Despite the high number of deaths in older adults from the Omicron surge, a significant number remain “un-boosted” – only about 29.5% of people 65 and older are “fully boosted” with both first and second booster shots.

At an Ethnic Media Services briefing, June 29, speakers – Susan DeMarois, Director, California Department of Aging; Denny Chan, Directing Attorney, Justice in Aging; Roberto Velasquez, President & CEO, Southern Caregiver Resource Center, serving San Diego and Imperial Counties – Working with vulnerable older adult care givers taking care of older adults; and Dr. Sara Tartof, Infectious Disease Epidemiologist, Kaiser Permanente Southern California – discussed the challenges of getting older adults fully boosted, the efficacy of boosters against new variants for older adults, where access issues persist for isolated populations, and the need for sustaining public education campaigns to combat complacency and disinformation.

(Above, l-r): Susan DeMarois, Director, California Department of Aging; Denny Chan, Directing Attorney, Justice in Aging; Roberto Velasquez, President & CEO, Southern Caregiver Resource Center, serving San Diego and Imperial Counties – Working with vulnerable older adult care givers taking care of older adults; and Dr. Sara Tartof, Infectious Disease Epidemiologist, Kaiser Permanente Southern California. (EMS)

Susan DeMarios of Department of Aging, co-host this briefing, said, “We’re doing everything we can with (the media’s) help and with the 50-61-62 participants joining us today to continue to get the word out to communities throughout California about the value of vaccines and boosters and testing to treating for this population, the population of older adults who have been hardest hit from the outset of the pandemic and still to this day.

“We know today that 84 percent of adults 65 and above have had their primary series completed; 76 percent have had at least one booster; but more significantly, we know that 70 percent of all COVID deaths in California are people 65 and older.

“As things reopen and people regather how we can still continue to protect and keep safe older adults especially older adults of color?”

Dr Sara Tartof spoke about the risks of being immunocompromised, “I’ve had a lot of opportunity to gain insights and learn a lot about the vaccines. We were one of the first very large publications on waning of immunity from COVID vaccines and that paper was presented at the FDA for recommendations, and to the CDC, ACIP, and was used for the recommendations of booster doses. Since then, we have expanded to looking at different variants which is important to understand why vaccine effectiveness or how well the vaccine works changes over time and helps us to understand a little bit about what we’re seeing with Omicron, for example, versus what we saw with Delta.

“This paper that that was covered in The New York Times was based in Southern California. We wanted to focus on severe outcomes, and we looked at hospitalizations and emergency department visits instead of focusing on just infections, and what we found was that at this time there was no real data on three doses against Omicron, so it was important timing to help us understand the third dose against Omicron.

“We saw that against hospitalizations, and this is something that we have seen throughout the pandemic, the vaccine does seem to work better against severe outcomes than against infections, so for example a lot of people are getting infections, but we haven’t seen that spike in hospitalizations to quite the extent that we have seen in the past and we did see that in our study.

“With three doses, we saw consistent protection against hospitalization. Protection is not as good against ED visits because that’s sort of what we consider a proxy for a somewhat less severe outcome, but the important takeaway from this paper was that among the immunocompromised, we did see significant waning of protection and that even with three doses, that initial bump most people get from the third dose which exceeds the protection seen in any of the first two doses.

“The second dose protection starts to go down and then when you get your third dose, you get a big boost in protection.

“What we saw for immunocompromised people is that this protection doesn’t get boosted as high to begin with, and it also wanes quickly after the third dose.

“As you age, you are more likely to develop immunocompromising conditions and proportionally, you do have more older people with immunocompromise conditions, and these patients are at increased risk of severe outcomes, so it is critical that boosters are followed or administered in these populations.

“As the recommendations change constantly, it’s difficult to keep track of what boosters are required. The third dose is good in the older population but now we’re on to four doses.

“It’s important to note that for the immunocompromised population, the recommendation is five doses right now because when we refer to the primary series that can be two doses for some people, but for the immunocompromised, it’s three doses for the primary series.

“There are two boosters that are recommended and there is the recommendation to move towards an adapted vaccine that is more tailored to Omicron.

“We’re not there yet as we don’t have those vaccines yet, and it’s important to emphasize, especially to more vulnerable populations, that you really need to protect yourself with the recommendations that we have currently and with the products that we have currently because as we see now, BA.4 and BA.5 are coming in. We don’t have a lot of data on how well this vaccine protects against those two variants.

“We started to see the increase in the older population when there was a decline in use of protective gear, masks. We started to relax a lot of public health measures that we had in place to reduce transmission. Once those things fell away, it was the people that are the most vulnerable that we began to see an increase in severe outcomes. Masking isn’t happening as it was before. It’s not going to come back unless there is a big change in hospitalizations, so in that context, I think vaccines are important.

“It’s very important to be up to date and to try to keep track of what the current recommendations are,” said Dr Tartof.

Denny Chan, directing attorney at Justice in Aging, remarked, “COVID 19 is far from over. We know because of the process of aging older adults tend to experience higher hospitalization and death rates. There’s been a disproportionate impact of COVID 19 in congregate living settings.

“National CMS data as of late last year shows higher hospitalization rates for Black, Hispanic, American Indian, and Alaskan native older adults.

“A closer look at the data shows the rates are higher in those communities of color in terms of the risk of hospitalization.

“California data shows that there are higher rates of infection and there are higher rates of spread when there are higher proportions of residents of color in nursing facilities.

“At the very beginning, in December 2020, when we were all beginning this vaccination adventure together, we didn’t have a whole lot of things set up. Today we have systems that are set up for older adults to get vaccinated and people to get vaccinated relatively easily.

“There are ways for people to get vaccinated at home. There are ways to sign up for a vaccine if you don’t have the Internet or if you don’t have a cell phone.

“We also have plenty of vaccine. There were times where we had a vaccine shortage or scarcity and had made hard decisions about who would get what, now vaccines are being approved for more and more age groups, so we’re getting easier access and there’s a potential for more specific vaccines targeting variants along the way, perhaps coming down the pike.

“We also know that vaccines work, and this is based on the state data that shows that as of May of just last month, unvaccinated people are five times more likely to get covered, seven times more likely to be hospitalized, and ten times more likely to die than those who have been boosted.

“Data shows that there are still many out there who would benefit from vaccines and boosters. “We’ve also learned throughout this course of the pandemic that we can’t have a one-size-fits-all approach to getting people vaccinated,” said Chan.

Roberto Velasquez, president and CEO, Southern Caregiver Resource Center, that has clients across the Imperial County and San Diego County, has been at the forefront of elder issues for over 30 years. He spoke next at the briefing.

“If you are a family caregiver, for example, of somebody with Alzheimer’s or Parkinson’s or just a frail older adult with some cognitive impairment, all you have to do is go to caregivercalifornia.org and enter a zip code or go on to the interactive map and it’ll tell you what caregiver resource center would respond to your needs as a family caregiver.

“The profile of the family caregivers that we serve, approximately 48 of our family caregivers are between the age of 45 to 64. They’re adult children taking care of parents. 36 percent are 65 to 84 which means most of those are spouses. 52 are White, 31 are Hispanic, 8 Asian Pacific Islander, and about 6 percent are Black African-American,” said Velasquez.

He spoke about the difficulties faced by both the caregivers and seniors due to the pandemic and the isolation it brought with it. He also gave a presentation on the efforts and work that his center and other similar centers put in to help ease the pain of COVID.