For Many Older Americans, the Pandemic Is Not Over

In early December, Aldo Caretti coughed and despite all his precautions, he tested positive for Covid in a home test. It took his family a few days to persuade Mr. Caretti, who has never loved doctors, to go to the emergency room. There, he was sent straight to the intensive care unit.

Mr. Caretti and his wife, Consiglia, both 85, lived quietly in a condo in Plano, Texas. “He loved to read and learn English and Italian,” said his son Vic Caretti, 49. “He absolutely loved his three grandchildren.”

Aldo Caretti suffered some health setbacks last year, including a mild stroke and a severe attack of shingles, but “he recovered from it all.”

Covid was different. Mr. Careti was having trouble breathing, despite being on a ventilator. After 10 days, “he wasn’t getting better,” said Vic Caretti, who flew in from Salt Lake City. “His organs were starting to break down. He said, ‘He’s not going to make it.’

At least, at the end of this pandemic, families can be with their loved ones at the end of life. When the family agreed to take Mr. Kereti off the ventilator and provide him with comfort care, “he was alert, very aware of what was happening,” his son said. “He was holding everyone’s hand.” He died a few hours later on 14 December.

For older Americans, the pandemic still poses significant dangers. Nearly three-quarters of Covid deaths have occurred in people over 65 years of age, with the highest casualty among those over 75 years of age.

In January, the number of Covid-related deaths declined after the holiday surge, but still remained at nearly 2,100 among those aged 65 to 74, more than 3,500 among those aged 75 to 84, and nearly one among those over 85. There were 5,000 in number. Those three groups accounted for nearly 90 per cent of the Covid deaths in the country last month.

The number of hospitalizations is also falling, being five times higher for people over the age of 70 than those in their 50s. Hospitals can put older patients at risk even when the conditions that brought them on are successfully treated; The harmful effects of drugs, inactivity, lack of sleep, delirium and other stresses can take months to recover from – or land them back in the hospital.

“Covid continues to have very high costs,” said Julia Raifman, a public health policy specialist at the Boston University School of Public Health and co-author of a recent editorial in The New England Journal of Medicine.

The demographic divide reflects a debate that continues as the pandemic rages: What is the responsibility of those at low risk from the virus to those at high risk — not just older people, but those who are immunosuppressed or have chronic conditions?

Should individuals, institutions, businesses and governments maintain strategies such as masking that help protect everyone but particularly benefit the more vulnerable?

“Do we distribute them among the entire population?” Dr. Raifman asked about those measures. “Or do we forget it, and let the chips fall where they may?”

Nancy Berlinger, a bioethicist and research scholar at the Hastings Center, made a similar point: “The fundamental questions about morality are about what we owe to others, not just ourselves, not just our families and To the circle of friends.”

Three years on, the social answer seems clear: Mask and vaccination mandates have mostly expired, testing centers and vaccination clinics have closed and the federal public health emergency is set to end in May, leaving older adults on their own.

“Americans don’t agree about the duty to protect others, whether from a virus or gun violence,” Dr. Berlinger said.

Only 40.8 percent of seniors received a bivalent booster. Some who don’t believe they have strong protection against infection, a CDC survey reported last month (though the data indicates otherwise).

Others worry about side effects or feel unsure about the effectiveness of boosters. Seniors may also find it difficult to locate vaccination sites, make appointments (especially online), and travel to sites.

In the nursing home where the initial pandemic proved so devastating, last month only 52 percent of residents and 23 percent of staff members were updated about vaccinations. Initially, a successful, federally funded campaign sent health care workers to nursing homes to deliver doses of the original vaccine. Medicare also mandates vaccination of employees.

But for boosters, nursing homes were allowed to develop their own policies — or not.

“It makes absolutely no sense,” said David Grabowski, professor of health policy at Harvard Medical School. “This is the group that should have the highest vaccination rates in the country. Everyone there is very susceptible.

The costs of Covid for older people go beyond the most extreme threats and include limited activities, shorter lives and the continued isolation and risks associated with it.

In Hillsboro, Ore., Billy Irwin, 75, feels especially vulnerable because he has type 1 diabetes. She and her husband have concerts and theater performances, indoor restaurant meals with friends, moviegoing and volunteering. His book group disbanded.

“We used to spend a lot of time on the Oregon coast,” Ms Irwin said. But because the journey involves an overnight stay, he has been there only twice in three years; The Oregon Shakespeare Festival’s annual tour ended for the same reason.

The ongoing disruptions have further exacerbated Ms. Irwin’s depression; Some days, she doesn’t even bother to get dressed.

“I’m disappointed that we don’t consider other people as much as we should,” she said. “I don’t know that most people even think about it.”

Eleanor Bravo, 73, of Corrales, NM, lost her sister to COVID early in the pandemic; Two years passed before the family gathered for the memorial. “I was very afraid that if I got Covid, I would die too,” Ms. Bravo said.

She got Covid in July and recovered. But he and his partner still avoid most cultural events, travel and restaurants. “Our world has become too small,” she said. An organizer with Marked by Covid, a national nonprofit, she is working to build a memorial for the 9,000 New Mexicans who have died from the virus.

Of course, many older Americans have also resumed their pre-pandemic routines. In Charlotte, NC, Donna and David Bowles, both 67, fell ill with Covid in May — “I’ve been sicker than I can remember,” Ms. Bowles said.

But later, they returned to restaurants, concerts, shopping, her part-time retail job and her church choir without masks. “It’s a risk I’m willing to take,” she said. “I feel like I’m living life on my own terms, doing what I want to do.”

Although the political feasibility of mandating masks, vaccinations or better indoor air quality appears nil, policymakers and organizations can still take measures to protect older (and immunocompromised) people without forcing them to become hermits.

Health care systems, pharmacies and government agencies can launch renewed vaccination campaigns in communities and nursing homes, including mobile clinics and home visits.

Remember the “senior hours” some supermarkets instituted early in the pandemic, allowing older customers to shop with fewer crowds and less risk? Now, “public places are not accessible to people concerned about infection,” Dr. Raifman said.

they could be. Markets, libraries and museums may adopt certain mask-required hours. Many Off Broadway theaters already designate two or three masked performances each week; Others may follow suit. Steven Thrasher, author of “The Viral Underclass,” organized a masked book tour last fall with stops in 20 cities.

“Between the extremes of shutting everything down and doing nothing to reduce infections, there is a middle ground,” Dr. Raifman said. “We can reduce transmission in smart and inclusive ways.”

Yet Vic Caretti, who has found a bereavement support group helpful, faces comments from strangers in Salt Lake City because he wears a mask in public.

“I don’t think people understand how COVID affects older Americans,” Mr. Caretti said with frustration. “In 2020, it was an all together vibe, and it has been annihilated. People just need to care about other people, man. That’s my soapbox.