As pandemic precautions fall, seniors remain the most likely to die of COVID in U.S.

Over the course of this historic pandemic — from pants-on-fire emergency to slow, steady simmer, from the very first virus to its nth mutation — there has been remarkable consistency in who gets sick and dies:

Older people.

That has remained stunningly steady, with folks over 65 years old accounting for roughly three-quarters of all U.S. COVID deaths since the dawn of the pandemic. To wit: In 2020, older folks accounted for 75.4% of deaths. In 2021, they accounted for 73%. In 2022, 71%. And through the first half of this year, 72%.

This holds true as total COVID-19 deaths have dropped dramatically — largely thanks to immunity built up through vaccination and natural infection — and even in the face of a nearly total abandonment of safety precautions like masking, keeping a respectful distance and staying up to date on vaccinations.

Might more lives be spared if we were a bit more cautious?

“Although the number of open outbreak investigations across Los Angeles County is near an all-time low, skilled nursing facilities continue to experience a high proportion of outbreaks when compared to other sectors,” the LA Department of Public Health warned last week.

“Given the vulnerability of skilled nursing facility residents associated with advanced age and serious health conditions, preventing the spread of COVID-19 remains of paramount importance.”

But not everyone treats it that way.

Is ‘better’ good enough?

Outbreaks at nursing home facilities in Orange County hit 31 in December. In June there were five. So far in July, there have been three.

“We appear to be in a steady state with no real meaningful increase detected in the recent months,” said Ellen Guevara, spokeswoman for the Orange County Health Care Agency.

Outbreak investigations in L.A. County nursing homes reached an apex after Christmas 2021, with 94 in one week. Over the past several months, though, it hasn’t topped 10.

All good, but — fully half of open outbreak investigations are at skilled nursing facilities in L.A. County, and it’s similar most everywhere else, officials said. It’s as if “better” is “good enough.”

“I’m not surprised to see a high death rate in nursing homes given the age and health status of the occupants. Still, I’m disappointed that we are not doing a better job protecting these individuals,” said Dr. John Swartzberg, clinical professor emeritus in the UC Berkeley School of Public Health’s division of infectious diseases and vaccinology.

“I say this because we have known shortly after the pandemic began that this patient population was at very high risk for infection, serious disease and death. Currently, very few are doing what works to protect themselves from infection (e.g., masking, PPE, prudent decision-making) since the Centers for Disease Control and California Department of Public Health relaxed their guidelines. While this may make sense for most, it does not for people in nursing homes.”

It also doesn’t help that most folks of all ages are turning their noses up at revving up their immunity as time wears on.

Statewide, only 21% of all Californians are up to date on their COVID vaccinations, meaning they’ve had the bivalent booster. However, people in nursing facilities are vaccinated at higher levels, officials in L.A. County said.

The overwhelming majority at skilled nursing facilities have had the first round of shots, with 89% of residents and 98% of staff vaccinated. But the first shots do little to protect from current strains, and just 70% of residents and 48% of staff have had the bivalent booster.

Still, the proportion of COVID deaths among skilled nursing facility residents has dropped steadily since vaccinations became available, officials said. In the summer of 2020, 58% of COVID deaths were among skilled nursing facility residents. In June, it was 11%.

No surprises, but jury out

The fact that most COVID deaths are among the elderly is completely in line with expectations, said Andrew Noymer, an epidemiologist and demographer at UC Irvine.

“The good news is that deaths are going down. The bad news is, ‘Watch this space,’” he said.

Unlike, say, the flu, which recedes in summer, COVID has wrought some of its greatest devastation in summer. “I’m hopeful — though not necessarily optimistic — that summer 2023 will be a normal summer,” he said. “What I’m looking for is to see whether we’ve really turned a corner. We won’t know until we close the books in the fall.”

Noymer will also be watching how COVID mortality compares to all-cause mortality.

Berkeley’s Swartzberg insists there’s more we can do to protect older people.

“Instead of using a ‘one size fits all’ approach, public health should have been much more refined in its guidelines,” he said. “For example: I do not think mask mandates should have been lifted for this population (patients, staff, and visitors). I’m agnostic about COVID vaccination for the workers, but feel strongly that all nursing home patients should be up to date with their immunizations (they are not).

“Infection control principles must be better enforced in nursing homes,” he continued. “In general, the enforcement in this setting is much more lax than in hospitals.”

The family and friends of our most vulnerable seniors should work to prevent infection when visiting skilled nursing facilities, said Dr. Barbara Ferrer, director of the Los Angeles County Department of Public Health.

If would-be visitors show signs of respiratory illness — cough, sore throat, fever, headache — they should wait until symptoms have passed before visiting. They can take a COVID-19 home test beforehand to help ensure they’re not infected. And having the latest vaccine provides another layer of protection.

“While I share in the relief that we are in a much less dangerous phase of the pandemic, I remain acutely aware that each day very vulnerable residents still die from COVID-19,” Ferrer said in a prepared statement.

“I worry that some people think that COVID is gone and that common-sense precautions are no longer helpful. Unfortunately, for some of our residents, particularly those residing in skilled nursing and long-term care facilities, sensible protections remain critically important to keep the risk of transmission low. By taking advantage of the abundant access to personal protective equipment, tests, vaccines, and treatment, we can all do our part to making sure that our vulnerable family and friends can also enjoy the summer with less worry and lower risk.”

Patients in nursing homes, Swartzberg said, are among the most vulnerable people in our society. “We know this, but we ignore too many of the tools known to protect them,” he said. “We would need a sociologist to explain why this is.”