Dialogue
Throughout January–mid-July 2023, COVID-19–related hospitalization charges amongst individuals aged ≥65 years declined however then elevated by means of the week ending August 26, 2023. All through the identical interval, adults aged ≥65 years continued to have the very best hospitalization charges of any age group, accounting for about one half of all COVID-19–related hospitalizations and ICU admissions in addition to almost 90% of in-hospital deaths. Most adults aged ≥65 years who have been hospitalized with a optimistic SARS-CoV-2 take a look at consequence have been doubtless admitted due to COVID-19 sickness and, amongst these, a considerable proportion had extreme outcomes, together with ICU admission, receipt of invasive mechanical air flow, and in-hospital dying. Roughly one in six adults aged ≥65 years hospitalized for COVID-19 have been LTCF residents. These findings recommend that COVID-19–related hospitalization continues to predominantly have an effect on adults aged ≥65 years and signify a continued public well being risk.
Practically all hospitalized adults aged ≥65 years had two or extra underlying medical situations. A earlier COVID-NET evaluation discovered that adults with two or extra underlying medical situations had a better than fourfold elevated threat for hospitalization after adjusting for age, intercourse, and race and ethnicity (3). Though asymptomatic or mildly ailing sufferers with optimistic SARS-CoV-2 take a look at outcomes is perhaps hospitalized for non-COVID causes, primarily based on data within the admission historical past and bodily examination or face sheet of the medical report, roughly three quarters of hospitalized adults aged ≥65 years on this evaluation have been doubtless admitted primarily for COVID-19–associated sickness, which prompted substantial morbidity and mortality on this age group.
In September 2022, the Advisory Committee on Immunization Practices (ACIP) beneficial a bivalent COVID-19 vaccine dose (4) and in April 2023, beneficial ≥1 extra bivalent dose for adults aged ≥65 years (5). Nonetheless, this evaluation discovered that roughly three quarters (76.5%) of adults aged ≥65 years hospitalized for COVID-19 throughout January–June 2023 had not obtained a bivalent dose, and 16% had not obtained any COVID-19 vaccine. Though bivalent vaccine effectiveness in opposition to COVID-19–related hospitalization has been proven to say no over time, effectiveness in stopping hospitalization and extreme outcomes, comparable to ICU admission, has been documented (6). ACIP not too long ago beneficial that each one individuals aged ≥6 months, together with these aged ≥65 years, obtain an up to date (2023–2024 Components) mRNA COVID-19 vaccine for the 2023–2024 respiratory season (7). Along with vaccination and adoption of measures to cut back threat for contracting SARS-CoV-2, different methods proven to cut back COVID-19–related hospitalization threat embody early outpatient remedy with ritonavir-boosted nirmatrelvir (Paxlovid), remdesivir (Veklury), or molnupiravir (Lagevrio) for individuals with SARS-CoV-2 an infection who’re at excessive threat for development to extreme illness, together with all adults aged ≥65 years (8,9). Prevention, vaccination, and early antiviral remedy are essential instruments in stopping hospitalization and extreme related outcomes on this high-risk age group.
Limitations
The findings on this report are topic to not less than three limitations. First, COVID-19–related hospitalizations might need been missed due to hospital testing practices or take a look at availability, and subsequently, hospitalization charges is perhaps underestimated. Second, a affected person’s doubtless presenting grievance on the time of admission is topic to misclassification and might need resulted in circumstances being unintentionally included or excluded from this evaluation. Hospitalization information that don’t specify COVID-19 or respiratory sickness as a probable presenting grievance can nonetheless lead to COVID-19–associated sickness and would possibly have an effect on medical decision-making and the course of hospitalization. Lastly, the COVID-NET catchment areas embody roughly 10% of the U.S. inhabitants; thus, these findings won’t be nationally generalizable.
Implications for Public Well being Apply
COVID-19–related hospitalization charges declined amongst individuals of all ages throughout January–July 2023 however elevated beginning in mid-July 2023. Charges amongst adults aged ≥65 years remained larger than these amongst youthful age teams, and this older age group accounted for about 60% of all COVID-19–related hospitalizations and almost 90% of deaths throughout hospitalization. Many hospitalized adults aged ≥65 years had a number of underlying medical situations, and most had not obtained the COVID-19 bivalent vaccine, which had been beneficial earlier than the interval of this evaluation.
COVID-19–related hospitalizations proceed to predominantly have an effect on adults aged ≥65 years and signify a continued public well being risk. All adults, particularly these aged ≥65 years and others at excessive threat for development to extreme COVID-19 sickness,††† ought to cut back their riskfor COVID-19–associated hospitalizations and extreme outcomes by receiving beneficial COVID-19 vaccines, adopting measures to cut back threat for contracting SARS-CoV-2,§§§ and in search of early outpatient antiviral remedy after receipt of a optimistic SARS-CoV-2 take a look at consequence.