Consider this: COVID-19 has hospitalizations and deaths among those over 65 are five and 90 times higher respectively than in those 18 to 29, according to the CDC. The rate also is a whopping 13 and 630 times higher among the 85 and older cohort than among younger people. Take into account that while adults 65 and older account for 16% of the U.S. population, they comprise 80% of COVID-19 deaths in the nation, according to the Kaiser Family Foundation.
Yet, while President-elect Joe Biden “understands that older Americans and others at high-risk are most vulnerable to COVID-19,” according to his presidential transition website, not one dedicated aging expert was on his all-star COVID-19 task force of infectious disease, epidemiology, health policy and other experts announced on Nov. 9.
“Representation really matters,” said geriatrician Louise Aronson, M.D., MFA, professor of medicine at UCSF and author of the New York Times bestseller Elderhood: Redefining Aging, Transforming Medicine and Reimagining Life, at a Nov. 11 panel to age-beat journalists. “It’s not just that there are two pediatricians and 11 adult specialists on the Biden COVID task force and zero people who specialize in aging.”
“There are two specialists in HIV; there are equity specialists; there are global health specialists,” Aronson noted. “We have an 80% death rate in old people, and there’s no one who knows anything about old people?”
COVID-19 presents and manifests differently in older adults, KHN’s Judith Graham wrote, with one reason the death rate was so high in that group being atypical symptoms and misdiagnosis at the beginning of the pandemic. A lack of knowledge about asymptomatic transmission in the often crowded, congregate living conditions in nursing homes was a significant factor.
Subconscious ageism pervasive in health care is a problem, especially among those who should know better. Biden, after all, will be the oldest new president when he takes office on Jan. 20. Big-name Biden medical advisers like Atul Gawande, Zeke Emmanuel, Vivek Murthy and Michael Osterholm are not geriatricians or gerontologists. They’re not as intimately familiar with the biological, psychological, or social effects of aging as a gerontologist like Aronson, a researcher like Yale’s Becca Levy, Ph.D., or professionals who view public health through an aging lens, such as Columbia University’s Linda Fried, M.D. (who also happens to be an epidemiologist).
As we get older, our bodies process, metabolize and react to medications and vaccines differently. That’s why there’s a specific flu shot for those over 65, why drug-drug interactions can have more serious side effects for that age group and why serious infections in younger adults (like pneumonia) can quickly turn deadly among an older, sicker, frailer population.
It’s not yet clear whether there will be significant differences in how the new COVID-19 vaccines will work in those over 65, compared with age 45 or 50. There may or may not be significant contrasts among some older people. One reason it can be hard to determine is that older adults are more likely to be excluded from vaccine and treatment trials than other groups, according to this JAMA study. Even in trials that do include older people, there’s no good long term data, even though older adults are near the top of the list when vaccine distribution begins, as reported in The Hill.
The rampant spread of COVID-19 cases and deaths is tragic beyond words. Not only are older adults at higher risk of contracting COVID-19, but they generally face worse outcomes if they get sick. How many grandparents have not seen or hugged their grandkids for months out of fear of contracting the virus? How many families have been unable to visit parents in nursing homes or assisted living facilities? They’re listening to the experts. To effectively address the physician and mental health of the older population, the task force needs to bring on, and listen to, aging experts.
Journalists may want to reach out to companies conducting phase 3 trials of COVID-19 vaccines to determine whether they’ve enrolled older adults and how many, how they anticipate breaking out the data, and whether preliminary results show any significant differences in efficacy or side effects based on age.