COVID is still a deadly threat to older Floridians

As the delta variant spread across the state earlier this month, Gov. Ron DeSantis told reporters that Florida was well-positioned to handle the next wave of COVID-19 infections.

The state had already vaccinated its oldest — and thus most vulnerable — residents, he said.

“I’d rather have 5,000 cases amongst 20-year-olds than 500 cases among seniors,” DeSantis said during an Aug. 3 news conference in the Everglades.

But public health experts say COVID-19 is still a threat to older Floridians.

Since the latest wave of cases started rising on June 18, Floridians ages 60 and up have accounted for 16 percent of infections. But they represent about half of all hospitalizations and 74 percent of deaths.

Nearly 3,500 older adults have died of COVID-19 in Florida since the start of the fourth wave. That’s about three times the number of deaths suffered by every other age group combined.

Florida has seen record infections and hospitalizations in recent weeks, due to the more transmissible variant and lagging vaccination rates in younger populations.

University of Florida epidemiologist Cindy Prins said there’s no way to protect one segment of the population from this level of mass infection. Hundreds of thousands of older adults haven’t received the vaccine in a state where 38 percent of the total population is unvaccinated.

“The 5,000 cases among the younger are going to turn into 500 cases among the older,” she said. “The populations are not mutually exclusive. They are family members, and they’re neighbors, they’re co-workers, they’re caretakers.”

In an email to the Tampa Bay Times, governor’s spokesperson Christina Pushaw said high vaccination rates among older Floridians show the success of DeSantis’ “Seniors First” campaign. The state reported Friday that 86 percent of residents 65 and older have had at least one vaccination shot.

“This is a very high vaccination rate and should offer a high level of protection to most at-risk Floridians,” she said.

Dr. Santosh Kamata, a geriatrician who practices in Manatee County, said the toll older adults will suffer is inevitable.

“I think that in the next few weeks, we could see a much higher mortality in the 65-plus age groups.”

Older adults remain at risk

Florida’s 60-plus population has the highest vaccination rate in the state. But as of Friday, more than 200,000 older adults were only partially vaccinated and more than 900,000 Floridians over 60 have yet to receive their first shot.

Vaccination rates among the elderly have plateaued, increasing just 3 percent in the past two months. ”This suggests to me that we’re seeing a largely resistant population or they face persistent barriers like isolation or internet illiteracy,” said University of South Florida epidemiologist Jason Salemi. “It may take a lot of effort to make that percentage budge.”

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Once an unvaccinated older adult is exposed to the virus, the likelihood that it develops into a serious infection is much higher compared to younger patients.

The Centers for Disease Control and Prevention estimate that people ages 65 to 74 are six times as likely to be hospitalized from a COVID-19 infection compared to the 18-to-29 age group. They are 95 times as likely to die.

The statistics look bleaker among older adults. Those 85 and over were 15 times as likely to end up in the hospital and 600 times as likely to die.

“Older people are just not capable of mounting the immune response that is necessary to fight the virus,” said Johns Hopkins University epidemiologist Morgan Katz. “And older people just develop over time comorbidities that put you at risk for a more severe reaction.”

Pushaw said the governor has opened 21 monoclonal antibody treatment sites across Florida to treat COVID-19. That will help high-risk patients, including older Floridians with underlying health issues.

“The widespread availability of monoclonal antibody treatments, including state supported Regeneron sites, will help save the lives of people 65+ (or in another risk group, whether vaccinated or not),” she said in an email.

Kamata has been treating several older patients for COVID-19 who then ended up hospitalized. One story struck him: A husband and wife in their 60s both contracted the virus at the same time – but she was vaccinated, and he was not.

“The outcome is just so starkly different,” he said. “Looking at his X-rays and lab work is like looking at patients that I saw in early February 2020, when COVID first came in and we didn’t have any vaccines.”

The husband remains hospitalized and was placed on a ventilator.

Proof vaccines work, and COVID is deadly

The numbers for older Floridians remain grim nearly 18 months after the pandemic started and eight months since vaccines became available. In January, adults over 60 accounted for nearly 70 percent of Florida’s hospital admissions, according to federal data. Now, they make up half of all Floridians admitted to hospitals for COVID-19.

While fewer older adults are dying during this wave, they still account for the majority of Florida deaths. Floridians over 60 made up 89 percent of deaths prior to June 18. Now they account for 74 percent of deaths. They also account for the majority of Florida’s record hospitalizations: More than 7,400 adults over 60 were admitted to Florida hospitals last week. That’s nearly 50 percent of COVID hospitalizations that week.

Older Floridians still have the highest death rate. The state has lost nearly 3,500 older adults to the current wave, five times the rate of younger Floridians, adjusted for population size. Breakthrough cases remain rare among those who were vaccinated, but do happen. Florida does not report breakthrough infections or whether those who were hospitalized or died from COVID were vaccinated or unvaccinated.

But a recent Kaiser Family Foundation study found that, in 25 states, less than 1 percent of vaccinated individuals tested positive for COVID-19 and basically zero percent were hospitalized or died due to COVID-19.

Health experts worry that older adults and the immunocompromised are most at risk for breakthrough infections. But Dr. Jacquelyn Cawley, vice president for population health and chief medical officer for ambulatory and clinical integration at BayCare Health System, says they are rare even among elderly cases.

“It’s the minority of cases,” she said. “The majority of cases really are the younger patients and those that are unvaccinated.”

Federal health officials announced plans last week to roll out booster shots for Americans who received either the Pfizer or Moderna vaccines. Pending federal approval, the shots would be available Sept. 20 to Americans eight months after receiving the second dose of either two-part vaccine.

The announcement came on the heels of three studies released last week by the CDC, which showed a declining effectiveness of the two mRNA vaccines.

The announcement indicated that booster shots may also be needed for Americans who received the Johnson & Johnson vaccine.

Rising cases puts everyone at risk

All of Florida is considered an area of high community transmission by the CDC. The state’s positivity level is 19.8 percent.

“We have a perfect storm here,” said Katz, “where there’s a significant number of people who are unvaccinated who are also not wearing masks in public, and then the delta variant is much more contagious than the previous variant.”

That level of uncontrolled spread threatens to overwhelm Florida’s hospital systems, she said, putting vulnerable COVID-19 patients, many of them 60-plus, at even greater risk.

Pushaw, the governor’s spokesperson, said that Florida hospitals can still admit patients.

“Hospitals all over the state have space for patients in need of care, though staffing in health care continues to be a challenge throughout the country,” she said. “Gov. DeSantis and state agencies coordinate closely with hospital leaders to help meet any needs that arise.”

Prins, the University of Florida epidemiologist, said the best way to protect older adults is to use the same methods that proved effective earlier during the pandemic, including wearing masks and social distancing. But the best advice remains the same:

“The number one thing, and we’ve been saying this for months, is for everyone in your family to get vaccinated.”

Times staff writer Hannah Critchfield contributed to this report.

Editor’s note: This story was updated with responses from Gov. Ron DeSantis’ office.

Responses from Gov. Ron DeSantis’ office:

The governor’s office sent these responses to the Times’ questions:

How concerned is the governor about community spread affecting older Floridians?

In Florida, thanks to Governor DeSantis’ Seniors First campaign to prioritize vaccinating the high risk elderly, more than 90% of Floridians 65 and older have at least one shot and at least 86% are fully vaccinated. This is a very high vaccination rate and should offer a high level of protection to most at-risk Floridians. The widespread availability of monoclonal antibody treatments, including state supported Regeneron sites, will help save the lives of people 65+ (or in another risk group, whether vaccinated or not) by allowing them to boost their immunity and avoid infection through post exposure prophylaxis — or prevent symptoms from worsening if they test positive. Locking down young adults — or anyone else — isn’t the role of the government. Informing the public and expanding access to vaccines and effective treatment is. That’s exactly what Governor DeSantis has done.

How concerned is the governor about long-covid and other long-run consequences of COVID-19 affecting young adults?

Hospitalizations among young adults are comparatively rare. Most people with severe COVID outcomes are either seniors or in another high risk group. Of course, some young adults are in those risk groups and should take extra precautions, and everyone who can get the vaccine should protect themselves and their communities that way.

“Long Covid” is poorly understood and documented; scientific studies on it are lacking, we mostly hear about it in media through anecdotal reports. It appears to be very rare. The Governor makes decisions based on data and empirical evidence, and there is no evidence that shows lockdowns or mask mandates would prevent “Long COVID.” However, there have been anecdotal reports that getting the vaccine has resolved “Long Covid” symptoms in some people.

How concerned is the governor about hospital utilization rates and the impact on both COVID-19 patients and every-day Floridians?

Hospitals all over the state have space for patients in need of care, though staffing in healthcare continues to be a challenge throughout the country. Governor DeSantis and state agencies coordinate closely with hospital leaders to help meet any needs that arise. For example, the Governor’s idea to promote Regeneron monoclonal antibody treatment came from a conversation with hospital CEOs, in which they told him that most of their COVID inpatients had NOT received Regeneron — and many didn’t even know about it. In other words, some of those hospitalizations could have been prevented with more awareness of treatments, and Governor DeSantis is completely focused on raising that awareness now. He’s traveling all over the state everyday to launch 21 new regeneron treatment sites that can each serve hundreds of patients a day, with most open 7 days a week. These sites have already treated thousands of patients and prevented many hospitalizations thus alleviating some of the pressure from the hospital system — and saving lives.

To clarify my other point you mentioned about lockdowns and NPIs — I see the point those experts are making in their pushback, but to be clear, there is no evidence that lockdowns and mask mandates save lives from COVID-19. If that were the case, then why would lockdown states like Hawaii have record surges right now? Why would California have had such a deadly surge in December after months of lockdown and mask mandate? Why would Michigan have a record surge shortly after that, despite Governor (Gretchen) Whitmer’s heavy handed interventions? The modeling and theoretical projections are one thing, but what we have seen in real life doesn’t support the assertion that lockdowns work — unless you trust China’s data (which I would not) and you are willing to completely disregard individual rights.

Few lockdown advocates even consider the possible harms of their favored policy: in terms of individual rights and civil liberties, societal cohesion, economic concerns, etc. Public health does not exist in a vacuum and cannot be separated from mental health, emotional well being, or personal health (for example, opioid overdoses spiked over the past year, child psychiatric hospitalizations increased in some areas, and a survey earlier this year showed that most Americans gained a significant amount of weight in lockdown, and obesity is already a serious public health issue because of the correlation with cardiovascular disease and other health risks). Reshaping society around a virus, using unchecked government power in ways that aren’t even shown to make a difference to COVID prevalence, is dangerous to say the least. Governor DeSantis believes in keeping Floridians informed, ensuring access to proven interventions like vaccines and Regeneron, and trusting adults to make their own decisions.

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