在美國,與新冠病毒相關的住院率再次攀升,老年人在美國死亡病例中的占比不斷提升,而到目前為止美國養老院已接種新冠疫苗的老人比例不到一半。
這些值得警惕的信號預示著老年人將面臨一個難熬的冬天,這令81歲的養老院居民巴特利·奧哈拉非常擔心。他表示“他已經在最大限度以內接種了疫苗”,也一直在關注與新冠病毒有關的醫院趨勢。他發現老年患者的“比例增加”,而年輕人的趨勢依舊平穩。
來自華盛頓特區的奧哈拉表示:“并非所有人都能感受到這種緊迫感。但如果你今年21歲,你或許應該關心一下長輩的安危。我們要共同面對這件事。”
有一個令老年人擔
憂的指標是,在兩周內,因新冠住院的患者數量增加了超過30%。美國疾病預防控制中心(Centers for Disease Control and Prevention)主任羅謝爾·瓦倫斯基博士表示,其中大部分新增住院患者為老年人和現有健康問題的患者。數據包括檢測呈陽性的所有患者,未考慮這些患者住院的原因。
斯克里普斯研究轉化研究所(Scripps Research Translational Institute)負責人埃里克·托波爾博士表示,在保護老年人方面,“美國做得很糟糕”。
養老院的負責人不斷加大力度,要求員工和居民接種新版加強針疫苗,目前新版疫苗建議6個月以上人群接種,但與此同時他們還要應對自滿的心態、虛假信息和新冠倦怠等問題。他們請求白宮幫助“攜手共進”應對這個問題。
LeadingAge總裁凱蒂·史密斯·斯隆表示,需要清晰說明接種疫苗能夠發揮的作用和無法達到的效果。LeadingAge是非盈利養老院的代表。
她表示,突破性感染并不意味著疫苗沒有發揮作用,但這種錯誤認知卻難以消除。
斯隆表示:“我們需要改變傳達的信息,準確介紹疫苗能夠發揮的作用,即預防重癥、住院和死亡。病毒存在潛伏期,它會在任何地方持續出現。我們只需要如實說明即可。”
養老院面臨的問題包括毫無理由地不愿意快速為老年人開具抗病毒藥物Paxlovid處方,因此有五家大型醫療協會針對醫生召開了名為“Vax & Pax:今年冬天如何保障患者安全”(Vax & Pax: How to Keep Your Patients Safe This Winter)的網絡教育研討會。
放寬疫情防控、人口整體較高的免疫比率和關于疫情是否已經結束的各種說法,削弱了年輕人對于威脅的緊迫感。這可能是受大多數人歡迎的變化,但這種心態卻對養老院產生了負面影響。
養老院負責人表示,為養老院居民接種疫苗征求其家庭成員的同意變得更加困難。一些可以自己出具知情同意書的養老院居民拒絕接種疫苗。到目前為止,只有23%的養老院員工接種了新冠疫苗。
德克薩斯州奧斯汀的西茜·桑德斯曾嘗試讓73歲的媽媽接種加強針,結果阻礙重重。她媽媽目前住在養老院,沒有安排接種加強針的診所。養老院告訴她,他們找不到疫苗接種員。因此,她計劃本月晚些時候帶媽媽去沃爾格林(Walgreens)接種加強針。
她說道:“老年患者住院和死亡病例增加令我擔憂,我擔心媽媽所在的養老院對于給居民和員工接種最新加強針缺乏緊迫感。”
員工和訪客通常是病毒入侵養老院的潛在入口。優秀的養老機構會采用分層機制,用口罩、問題篩查、體溫檢測和增強感染預防等措施保護居民安全。
位于美國首都哥倫比亞特區的Forest Hills養老院的CEO緹娜·桑德利表示:“我們在新冠疫情期間得到的一點教訓是,病毒的傳播率取決于社區傳播率。我在自己的房子里比在其他地方感覺更安全,包括食品雜貨店里。”
與此同時,美國各地醫院接診的老年患者數量增加,托波爾認為這“非常值得警惕”。據美國衛生及公共服務部(Department of Health and Human Services)的統計數據顯示,美國70歲及以上確診或疑似新冠患者的每日住院率從11月15日的每10萬人8.8例,增加到12月6日的每10萬人12.1例。托波爾表示,在加州和紐約州,老年新冠患者的住院率都超過了春季和夏季奧密克戎疫情期間的水平。
紐約大學朗格尼健康中心(NYU Langone Health)首席醫院流行病學專家邁克爾·菲利普斯博士表示,越來越多老年人因為感染新冠入住他所在的醫院。但增加比例最大的是急診科。急診科因為新冠患者和流感患者“變得異常忙碌”。
德克薩斯州休斯敦衛理公會醫院(Houston Methodist)病理學家韋斯利·朗博士表示,他也發現過去兩周因新冠住院的患者增多,許多患者是患其他疾病的老年人。有些患者因為其他疾病住院,但在入院后新冠檢測呈陽性。有好消息嗎?他說道:“我們并未看到重癥監護患者增多。”
針對奧密克戎和原始冠狀病毒株的新組合加強針疫苗,對最近導致感染者數量增加的主要奧密克戎變異株BQ.1.1提供了保護力。這種變異株的免疫逃脫力尤其強大。
托波爾表示:“但老年人的加強針疫苗接種率低得可憐。”只有三分之一老年人接種了加強針。
朗表示,休斯敦衛理公會醫院的醫護人員“會抓住一切機會”宣傳接種加強針。但醫護人員并未向因新冠住院的患者施打疫苗。患者通常會被告知,被感染后需要等待三個月再接種加強針。
菲利普斯也呼吁民眾如果存在重癥風險,或者計劃與存在重癥風險的其他人共處,應該接種加強針。他表示,有更多未接種疫苗者需住院治療。
與住院率一樣,死亡率也在升高。
最令人擔心的是會有更多老年人去世。去年春季和夏季,由于更多人通過接種疫苗和先前感染獲得了免疫力,因此死亡率整體下降。但85歲及以上的老年人,與新冠相關的死亡人數占比提高到40%。該群體占美國總人口的2%。
在疫情期間,五分之一新冠死亡病例來自長期護理機構的居民。
瓦利德·米謝林博士是天主教紐約總教區經營的七家非營利性養老院的首席醫療官。他表示,美國人需要繼續認真對待新冠疫情。
他說道:“疫情并未結束。病毒依舊在傳播。我們會發現新變異株,誰知道新變異株的攻擊力多強?想到這些令我徹夜難眠。”
—— 尼基·福斯特從紐約供稿(財富中文網)
翻譯:劉進龍
審校:汪皓
美國各地醫院接診的老年患者數量增加。
攝影:NATHAN HOWARD —— AP PHOTO
在美國,與新冠病毒相關的住院率再次攀升,老年人在美國死亡病例中的占比不斷提升,而到目前為止美國養老院已接種新冠疫苗的老人比例不到一半。
這些值得警惕的信號預示著老年人將面臨一個難熬的冬天,這令81歲的養老院居民巴特利·奧哈拉非常擔心。他表示“他已經在最大限度以內接種了疫苗”,也一直在關注與新冠病毒有關的醫院趨勢。他發現老年患者的“比例增加”,而年輕人的趨勢依舊平穩。
來自華盛頓特區的奧哈拉表示:“并非所有人都能感受到這種緊迫感。但如果你今年21歲,你或許應該關心一下長輩的安危。我們要共同面對這件事。”
有一個令老年人擔憂的指標是,在兩周內,因新冠住院的患者數量增加了超過30%。美國疾病預防控制中心(Centers for Disease Control and Prevention)主任羅謝爾·瓦倫斯基博士表示,其中大部分新增住院患者為老年人和現有健康問題的患者。數據包括檢測呈陽性的所有患者,未考慮這些患者住院的原因。
斯克里普斯研究轉化研究所(Scripps Research Translational Institute)負責人埃里克·托波爾博士表示,在保護老年人方面,“美國做得很糟糕”。
養老院的負責人不斷加大力度,要求員工和居民接種新版加強針疫苗,目前新版疫苗建議6個月以上人群接種,但與此同時他們還要應對自滿的心態、虛假信息和新冠倦怠等問題。他們請求白宮幫助“攜手共進”應對這個問題。
LeadingAge總裁凱蒂·史密斯·斯隆表示,需要清晰說明接種疫苗能夠發揮的作用和無法達到的效果。LeadingAge是非盈利養老院的代表。
她表示,突破性感染并不意味著疫苗沒有發揮作用,但這種錯誤認知卻難以消除。
斯隆表示:“我們需要改變傳達的信息,準確介紹疫苗能夠發揮的作用,即預防重癥、住院和死亡。病毒存在潛伏期,它會在任何地方持續出現。我們只需要如實說明即可。”
養老院面臨的問題包括毫無理由地不愿意快速為老年人開具抗病毒藥物Paxlovid處方,因此有五家大型醫療協會針對醫生召開了名為“Vax & Pax:今年冬天如何保障患者安全”(Vax & Pax: How to Keep Your Patients Safe This Winter)的網絡教育研討會。
放寬疫情防控、人口整體較高的免疫比率和關于疫情是否已經結束的各種說法,削弱了年輕人對于威脅的緊迫感。這可能是受大多數人歡迎的變化,但這種心態卻對養老院產生了負面影響。
養老院負責人表示,為養老院居民接種疫苗征求其家庭成員的同意變得更加困難。一些可以自己出具知情同意書的養老院居民拒絕接種疫苗。到目前為止,只有23%的養老院員工接種了新冠疫苗。
德克薩斯州奧斯汀的西茜·桑德斯曾嘗試讓73歲的媽媽接種加強針,結果阻礙重重。她媽媽目前住在養老院,沒有安排接種加強針的診所。養老院告訴她,他們找不到疫苗接種員。因此,她計劃本月晚些時候帶媽媽去沃爾格林(Walgreens)接種加強針。
她說道:“老年患者住院和死亡病例增加令我擔憂,我擔心媽媽所在的養老院對于給居民和員工接種最新加強針缺乏緊迫感。”
員工和訪客通常是病毒入侵養老院的潛在入口。優秀的養老機構會采用分層機制,用口罩、問題篩查、體溫檢測和增強感染預防等措施保護居民安全。
位于美國首都哥倫比亞特區的Forest Hills養老院的CEO緹娜·桑德利表示:“我們在新冠疫情期間得到的一點教訓是,病毒的傳播率取決于社區傳播率。我在自己的房子里比在其他地方感覺更安全,包括食品雜貨店里。”
與此同時,美國各地醫院接診的老年患者數量增加,托波爾認為這“非常值得警惕”。據美國衛生及公共服務部(Department of Health and Human Services)的統計數據顯示,美國70歲及以上確診或疑似新冠患者的每日住院率從11月15日的每10萬人8.8例,增加到12月6日的每10萬人12.1例。托波爾表示,在加州和紐約州,老年新冠患者的住院率都超過了春季和夏季奧密克戎疫情期間的水平。
紐約大學朗格尼健康中心(NYU Langone Health)首席醫院流行病學專家邁克爾·菲利普斯博士表示,越來越多老年人因為感染新冠入住他所在的醫院。但增加比例最大的是急診科。急診科因為新冠患者和流感患者“變得異常忙碌”。
德克薩斯州休斯敦衛理公會醫院(Houston Methodist)病理學家韋斯利·朗博士表示,他也發現過去兩周因新冠住院的患者增多,許多患者是患其他疾病的老年人。有些患者因為其他疾病住院,但在入院后新冠檢測呈陽性。有好消息嗎?他說道:“我們并未看到重癥監護患者增多。”
針對奧密克戎和原始冠狀病毒株的新組合加強針疫苗,對最近導致感染者數量增加的主要奧密克戎變異株BQ.1.1提供了保護力。這種變異株的免疫逃脫力尤其強大。
托波爾表示:“但老年人的加強針疫苗接種率低得可憐。”只有三分之一老年人接種了加強針。
朗表示,休斯敦衛理公會醫院的醫護人員“會抓住一切機會”宣傳接種加強針。但醫護人員并未向因新冠住院的患者施打疫苗。患者通常會被告知,被感染后需要等待三個月再接種加強針。
菲利普斯也呼吁民眾如果存在重癥風險,或者計劃與存在重癥風險的其他人共處,應該接種加強針。他表示,有更多未接種疫苗者需住院治療。
與住院率一樣,死亡率也在升高。
最令人擔心的是會有更多老年人去世。去年春季和夏季,由于更多人通過接種疫苗和先前感染獲得了免疫力,因此死亡率整體下降。但85歲及以上的老年人,與新冠相關的死亡人數占比提高到40%。該群體占美國總人口的2%。
在疫情期間,五分之一新冠死亡病例來自長期護理機構的居民。
瓦利德·米謝林博士是天主教紐約總教區經營的七家非營利性養老院的首席醫療官。他表示,美國人需要繼續認真對待新冠疫情。
他說道:“疫情并未結束。病毒依舊在傳播。我們會發現新變異株,誰知道新變異株的攻擊力多強?想到這些令我徹夜難眠。”
—— 尼基·福斯特從紐約供稿(財富中文網)
翻譯:劉進龍
審校:汪皓
Hospitals across the country are seeing an influx of senior patients.
NATHAN HOWARD—AP PHOTO
Coronavirus-related hospital admissions are climbing again in the United States, with older adults a growing share of U.S. deaths and less than half of nursing home residents up to date on COVID-19 vaccinations.
These alarming signs portend a difficult winter for seniors, which worries 81-year-old nursing home resident Bartley O’Hara, who said he is “vaccinated up to the eyeballs” and tracks coronavirus hospital trends as they “zoom up” for older adults, but remain flat for younger folks.
“The sense of urgency is not universal,” said O’Hara of Washington, D.C. But “if you’re 21, you probably should worry about your granny. We’re all in this together.”
One troubling indicator for seniors: Hospitalizations for people with COVID-19 rose by more than 30% in two weeks. Much of the increase is driven by older people and those with existing health problems, said Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention. The numbers include everyone testing positive, no matter why they are admitted.
When it comes to protecting seniors, “we’re doing a terrible job of that in this country,” said Dr. Eric Topol, head of Scripps Research Translational Institute.
As nursing home leaders redouble efforts to get staff and residents boosted with the new vaccine version, now recommended for those 6 months and older, they face complacency, misinformation and COVID-19 fatigue. They are calling on the White House for help with an “all hands on deck” approach.
Clear messages about what the vaccine can do — and what it can’t — are needed, said Katie Smith Sloan, president of LeadingAge, which represents nonprofit nursing homes.
Breakthrough infections do not mean the vaccine has failed, she said, but that false perception has been hard to fight.
“We need to change our messaging to be accurate about what it does, which is prevent serious illness and hospitalization and death,” Sloan said. “This virus is insidious, and it just keeps popping up everywhere. We just need to be real about that.”
Problems include unwarranted hesitance to prescribe the antiviral pill Paxlovid quickly in the elderly, which prompted five major medical societies to hold a web-based educational session for doctors, “Vax & Pax: How to Keep Your Patients Safe This Winter.”
Easing restrictions, broader immunity in the general population and mixed messages about whether the pandemic is over have softened the sense of threat felt by younger adults. That may be a welcome development for most, but the attitude has seeped into nursing homes in troubling ways.
Getting family consent for vaccinating nursing home residents has become more difficult, nursing home leaders say. Some residents who can give their own consent are declining the shots. Only 23% of nursing home staff are up to date on COVID-19 vaccinations.
Cissy Sanders of Austin, Texas, met multiple obstacles trying to get a booster for her 73-year-old mother, who is in a nursing home. No booster clinic was scheduled. The facility told her they couldn’t find a vaccinator. So she made plans to take her mom to Walgreens later this month.
“I’m concerned about the uptick in hospitalizations and deaths among seniors, and concerned about the lack of urgency at my mother’s nursing home in getting the residents and staff vaccinated” with the latest booster, she said.
Staff and visitors are potential entry points to nursing homes for the virus. The best facilities use a multi-layered approach, protecting residents with masks, screening questions, temperature checks and enhanced infection control.
“What we’ve learned during COVID is that the rate of spread is dependent on the community rate of spread,” said Tina Sandri, CEO of Forest Hills of D.C., a nursing home in the nation’s capital. “I feel safer in my building than anywhere else, including the grocery store.”
Meanwhile, hospitals across the country are seeing an influx of senior patients that Topol calls “pretty alarming.” Nationally, the rate of daily hospital admissions for those 70 and older with confirmed or suspected COVID-19 rose from 8.8 per 100,000 people on Nov. 15, to 12.1 per 100,000 people on Dec. 6, according to statistics from the Department of Health and Human Services. In California and New York, Topol said, hospitalizations for seniors with COVID-19 have already surpassed those during spring and summer omicron waves.
At NYU Langone Health, chief hospital epidemiologist Dr. Michael Phillips said a growing number of seniors are being admitted to his hospital with COVID-19. But the biggest increase he’s seen is in the emergency department, “which is very, very busy” with COVID-19, as well as flu patients.
Dr. Wesley Long, a pathologist at Houston Methodist in Texas, said his hospital has also seen an increase in COVID-19 admissions over the last couple of weeks — and many of the patients are seniors with other health problems. Some are admitted for different illnesses and test positive for COVID-19 in the hospital. The good news? “We haven’t seen an increase in ICU admissions,” he said.
The new combination booster shot, which targets both omicron and the original coronavirus, provides protection against one of the main omicron variants pushing up cases lately: BQ.1.1, which is especially adept at escaping immunity.
“But our booster rates among seniors are pathetically low,” Topol said, with only about a third getting the shot.
Long said health care providers at Houston Methodist promote the booster “every chance we get.” But they don’t administer it to people hospitalized with COVID-19, who are generally told to wait three months after being infected to get it.
Phillips also urges people to get their boosters, especially if they are at risk of serious illness or planning to spend time with someone who is. He said they see many more hospitalizations among people who are unvaccinated.
Deaths, like hospitalizations, are now rising.
The ultimate worry is that more seniors will die. Last spring and summer, death rates declined overall as more people gained protection from vaccination and prior infection. But the share of COVID-19–related deaths for the oldest old — adults 85 and older, who make up 2% of the population — grew to 40%.
Over the course of the pandemic, 1 in 5 COVID-19 deaths was among those who were in a long-term care facility.
Dr. Walid Michelen, chief medical officer for seven nonprofit nursing homes operated by the Archdiocese of New York, said Americans need to continue taking the pandemic seriously.
“It’s not going away. It’s here to stay,” he said. “We’re going to get a new variant, and who knows how aggressive that variant is going to be? That keeps me up at night.”
—Nicky Forster contributed from New York