Protecting older adults against COVID-19

This article first appeared on the Healthfeed blog

The risk of getting infected with COVID-19 and experiencing severe illness increases with age. According to the Centers for Disease Control and Prevention (CDC), older adults are at the highest risk. Now, older adults (age 70+) in Utah can get vaccinated. University of Utah Health hosted a panel with two of our health care experts to answer common questions about the vaccine and what older adults can expect.

Emily Spivak, MD, associate professor in the Division of Infectious Diseases

Mark Supiano, MD, professor and chief of the Division of Geriatrics

Why should older adults get vaccinated? Should they be worried if they have any underlying health conditions or are frail?

Supiano: It’s been known since the beginning of the pandemic that older people are at very high risk of severe COVID-19 outcomes—and even death. In Utah, data over the last year shows 70 percent of deaths from COVID-19 have been in people age 65 and older—over 1,500 deaths total. Age is a strong risk factor in bad outcomes in COVID-19. This is why it’s extremely important for older adults to get the vaccine as soon as possible. People who are in this age group—who have multiple chronic conditions, who may be frail, or living in a nursing home—all the more need the vaccine. The data we have at this point suggests the two vaccines (Moderna and Pfizer/BioNTech) that are available are extremely safe and well tolerated in this age group.

Can the vaccine make people sick?

Spivak: You cannot get COVID-19 from this vaccine. It’s more likely people may experience side effects after receiving the second dose of the vaccine. Side effects are more commonly reported among younger people and typically occur 12-24 hours after vaccine administration. Side effects include fever, fatigue, headache, and muscle aches. This reaction is your body’s immune system mounting to the virus and your immunity building. Tylenol or ibuprofen can help alleviate these symptoms. There’s no other infections or illness you can get directly from the vaccine itself. We hear people say, “I got the flu from the flu shot,” but really this reaction is more likely the exact same phenomenon: it’s your immune system mounting a response to the virus and the vaccine.

Supiano: Data suggests these mild symptoms are less common in older adults but still more common after the second dose. These side effects are minimal and short-lived. It’s well worth receiving the vaccine instead of getting infected with COVID-19.

Should people be concerned about experiencing adverse reactions to the vaccine?

Spivak: Eleven in a million people have experienced severe allergic reactions to the vaccine, which is extremely rare. These are allergic reactions like swelling, itching, and difficulty breathing. Allergic reactions to the COVID-19 vaccines are very uncommon and tend to occur in people who had previous allergic reactions to other medications or vaccines. Overall, severe side effects are rare, and the likelihood of experiencing an adverse reaction to the vaccine is far less common than the rate of getting COVID-19.

How can people help family members or friends who post anti-vaccination information online?

Spivak: I encourage people to not be judgmental and provide family and friends with the facts. The CDC’s website on COVID-19 vaccines is the best resource for health care providers and the general public to share with others.

Supiano: In addition to the CDC website, the American Geriatrics Society has a tip sheet tailored specifically to older adults. It’s important to provide education. There’s a lot of myths about COVID-19 and vaccines and we need to do our best to share the facts, science, and data that have been published.

Can people with underlying health conditions such as multiple sclerosis (MS) receive the vaccine right now?

Spivak: Yes, they can receive the vaccine. The CDC has a list of certain medical conditions and what specific recommendations are for vaccination. Many underlying conditions are risk factors for severe COVID-19 and worse outcomes. Therefore, people with underlying health conditions are encouraged to get the vaccine when it becomes available to them.

How much immunity will an older adult have after the first dose of the vaccine?

Supiano: The 95% protection against the virus happens after the second dose. The antibody levels that are achieved with that 95% effectiveness will take place within 7-10 days after the second dose. While the patient will be protected, it’s still not known whether they can spread COVID-19 to those who aren’t vaccinated.

Spivak: According to current data, the vaccine is about 50-55% effective in preventing symptomatic COVID-19 after the first dose. The role of the second dose is boosting a patient’s immunity to the virus. I would caution people and encourage them to presume they have no protection between the first and second dose. It takes 10-14 days after the second dose for the vaccine to be 95% effective at preventing symptomatic infection. Since we don’t know if COVID-19 vaccines prevent asymptomatic infection, people should still be careful after the second dose. This includes wearing a face mask and physically distancing until we can get the whole population vaccinated.

Some states have reported the vaccine rollout for long-term care facilities have been having trouble getting a shot. Is that a problem in Utah?

Supiano: The reason this is being reported is because skilled nursing facilities have an organized nursing staff, medical director, and a standard practice of delivering the vaccine to skilled nursing home residents. These facilities are getting the vaccines from pharmacies that are delivering them on a scheduled basis. Those in assisted living facilities or living in independent apartments don’t have the benefits of standardized scheduling or an organization helping them facilitate getting the vaccine. These groups of people may be responsible for making their own appointments to get the vaccine.

Will the current COVID-19 vaccinations work against variants?

Spivak: This is still being studied, but preliminary data suggests the current vaccines do protect against the B-117 or UK variant specifically. For now, we think the vaccine protects against variant strains, but there is concern that if we don’t get vaccines out fast enough, there may be other variant strains that develop.

Some people might be worried about getting the vaccine due to the unknown long-term side effects. What would you say to people who are hesitant?

Supiano: We’d like to have more long-term data, but the data we do have about COVID-19 is so chilling that the benefit of getting the vaccine outweighs the risk of getting COVID-19. If you are an older adult and are unfortunate enough to get COVID-19, your risk of death is extraordinarily high. What’s even more compelling is that people who have recovered from the virus are experiencing devastating long-term side effects.

Can a person stop wearing a face mask after they’ve been vaccinated?

Spivak: We do not know yet if a person is 100% immune to COVID-19 after getting two doses of the vaccine. What we know is that two doses reduces your chance of getting symptomatic COVID-19 by 95%. Patients who participated in the vaccine trials were not all systematically tested for COVID-19, regardless of symptoms, to determine if the vaccine decreases the chances of asymptomatic infection. For now, until we can get the vaccine more widely distributed to the public, it should not change your behavior. Masking, physically distancing, frequently washing your hands, and staying home when sick are still important rules to follow.

Can educators and older adults get the vaccine through U of U Health?

Spivak: Aside from employees, U of U Health is not currently providing the vaccine to the public. The Utah Department of Health is vaccinating groups in the public through local county health departments. You should contact your local county health department for vaccination distribution information.