By Deidre McPhillips, CNN
When Linda Stewart felt a tickle in her throat a few weeks ago, she got worried.
She's a 76-year-old woman, and she was well aware of the risks posed to her and her husband's health by COVID-19, flu and other colds that are sweeping the United States amid a rough respiratory virus season.
"I don't want to take any chances with my health," she said.
Throughout the pandemic, a positive COVID-19 test for a senior has carried an extra heavy weight.
Only about 13% of all reported cases in the U.S. have been among people 65 and older, according to data from the U.S. Centers for Disease Control and Prevention. But about half of all hospitalizations and three-quarters of all deaths have been in this age group.
The COVID-19 hospitalization rate for seniors has generally risen and fallen in line with broader trends, reaching a record high last winter during the omicron surge and dropping significantly in the summer. But compared with other age groups, hospitalization rates have consistently been higher among the 65 and older population.
This winter, COVID-19 trends are again on the rise across the country. So far, the increase appears to be relatively mild — hospitalizations are ticking up in most states, although the overall rate is still just a fraction of what it was during other surges.
But for older adults, the situation is much more severe. Hospitalizations among seniors are nearing the peak from the delta surge and rising fast.
And the age gap has never been wider. Since October, the COVID-19 hospitalization rate among seniors has been at least four times higher than average.
Even during the first winter surge in 2020, when COVID-19 took a devastating sweep through nursing homes, there was never more than a three-fold difference.
Dr. Eric Topol, a physician and professor of molecular medicine at Scripps Research, has dubbed the ongoing rise the "senior wave."
"Right now, we have an immunity wall built up against the omicron family — between shots and prior infections and combinations thereof — that seems to be keeping younger folks in pretty good stead. But the immune systems of people of advanced age are not as strong," Topol said.
Younger adults who are immunocompromised are also likely experiencing disproportionately severe effects of the latest wave, he said, but there isn't sufficient data to understand trends in that population as well.
New variants that are more immune evasive and relatively low utilization of treatments like Paxlovid may have played a role in the rising hospitalization rate among seniors, Topol said.
But "the main culprit is booster deficiency" with rates that are "woefully inadequate," he said. "It all points to waning immunity. If more seniors had their booster, the effect would be minimal."
Vaccines help, and boosters still work
Stewart said that she's eased back on personal mitigation measures, but still keeps an eye on COVID-19 trends. She's found a balance between caution and contentment that she says works for her — but getting her vaccines is really what helps her feel safest.
"I'm paying attention to the fact that it's picking up, so I'm a little bit more careful than I was, say, six weeks ago," she said. "With the pickup, I haven't reverted to how I was handling it a couple of years ago, but I'm more aware of who I'm around and maybe wearing my mask a little bit more than I used to."
A home test was negative for COVID-19 and confirmed by another test at a healthcare provider's drive-through, which brought some relief, she said. But even if it was positive, knowing she was vaccinated and boosted gave her reassurance.
"That was the whole idea of being so proactive with all these vaccines. There was a very good chance that yeah, you might get sick, but you wouldn't get as sick as someone who didn't get all their shots and there was a really good chance you wouldn't end up in the hospital," she said. "So that really gave me a sense of security in some ways that even if I did get it, it wouldn't be really bad."
But most seniors are not as well protected as Stewart.
Just about a third of the 65 and older population has gotten an updated booster shot, according to CDC data — a number that's concerningly low to public health experts.
"It's very, very concerning," said Dr. Preeti Malani, a physician at the University of Michigan Health who specializes in infectious disease and geriatric medicine.
"There's a sizable number of people who actually got previous boosters who have not gotten this one and I worry that there's confusion, there's misinformation. So to seniors — and to everyone — I say: if you have not been boosted, go get boosted."
A recent survey from the Kaiser Family Foundation found that 60% of seniors were worried about a rise in COVID-19 cases and hospitalizations this winter — a far larger share than average.
More than 40% were worried that they would get seriously sick themselves, but nearly as many said that they don't have plans to get the updated booster any time soon. In fact, nearly a quarter of seniors say they don't have any plans to get it at all, or will only get it if it's required.
The way forward isn't all or nothing
Stewart plans to host her family for Christmas again this year, for the first time since the pandemic started.
"We're careful about who we interact with. There isn't any undue risk that we felt in gathering with family. That's kind of our safe group," she said.
She and her husband also get together with small groups of friends that they trust are also vaccinated and similarly cautious, but they still plan to stay away from baseball games — even though it's one of their favorite pastimes.
"We love going to baseball games. We're real fans, and we're very supportive of our team, but there's a lot of risk there. We take the ferry over and on that ride over, you're riding very closely with a lot of other people. And going to the ballpark, again, we're very close to a lot of unknown people," she said. "It's too risky still."
Malani, the infectious disease specialist, said she recently spoke with a friend who seemed to be seeking permission to gather with family this holiday season. She was eager to celebrate in person with loved ones after years spent apart but anxious about letting her guard down amid a rough respiratory virus season.
"It's about finding a balance because the viruses are dangerous, but so is isolation," she said. "There's always a way forward and for now, it's through vaccination."
I don't mask or isolate. I get the boosters everytime they are available and will continue to do so. If the vaccines don't work, we are all fucked anyway. The people who don't get the shots, except those who can't for medical reasons, are the real problem. Stupid kills.
I'm consistently surprised at the number of people I know who have become avoident to new boosters with ridiculous excuses like Covid is almost gone, their risk is low, and (a real winner) they've had enough toxins in their body with the previous vaccines and don't want to keep getting them. Meanwhile, we keep getting emails about our ERs being dangerously over-run.
I had RSV in September and it kicked my butt for almost two weeks, and I'll do whatever it takes to not be sick any more than I have to, including updated boosters whenever they're available.