As older Americans continue to shoulder COVID-19 burden, treatments are underutilized
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Key takeaways:
- Nearly 90% of people hospitalized with COVID-19 were aged 65 years or older.
- Four in five people with a severe COVID-19 outcome did not receive outpatient antiviral treatment.
As older Americans continue to shoulder much of the COVID-19 burden, new data show that most went without a vaccine last winter, and those who got sick rarely received antivirals.
“Hospitalization due to COVID-19 has remained a public health concern since the start of the COVID-19 pandemic,” Christopher A. Taylor, PhD, epidemiologist in the Coronavirus and Other Respiratory Viruses Division in the CDC’s National Center for Immunization and Respiratory Diseases, and colleagues wrote in the study, published in MMWR.
“Persons of all ages remain at risk for COVID-19-associated hospitalization. Among adults, the risk for hospitalization increases with age,” they wrote.
Physicians have warned that older adults are at the highest risk for hospitalization from COVID-19 since the start of the pandemic, which has remained true even with the availability of effective antiviral treatments and updated vaccines.
Although COVID-19 vaccines have been updated several times in the last 4 years — the 2023-2024 vaccine reduced risk for hospitalization by roughly 50% — their uptake has decreased significantly, including among older adults, potentially increasing the number of people at risk for severe disease or hospitalization.
Taylor and colleagues analyzed data from the COVID-19-Associated Hospitalization Surveillance Network (COVID-NET) on nearly 39,000 people in 12 states aged 18 years and older who were hospitalized with COVID-19 between Oct. 1, 2023, and April 27, 2024.
According to the study, adults aged 65 years and older accounted for 70% of all adult COVID-19-associated hospitalizations. People aged 75 years and older were hospitalized at a rate higher than all other age groups — nearly one out every 100 COVID-19 hospitalizations — the researchers wrote. They added, however, that COVID-19-associated hospitalizations during the 7-month period were the lowest during an October to April surveillance period since the first year of the pandemic.
Additionally, the researchers reported that 88.1% of adults hospitalized with COVID-19 had not received a 2023-2024 COVID-19 vaccine, 80% had multiple underlying conditions, roughly 50% had not received any COVID-19 vaccine since September 2022 and 16.6% were residents of long-term care facilities.
Antivirals have been underused among older adults with COVID-19, according to a separate analysis of data on nearly 400,000 people treated in an outpatient setting in the United States between April 2022 and September 2023 that was also published in MMWR.
That study showed just 21.1% of patients with a severe COVID-19 outcome had received outpatient antiviral treatment, compared with 46.7% of patients without severe outcomes.
Additionally, older age made it less likely people would receive outpatient COVID-19 antivirals, with 48.4% of people aged 65 to 75 years, 43.5% of people aged 76 to 89 years and 35.2% of people aged older than 90 years receiving them, researchers reported.
“COVID-19-associated hospitalizations continue to largely affect adults aged 65 years and older,” Taylor and colleagues wrote. “All adults, especially those aged 65 years and older and others at increased risk for progression to severe COVID-19 illness, including residents of [long-term care facilities], should reduce their risk for COVID-19 hospitalization and severe outcomes by receiving recommended COVID-19 vaccines, adopting measures to reduce risk for contracting SARS-CoV-2 and [by] seeking early outpatient antiviral treatment after receipt of a positive SARS-CoV-2 test result.”
References:
- CDC. COVID data tracker. https://covid.cdc.gov/covid-data-tracker/#datatracker-home. Updated Sept. 30, 2024. Accessed Oct. 3, 2024.
- Quinlan CM, et al. MMWR Morb Mortal Wkly Rep. 2024;doi:10.15585/mmwr.mm7339a3.
- Taylor CA, et al. MMWR Morb Mortal Wkly Rep. 2024;doi:10.15585/mm7339a2.
Perspective
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We have known that vaccination uptake was dismal this year; now we are beginning to see the consequences of poor uptake. The CDC report shows that 88% of people who were hospitalized with COVID-19 had not received their vaccination. Much of this could have been possibly averted.
Although this report shows that older adults account for the majority of hospitalization with COVID-19, it is also clear that among nearly 40,000 hospitalizations, 13.5% were among people aged 18 to 49 years and 16.7% were among people aged 50 to 64 years — reflecting the significant and sizable impact of COVID-19 on younger lives. Altogether, this shows that COVID-19 continues to wreak havoc in people’s lives.
It is also disappointing to see the dramatic decline in antiviral utilization with increased age [found in the study by Quinlan and colleagues]. Older adults are most vulnerable to the adverse consequences of COVID-19, and they stand to benefit the most of antivirals. Older adults tend to have more comorbidities and are on many drugs, which may have precluded antiviral use, but it is important to emphasize that the issue of drug-drug interactions is manageable, and providers should do their best to evaluate their patients for antivirals.
It is also important to note that these data are from April 2022 through Sept. 2023 — we know that antiviral use declined further in the remainder of 2023 and in 2024.
The U.S. must face the reality that COVID-19 remains a significant threat to public health and that reducing the risk of infection and improving vaccination and antiviral uptake, should remain the focus of public health policy.
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