When the COVID-19 pandemic finally ends, our most glaring failure, and our greatest source of shame, will unquestionably be our unwillingness to protect society’s most vulnerable group: the elderly.
The 65 years and older cohort makes up only a little more than 15% of the U.S. population but accounts for more than 75% of all COVID-19 deaths, a significant increase in elderly deaths over recent non-pandemic years.
This breakdown in care has been especially glaring in our nursing homes, which are often referred to as residential care facilities. The Centers for Disease Control and Prevention reported that there have been over 1 million COVID-19 cases in American nursing homes (1.2% of total U.S. cases) and more than 151,000 deaths (16% of total U.S. COVID-19 deaths, which does not include the far larger number of deaths in the elderly who died outside of nursing homes). The 15% COVID-19 mortality rate in nursing home residents is 12 times the national average. Caregivers in these facilities have also suffered disproportionately, with another 1 million cases in nursing home workers and over 2,300 deaths.
When government and public health officials ultimately sit down to review their responses to the pandemic, one of the first things they should revisit is the lack of strict institutional control measures at the local, state and federal levels. This, combined with the appalling decision by some governors to return infected patients to nursing homes who might still be contagious, was the predicate for high death counts, especially early in the pandemic.
Even today, we continue to disregard best practices: More than 10% of nursing home patients remain unvaccinated, and greater than 25% have not received a booster. (Also, more than half of nursing home staff members nationwide have not received boosters.)
This travesty is by no means exclusively an American fiasco; it is occurring in most industrialized countries worldwide. Now another country, one that was once acclaimed for its COVID-19 control policies, is reaping a similar catastrophic whirlwind.
Hong Kong, which had been pursuing a zero-COVID-19 strategy from the beginning of the pandemic, has been rocked by a recent surge from the omicron variant that is as devastating as anywhere in the world. For the first two years of the pandemic, Hong Kong had a total of roughly 13,000 cases. Since Jan. 1, cases have gone up nearly 40-fold and have now passed 600,000. This omicron surge is not the benign wave that is commonly described — in the last month, Hong Kong has had the highest per capita death rate in the world. On Jan. 1, there were 200 total deaths over the first two years of the pandemic. In the last month, there have been 3,000.
Just as in the U.S., omicron has torn through the majority of Hong Kong nursing homes, infecting residents and staffers at a dramatic rate. And although Hong Kong has one of the top vaccination rates of any country in the world, only 15% of its nursing home residents have been vaccinated. Nine out of 10 COVID-19 deaths in Hong Kong have occurred in the unvaccinated, the majority of whom are 70 years old or older.
Yuen Kwok-yung, a University of Hong Kong microbiology professor and government adviser on COVID-19, was spot-on in a recent interview: “It would have been better if (the elderly) were vaccinated in the past eight months. We could have avoided this huge problem now. … Unfortunately, I think the elderly will pay a huge price.”
This is at once a public health failure and a societal failure. Every pandemic singles out members of vulnerable groups who require greater protection, generally those at the extremes of age. COVID-19 is unusual in that children have been relatively spared; it is the elderly who need more resources and attention. Amid the hurly-burly of lockdowns, anti-vaxxer pushback, social distancing and mask mandates, this basic public health principle has been relatively ignored.
But the pandemic has also pulled back the veil on our reprehensible treatment of the aged. The practice of shuttling the elderly out of sight and out of mind has replaced the biblical commandment of honoring father and mother.
The omicron wave is receding in the U.S., even as an average of 1,000 people still die daily and the one-millionth U.S. death will be recorded in the next month. The good news is that this death rate will almost certainly decline in the next month, reflecting the recent lower case totals, but the bad news is we cannot rule out another wave of infections in the spring. Already, Western Europe is seeing new case rises that may reflect waning vaccine immunity, the new BA.2 variant or a combination of the two.
This new wave may not come to the U.S., but if it does, we must prioritize protecting our elderly much more than we do now. This will entail increasing vaccination rates and COVID-19 testing in nursing homes, as well as facilitating access to anti-COVID-19 oral medications for the elderly.
But it demands something else as well — encouraging a newfound respect for the elderly. It is the mark of a humane and responsible society.
Dr. Cory Franklin is a retired intensive care physician. Dr. Robert A. Weinstein is an infectious disease specialist at Rush University Medical Center.
