[Hac-announce] Fwd: Why older people are at higher risk for severe COVID-19
Manny Sholem Ratafia
manny at ratafias.com
Fri Aug 19 09:31:12 EDT 2022
Here is an interesting and useful explanation of how COVID effects
change as we grow older. I've pasted in some highlights here, and the
full article from Katelyn Jetelina is below.--Manny
"We already see benefits with older people vaccinated with one booster
dose having 4 times the risk of dying compared to people with two
booster doses. (Unvaccinated people had 42 times the risk of dying from
COVID-19 compared to those with 2 boosters.)...But, the FDA needs to
require pharmaceutical companies to test B cell and T cell functions—not
just neutralizing antibodies—to assess the added benefit, instead of
retrospectively determining good or bad policy...Only 39.8%
<https://substack.com/redirect/4e41f6eb-ee10-4ce8-bf3a-bab5434b45da?r=a13t>of
65+ year olds are up-to-date on COVID-19 vaccines. The best thing that
this group can do is to fill the holes in their immunity walls by
staying up-to-date. This also highlights that we cannot rely on immune
systems alone, especially people aged 50+. /Everyone else/also needs to
do their part
<https://substack.com/redirect/8f318fd0-9660-4130-8df9-b4c2ac9ec5cf?r=a13t>(still)
to keep the more vulnerable safe. "
"Fight for the things that you care about, but do it
in a way that will lead others to join you."
― Ruth Bader Ginsburg
-------- Forwarded Message --------
Subject: Why older people are at higher risk for severe COVID-19
Date: Fri, 19 Aug 2022 13:04:43 +0000
From: Katelyn Jetelina from Your Local Epidemiologist
<yourlocalepidemiologist at substack.com>
Reply-To: Katelyn Jetelina from Your Local Epidemiologist
<reply+1529t4&a13t&&a1e149ef80e675108cd4a98de654465e3b7a6e1423edb4e40ea4b426c7bc632b at mg1.substack.com>
To: manny at ratafias.com
Why older people are at higher risk for severe COVID-19
Age is the strongest predictor of COVID-19 severe disease and death.
Even though those aged 65+ are the leaders in vaccination rates, they
continue to lead hospitalizations in the U.S. and across the globe. But…
why? An onslaught of scientific information can tell us why this may be
the case. I worked with
Open in browser
<https://substack.com/app-link/post?publication_id=281219&post_id=68970280&utm_source=email>
<https://substack.com/redirect/2/eyJlIjoiaHR0cHM6Ly95b3VybG9jYWxlcGlkZW1pb2xvZ2lzdC5zdWJzdGFjay5jb20vcC93aHktb2xkZXItcGVvcGxlLWFyZS1hdC1oaWdoZXItcmlzaz90b2tlbj1leUoxYzJWeVgybGtJam8wTmpjNU9UTXNJbWxoZENJNk1UWTJNRGt4TkRRMU1Dd2lhWE56SWpvaWNIVmlMVEk0TVRJeE9TSXNJbk4xWWlJNkluQnZjM1F0Y21WaFkzUnBiMjRpZlEuYWRFSi01VmRoMURDTUZ3VmVka0R4OUVMWDdMUjR1SzBsVm9fb1VyWFAxUSIsInAiOjY4OTcwMjgwLCJzIjoyODEyMTksImYiOnRydWUsInUiOjQ2Nzk5MywiaWF0IjoxNjYwOTE0NDUwLCJpc3MiOiJwdWItMCIsInN1YiI6ImxpbmstcmVkaXJlY3QifQ.QB4DfH3-Tvhz3ZAdeRDgKty3PYt5F4MshXa6GC4-1jc?>
/Si quiere leer la versión en español, pulse aquí
<https://substack.com/redirect/e60a2e82-3fdd-49b8-a317-567455afaf70?r=a13t>./
------------------------------------------------------------------------
Why older people are at higher risk for severe COVID-19
<https://substack.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.KIf8Px5JNnlvqSf6dTWr10icSSHjHoVtC32HtXXx1Es?>
<https://substack.com/redirect/a6d50178-36c8-4215-8103-1ba15711be5d?r=a13t>
Katelyn Jetelina
<https://substack.com/redirect/a6d50178-36c8-4215-8103-1ba15711be5d?r=a13t>
Aug 19
<https://substack.com/redirect/2/eyJlIjoiaHR0cHM6Ly95b3VybG9jYWxlcGlkZW1pb2xvZ2lzdC5zdWJzdGFjay5jb20vYXBpL3YxL3Bvc3QvZW1haWwtcmVhY3Rpb24_dXRtX3NvdXJjZT1zdWJzdGFjayZ1dG1fbWVkaXVtPWVtYWlsJnRva2VuPWV5SjFjMlZ5WDJsa0lqbzBOamM1T1RNc0luQnZjM1JmYVdRaU9qWTRPVGN3TWpnd0xDSnlaV0ZqZEdsdmJpSTZJdUtkcENJc0ltbGhkQ0k2TVRZMk1Ea3hORFExTUN3aWFYTnpJam9pY0hWaUxUSTRNVEl4T1NJc0luTjFZaUk2SW5KbFlXTjBhVzl1SW4wLmktbHJwVTJiWW9OYmRoSldpNDIyX0VkRXh2cGEtTTJBUTJGdVlpbEJ2NlEiLCJwIjo2ODk3MDI4MCwicyI6MjgxMjE5LCJmIjp0cnVlLCJ1Ijo0Njc5OTMsImlhdCI6MTY2MDkxNDQ1MCwiaXNzIjoicHViLTAiLCJzdWIiOiJsaW5rLXJlZGlyZWN0In0.0riKevhhg53-zVqVPOb-p4TcPcMjWgjWJr-oq93-3pc?>
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Age is the strongest predictor of COVID-19 severe disease and death.
Even though those aged 65+ are the leaders in vaccination rates, they
continue to lead hospitalizations in the U.S. and across the globe.
But… /why/?
<https://substack.com/redirect/d29c4a66-f9bd-4053-ac6b-2585f5620a84?r=a13t>
Hospital admissions by age group (CDC)
An onslaught of scientific information can tell us why this may be the
case. I worked with Edward Nirenberg
<https://substack.com/redirect/c62d9705-e347-4f6c-973c-b3ea498cc14e?r=a13t>to
translate the science to show why boosters among this population,
especially, should be of utmost priority.
*First wall of defense: Degrading*
<https://substack.com/redirect/a1c08070-ff92-409a-9a76-ef469e60af55?r=a13t>
We have a complex immune system, but for simplicity, we can reduce it to
a few major walls of defense.
The first wall is neutralizing antibodies. These antibodies are powerful
because they act fast—you inhale the virus and neutralizing antibodies
stop the virus before there’s a chance for it to get into your cells
(and start replicating). This prevents infection from happening in the
first place. The issue is that it’s essentially impossible to retain a
high level of neutralizing antibodies without regular, repeated
exposures—and it gets even harder as you get older.
A recent preprint
<https://substack.com/redirect/84d9d526-1d80-4a64-a91d-7dea5f75bcd9?r=a13t>study
found that the number of neutralizing antibodies you make in response to
infection differs by age: the older you are, the fewer neutralizing
antibodies you have (see figure below). In fact, when faced with
Omicron, 43% of people had /no /detectable neutralizing activity and,
among those, the mean age was 63.5 years.
<https://substack.com/redirect/20438e07-06e6-41c4-aecf-801bf3595918?r=a13t>
Bates et al., preprint; Source here
<https://substack.com/redirect/84d9d526-1d80-4a64-a91d-7dea5f75bcd9?r=a13t>
Another important aspect of antibodies is not just the sheer number we
have, but also the ability for the same antibody to recognize different
variants of the same part of spike. Scientists found that antibodies
among people 65+ years old were less likely to recognize multiple
variants’ spikes compared to antibodies among those less than 65 years old.
Second wall of defense: Solid
<https://substack.com/redirect/cb03791c-823f-47bd-a56d-9d62f038ff13?r=a13t>
Another line of defense are memory B cells. When we come in contact with
a virus after having been vaccinated or previously infected, B cells
remember what they need to create and start pumping out antibodies to
help fight the virus. B cells can be quickly called in the event that
more antibodies are needed.
An article
<https://substack.com/redirect/30f090ca-9528-4b30-8664-aeb0833cf141?r=a13t>published
this week showed that B cell levels largely did /not /differ by age,
which is great news. This wall of defense is solid. The challenge,
however, is that for B cells to live up to their potential, they need
the help of another wall: T cells.
Third wall of defense: Degraded
<https://substack.com/redirect/2a5359e8-b0d7-4b5d-a443-f1f3fe9d8290?r=a13t>
The third wall of defense is T cells. T cells are a key factor
<https://substack.com/redirect/8d13e042-a930-4c95-8859-40fae0e4058e?r=a13t>in
determining the outcome of infections (severe or mild disease). There
are two major groups of T cells.
*
/*Killer T cells */recognize and kill infected cells
*
/*Helper T cells*/help B cells make antibodies and instruct B cells
to make better antibodies
This means that while T cells can’t stop infections from happening
altogether, they can rapidly control them once they start, potentially
even to the point that people don’t have symptoms.
But there’s a challenge with T cells. Once we reach puberty, the thymus
(the organ that gives rise to T cells) gradually degrades into a useless
blob of fat and we stop making new T cells. There’s an especially big
decline
<https://substack.com/redirect/f09ca59c-af75-476b-be75-70dbf59378d0?r=a13t>once
we hit about age 40. This is usually okay because we typically
accumulate all of the T cells we need throughout our lifespan. Unless a
totally new microbe comes along that we have no exposure to (and
fortunately, though SARS-CoV-2 is new, it’s still a coronavirus, so
there is T cell memory from old coronavirus infections to work with).
But as we get older, just like the rest of the body, our T cells age too.
Unfortunately, we see T cell dysfunction in COVID-19. Anarticle
<https://substack.com/redirect/30f090ca-9528-4b30-8664-aeb0833cf141?r=a13t>published
this week showed that the diversity of T cells for those aged 50+ years
is much more limited than those under 50 at infection. Once symptoms
resolved, there was restoration but people over 50 can’t really make
full use of this unless they are infected again.
Implications
<https://substack.com/redirect/48e8498d-aafc-431f-9ed8-af16977d117f?r=a13t>
Two of the three defense walls among people over 50 years old have more
holes than those of younger people. Comorbidities also increase with
age, which means the immune response in general is a lot more taxed.
This means the rate of breakthrough cases, and specifically /severe
/breakthrough cases, is substantially higher for older people.
The good news is that the immune system is still working for a majority
of people. We clearly see that the risk of severe disease even in the
very elderly dramatically declines
<https://substack.com/redirect/94861a88-0e4b-478b-b798-223cc4cd76ed?r=a13t>with
even just the primary vaccine series.
<https://substack.com/redirect/074ea170-42c7-4bb9-9339-4e2b362434bd?r=a13t>
(CDC)
However, it may take more doses to coax immune systems into doing the
things we want. This may mean more frequent boosting in older age
groups. We already see benefits with older people vaccinated with one
booster dose having 4 times the risk of dying compared to people with
two booster doses. (Unvaccinated people had 42 times the risk of dying
from COVID-19 compared to those with 2 boosters.)
<https://substack.com/redirect/ca53bfca-a87c-4acb-8bc5-57c4e49ea272?r=a13t>
How much each incremental booster helps (or does not help) is something
that we really don’t have a good grip on /prospectively/. For example,
we didn’t really know a second booster was needed among 50+ year olds.
We kind of guessed and relied on data from Israel (and the recent
articles suggests why 50 might be a key age). Retrospectively, we can
see that this was certainly the right policy call. But, the FDA needs to
require pharmaceutical companies to test B cell and T cell functions—not
just neutralizing antibodies—to assess the added benefit, instead of
retrospectively determining good or bad policy.
*Bottom line*
<https://substack.com/redirect/d07cba12-4cf5-4c88-bd0e-7c724c2931f8?r=a13t>
Only 39.8%
<https://substack.com/redirect/4e41f6eb-ee10-4ce8-bf3a-bab5434b45da?r=a13t>of
65+ year olds are up-to-date on COVID-19 vaccines. The best thing that
this group can do is to fill the holes in their immunity walls by
staying up-to-date. This also highlights that we cannot rely on immune
systems alone, especially people aged 50+. /Everyone else/also needs to
do their part
<https://substack.com/redirect/8f318fd0-9660-4130-8df9-b4c2ac9ec5cf?r=a13t>(still)
to keep the more vulnerable safe.
Love, YLE and Edward Nirenberg
------------------------------------------------------------------------
/“Your Local Epidemiologist (YLE)” is written by Dr. Katelyn Jetelina,
MPH PhD—an epidemiologist, biostatistician, wife, and mom of two little
girls. During the day she works at a nonpartisan health policy think
tank, and at night she writes this newsletter. Her main goal is to
“translate” the ever-evolving public health science so that people will
be well equipped to make evidence-based decisions. This newsletter is
free thanks to the generous support of fellow YLE community members./
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