three years ago, COVID-19 has become an increasingly potent driver of deaths and death rates, according to 2021 figures released on Thursday, Dec. 22 by the federal National Center for Health Statistics. 

2021 deaths attributed to COVID, at 104 per 100,000, accounted for more than three times those caused by Alzheimer’s disease, slightly lower year-over-year at 91 deaths per 100,000.

For a second year, COVID ranked as the third-leading cause of death, just below cancer and heart disease, and ranked above unintentional injury and stroke. And statisticians attributed another drop in life expectancy to COVID. 

Death rate increases actually took place at higher rates in middle age, at 12 percent for people 45-54. For older people, the increases were:

• 7.5 percent for 55–64,
• 2.4 percent for 75–84 and
• 3.5 percent for 85 and older.

Increase rates aside, total death rates are much higher for older people. People older than 85 made up 15,743.3 deaths per 100,000 in 2021. For people 45-54, it was 531 per 100,000.

Source: Centers for Disease Control and Prevention

Just as with nursing home residents, direct care workers can have a variety of reasons for deciding not to accept vaccines and boosters, said Kezia Scales, vice president of research and evaluation at PHI, a national research nonprofit.

“Direct care workers continue to struggle to schedule and attend appointments due to scheduling, transportation, and childcare barriers and the inability to take paid time off,” Scales said in an email. That could include taking time off for a day or two after a vaccination if needed.

In addition, CNAs responded in a 2021 study that many felt little confidence in whether vaccines were safe, effective and fully tested among people of color.

“Variation in uptake by race/ethnicity reflects deep-rooted disparities in how people of color engage with and experience the health care system — again calling out the need for trustworthy, relevant information and tailored supports to overcome access barriers,” Scales said.

Mostly women of color, North Carolina direct care workers continue to face low wage levels that contribute to a staffing crisis in long-term care and other means of looking after frail older people.

North Carolina Health News is an independent, non-partisan, not-for-profit, statewide news organization dedicated to covering all things health care in North Carolina. Visit NCHN at northcarolinahealthnews.org.