Comment: Covid fight should now focus on those over 65

By Faye Flam / Bloomberg Opinion

Covid is still killing about 500 Americans every day; picking off the oldest, frailest members of our society. About 9 in 10 covid deaths are now among people over 65.

Some older people feel left behind by 2023’s “back-to-normal” attitude. Protecting them should be the focus for the rest of us. And we can do that without the kind of sacrifices we endured in the early part of the pandemic.

“When we hear there are 460 deaths or 520 deaths and they’re all old people … that cuts very raw with me,” said epidemiologist Michael Osterholm on a recent podcast episode. “I put myself in that category; I will soon be 70 years of age. We feel like our lives are almost seen as disposable.”

I wrote to Osterholm, who directs the Center for Infectious Disease Research and Policy at the University of Minnesota, to tell him that while I was moved by his plea to care about the old, surely nobody wants to see closed playgrounds and schools again. Whatever solution we find for 2023, it has to allow kids full freedom to play, study and just be kids. “I couldn’t agree more,” he said. He does not want to see people return to universal masking or isolation.

So what should we be doing?

Despite our political polarization over the pandemic, Americans generally agree that we care about our old people and don’t want them to die. And now for the first time there’s some hope we can agree about what to do about it.

The political left and most of the public health community took the position that the best strategy was to try to prevent cases across the board, first through closing restaurants and other business, canceling school, and then imposing mask mandates and other restrictions after a partial reopening.

The view on the right was encapsulated in a petition called The Great Barrington Declaration, which emphasized the protection of seniors but wasn’t specific on how that would be accomplished other than that it should not be done by reducing the spread of the virus through children and young people.

But we have better scientific studies showing what’s most likely to help. There’s less guesswork to squabble over. We have better technology: drugs, vaccines and home tests.

Osterholm said we need to be clearer about the limitations of masking and make sure those at high risk know they can protect themselves by wearing an N95 mask in some circumstances, but can’t assume cloth and surgical masks offer protection (either to the wearer or anyone around them).

We should also use rapid tests before visiting elderly friends and relatives, and cancel plans with them if we feel sick or have recently been exposed to someone with covid. That’s much better than avoiding people, which has an enormous price. “That may be one of the cruelest things of all,” said Osterholm. “If we basically prevent [older people] from getting infected by isolating them to where it’s loneliness that does them in.”

We can talk to the older people in our lives about vaccines and boosters. An onslaught of false claims about the vaccines has frightened people away from getting them, even when they would clearly benefit from them. Older people are still dying because they have never been vaccinated, Osterholm said, or they skipped boosters that could save their lives.

And doctors can become better informed about treatment for patients who test positive. Many older people aren’t getting the antiviral Paxlovid, though it could save their lives. The drug should be given to people at elevated risk for dying from covid-19 as soon as possible after they develop any symptoms. But Osterholm said too many doctors thought the drug was only for people who had already developed severe symptoms.

Paxlovid requires that people be taken off some regular medications; but that can usually be done safely, he said. By contrast, getting infected with covid is never safe in people over 75. “There’s just a lot of misinformation even in the medical community,” he said.

But there is only so much regular people can do. We need scientists and public health officials to do more, putting older people at the center of their efforts. The plan to make covid shots into a seasonal vaccine given along with flu shots is unlikely to stop the stream of death because SARS-CoV-2 doesn’t follow a seasonal pattern and the evolution of variants remains unpredictable. What we need is for scientists to keep working toward a better vaccine.

Americans can go on forever trying to decide which political faction won the debate over how to handle the pandemic. The questions are different now; and so is the right strategy. When our senior citizens die before their time, we all lose.

Faye Flam is a Bloomberg Opinion columnist covering science. She is host of the “Follow the Science” podcast.