Why Tennessee seniors are still dying from COVID-19

KNOXVILLE, Tenn. (AP) - The Tennesseans who are dying of COVID-19 right now, records show, are the same group that was dying throughout the pandemic: Adults age 60 and older.

Over the past two months, more than 2,600 Tennesseans aged 60 and older have died from COVID-19. In contrast, about 520 people aged 31-60 were lost over the same period.

Deaths are still happening each day, even though 22% of Tennesseans have been fully vaccinated. While fewer people overall have died from COVID-19 in recent weeks, the problem is far from over.

Older Tennesseans were prioritized in the vaccine rollout, but many have yet to receive their first shot. That’s because most elderly residents who live at home weren’t part of Tennessee’s vigorous effort to vaccinate nursing home residents.

Because immunity is not immediate after a shot and because vaccine demand outweighs supply, people are still dying at an alarming rate.

“We need to be conscious and conscientious of the fact that there are people all around us who are not vaccinated and we need to be very thoughtful about making sure we aren’t spreading COVID to those people,” said Dr. Melissa McPheeters, a research professor of health policy at Vanderbilt University.

In recent weeks, the severity of the pandemic has downshifted from the incredible heights seen during the winter. New cases, hospitalizations and deaths are far below where they were at the start of 2021.

But keep this in mind: The pandemic has plateaued, but it’s still more serious than it was in spring of 2020 when the world was essentially shut down.

“What we are seeing is a decline in deaths and hospitalizations,” said Charity Menefee, the Knox County Health Department director of emergency preparedness. “Unfortunately those getting hospitalized and dying at greater rates is still that (older) age demographic.”

“I think we’re seeing the decline because it’s that population who has largely been vaccinated in our community and it’s a testament to what the vaccine can do,” Menefee continued.

Deaths dropped sharply approximately two months after the state began vaccinating health care workers and nursing home residents in mid-December. The state vaccinated all nursing home residents by Feb. 24. In turn, the drop off in fatalities was sharpest among the elderly, those most vulnerable to COVID-19.

The disease is especially lethal to the elderly. Elderly people have never made up the majority of COVID-19 cases but their death rate is proportionally larger. The vast majority of cases have occurred in people of working age, who have a tendency to leave their homes more often because of work and family obligations.

WHY IS THIS STILL HAPPENING?

Vaccinating nursing home residents saved lives, but the majority of older Tennesseans don’t live in nursing homes.

The Kaiser Family Health Foundation estimates that there were a little over 26,000 elderly people living in accredited nursing facilities as of 2018. The Tennessee Commission on Aging and Disability estimates that roughly 1.4 million people, or 1/5th of Tennessee’s population, is over the age of 60. That means that only roughly 2% of elderly people were covered by the effort to vaccinate nursing homes.

That 2% is an exceptionally vulnerable group. People in nursing facilities tend to have underlying health problems and live in close proximity with other vulnerable people.

But many older adults live in their own homes or with family, and they continue to hold jobs, attend church and volunteer.

“We don’t always have the full picture on housing status before hand,” health department spokesperson Kaylee Coffman wrote about local deaths. “For example, for those who pass away in the hospital we don’t always know if they were living independently previously.”

The COVID-19 pandemic has posed additional challenges for older people. Diesha Finley, who heads the Knoxville-Knox County CAC Senior Corps, said that her office had seen a multi-pronged crisis among the people they serve.

“Older adults are being evicted at a higher rate than we’ve ever seen before.” said Finley, “So many are facing housing insecurity, food insecurity, unemployment and a digital divide that limits their access to services.”

“The pandemic really destroyed whatever little support system that our older adults had put together,” she continued.

Finley said that many older adults had lost the support of family, friends and community during the pandemic. Sometimes that was because adult children lost income and could no longer help. Other times that was because they themselves could no longer work outside the home. According to U.S. Census data, approximately 5,000 grandparents raising grandkids were thrown into chaos by stress of lost income and reopening schools in Knox County. Statewide almost 77,000 grandparents are raising grandkids.

Older adults were already vulnerable. According to the United Way, 36% of older adults were struggling to make ends meet before the pandemic in Knox County. According to a report by the Knox County Planning Commission, 11% of homeless people in the county were older adults.

Finley said that particularly hard hit were “senior orphans”: Older adults who lack family, spouses, adult children or close friends. A recent study estimates that 22% of seniors are in this category. “Senior orphans” are at high risk during the pandemic because they are forced to go out for their personal needs and, in some cases, forced to seek work.

Finley said isolation has created vaccine hesitancy in some cases.

“For our clients at home and isolated and don’t have anybody else interacting with them, except for their television there’s a lot more hesitancy there,” Finley explained.

Many older adults also have chronic health conditions that make them more vulnerable to acute infections. And even physically healthy older adults tend to have reduced immune responses simply due to age. The disruption of social support networks caused by the pandemic made an already vulnerable population at elevated risk of exposure.

IMMUNITY TAKES TIME

As of the last week of March, the Tennessee Department of Health reported that 879,000 people over 60 had received at least one dose of the COVID-19 vaccine. That translates to roughly 60% of elderly people.

“On the one hand, vaccines are being rolled out incredibly quickly,” said McPheeters, from Vanderbilt University. “It’s exciting to see that happening, but we don’t have 100% of any population right not fully protected yet.”

The immune system needs roughly two weeks to develop a protective response, even after the second dose. That means that while more people every day are getting protection, not everyone who has a vaccine has the same level of protection.

“We don’t want to get ahead of ourselves,” said McPheeters. “We need to hold the course until we can truly get these vaccines, and not just shots in arms but reach that period when the vaccine has really taken effect.”

Supply continues to be constrained

While it’s clear that vaccines are having a protective effect, we can’t expect to see vulnerable people die of COVID at lower rates until more of the population is vaccinated.

The Knox County Health Department told Knox News that their goal is herd immunity through vaccination but that won’t happen for quite a while.

“Right now, at just over 20% (vaccination) there is still a long way to go regardless of the target,” wrote Coffman.

IS ANOTHER SURGE LOOMING?

McPheeters and others stressed that COVID-19 has the potential to surge during the vaccine rollout. COVID-19 cases are rising across half of the United States, particularly in Michigan where cases shot up by 50%, per data from the Department of Health and Human Services.

On March 29, Centers of Disease Control and Prevention Director Rochelle Walensky warned of “impending doom.”

“Yesterday we in the United States surpassed 30 million cases of COVID-19,” said Wollensky, citing early rising national COVID-19 statistics. “We have so much to look forward to, so much promise and potential for where we are but now I’m scared.”

Wallensky also warned that the U.S. still has an average of 1,000 deaths a day. In the face of this, health experts are asking the public to stay safe just a little longer while the vaccination effort rolls out.

“I am concerned that we are on the potential verge of another increase and none of us knows how big it’s going to be, if it’s going to be a surge or a smaller blip,” said McPheeters, “We are truly in a battle between getting vaccines out verses increasing cases and new variants.”

“We still need to wear masks, we still need to watch our distance, we still need to do the things that work while we give the vaccines a chance to do their thing,” McPheeters continued.