While there has been considerable debate about the use and value of COVID-19 interventions in young people, there is no doubt that they are really necessary in older individuals. Essentially 90% of deaths from COVID right now occur in those over 65 years old, and the bulk of the hospitalizations come from people in this age group with comorbidities. Despite this information, uptake of the new vaccines has lagged in this population.
So it is important to question whether interventions, such as the binary booster vaccines and Paxlovid are useful in this target population.
Three new studies would seem to provide definitive information that the value of these interventions in individuals over age 50 is substantial.
Importantly, prior vaccine immunity has provided substantial protection in this age group. Initially, it was not clear whether the new vaccines would help. Two recent studies looking at the effect of boosting with the binary vaccines in the elderly (over 65 years of age) do show substantial reductions in death and hospitalization as well.
These studies were well-controlled and showed that compared to individuals not getting this booster, there was a reduction in infection by 85% and 57% in each study. Both showed better protection against Omicron variant viruses as well.
Question have also been raised about Paxlovid use in vaccinated elderly individuals. While the initial studies with Paxlovid were done in individuals who had not been previously vaccinated, it wasn’t clear that individuals with background vaccines to COVID would still benefit from this drug. The current data seems to indicate there is benefit.
A study in the Annals of Internal Medicine (Ann Intern Med. doi:10.7326/M22-2141) showed that because of prior vaccination, overall deaths from COVID-19 have dropped remarkably in the over 50 population, even in those with other risk factors. COVID deaths are now occurring in only 1% of infections in this age group. In addition, Paxlovid further reduced deaths by half if it was used early on in the infections.
All of these studies show that there is substantial benefit from binary boosters and Paxlovid use in individuals over age 50 and especially if over age 65. If you are more than 6 months out from your last COVID-19 vaccine, get your binary booster and use Paxlovid if infected. And please share this good news with those of us celebrating our 65th Christmas and beyond!