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| 2022/12/08 22:14:04瀏覽1491｜回應3｜推薦36 | |
這是紐約時報昨天一篇評論的標題，另一個標題是「新冠肺炎已是老人流行病」，作者是紐時獲獎科學評論員華里斯-威爾斯。因為內容有很多我先前未知的資訊，蜂鳥就在這裡簡單幫大家譯重點。最關鍵的提醒是：
聖誕節新年假期將近，家人團圓很歡樂，但，務必愛護老人家們的健康，即使他們已打足疫苗。(原文貼在文末，還是希望大家花錢訂閱，救救第四權，也是救民主）
——
Covid-19 病毒肆虐地球已滿三年，美國人打上第一劑疫苗，也已滿兩年。目前每天全美還是有幾百人亡命此病毒，他們是哪些人？
老人！不管打或沒打疫苗的老人。
老人家本來就是新冠肺炎的高危社群，疫情爆發還沒疫苗的第一年，美國染疫死亡者的75%是年紀超過65歲的銀髮族；隨著疫苗施打的普及，去年九月，65歲以上老人佔比降至60%。而今天，儘管94%的65歲以上人口打了疫苗，他們在染疫死亡人口的佔比高達九成。
今年一月份Omicron變種病毒在年假結束後一發不可收拾，奪走8萬5000人命，拜登總統當時以「不打疫苗者的傳染病」稱之，當時，染疫死亡者未打任何疫苗的比例高達59%。
今年五月，全美疫苗未施打人口比例降至38%，但打了疫苗和加強劑卻仍死亡的，在當時Covid 致死人口中的佔比，也從一月份的12%提高到四月份的36%。這樣的佔比持續到夏天，但時序入冬，打足疫苗卻染疫死亡的老人，佔比不斷攀升，今年四月佔79%， 到了上個月，染疫死亡者的90%都是老人。
為什麼有這現象？
首先，或許不是打疫苗沒什麼效，而是，老人相較12歲以上人口，免疫系統弱也多病，這促使美國老人比任一年齡人口更踴躍打疫苗，而且，越老越孱弱的打得越積極。
再者，全美打過加強劑的比例偏低，只有34%，而打其他疫苗的比例是69%。
最後，疫苗對老人家的防護效果，比年輕人口差，因為人的免疫力隨年歲增加而降低。而且，啟動老人家的免疫機制和疫苗保護的續航力，都遠不及年輕人。
~end~
Though it’s sometimes uncomfortable to say it, mortality risk has been dramatically skewed by age throughout the pandemic. The earliest reports of Covid deaths from China sketched a pattern quickly confirmed everywhere in the world: In an immunologically naïve population, the oldest were several thousand times more at risk of dying from infection than the youngest.
But the skew is actually more dramatic now — even amid mass vaccinations and reinfections — than it was at any previous point over the last three years. Since the beginning of the pandemic, people 65 and older accounted for 75 percent of all American Covid deaths. That dropped below 60 percent as recently as September 2021. But today Americans 65 and over account for 90 percent of new Covid deaths, an especially large share given that 94 percent of American seniors are vaccinated.
Yet these facts seem to contradict stories we’ve told about what drives vulnerability to Covid-19. In January, Joe Biden warned that the illness and death threatened by the Omicron variant represented “a pandemic of the unvaccinated.” But that month, in which nearly 85,000 Americans died, the unvaccinated accounted for 59 percent of those deaths, down from 77 percent the previous September, according to analysis by the Kaiser Family Foundation. The share of deaths among older adults that January was nearly 74 percent.
Over the months that followed, the unvaccinated share of mortality fell even further, to 38 percent in May 2022. The share of deaths among people vaccinated and boosted grew significantly as well, from 12 percent in January 2022 to 36 percent in April. Those levels held roughly steady throughout the duration of the summer, during which time just about as many boosted Americans were dying as the unvaccinated. The share of deaths among older adults kept growing: In April, 79 percent of American deaths were among those 65 and older. In November, 90 percent.
As many Twitter discussions about the “base rate fallacy” have emphasized, this is not because the vaccines are ineffective — we know, also from the Centers for Disease Control and Prevention data, that they work very well. Estimates of the effectiveness of updated bivalent boosters suggest they reduce the risk of mortality from Covid in Americans over the age of 12 by more than 93 percent compared with the population of unvaccinated. That is a very large factor.
But it isn’t the whole story, or vaccinated older adults wouldn’t now make up a larger share of Covid deaths than the unvaccinated do. That phenomenon arises from several other factors that are often underplayed. First is the simple fact that more Americans are vaccinated than not, and those older Americans most vulnerable to severe disease are far more likely to be vaccinated than others.
It is also partly a reflection of how many fewer Americans, including older ones, have gotten boosters than got the initial vaccines: 34 percent, compared to 69 percent. The number of those who have gotten updated bivalent boosters is lower still — just 12.7 percent of Americans over the age of 5.
Finally, vaccines are not as effective among older adults because the immune system weakens with age. It’s much harder to train older immune systems, and that training diminishes more quickly. In Americans between the ages of 65 and 79, for instance, vaccination reduced mortality risk from Covid more than 87 percent, compared to the unvaccinated. This is a very significant reduction, to be sure, but less than the 15-fold decline observed among those both vaccinated and bivalent-boosted in the overall population. For those 80 and above, the reduction from vaccination alone is less than fourfold.
That is a very good deal, of course. But it also means that, given the underlying age skew, a twice-boosted 87-year-old shares a similar risk of Covid death as a never-vaccinated 70-year-old. Which is to say, some real risk. If it was ever comfortable to say that the unconscionable levels of American deaths were a “pandemic of the unvaccinated,” it is surely now accurate to describe the ongoing toll as a “pandemic of the old.”
So why aren’t we?
One answer is that as a country, we prefer just to not see those deaths at all, regarding a baseline of several hundred deaths a day as a sort of background noise or morbid but faded wallpaper. We don’t need to understand who is dying or why in part because we don’t want to reckon with the fact that around 300 Americans are now dying from Covid-19 every day, at a rough pace of about 100,000 per year, making it the country’s third leading cause of death. This is normalization at work, but it is also a familiar pattern: We don’t exactly track the ups and downs of cancer or heart disease either.
Another answer is that — partly to promote good behavior, partly to more easily blame others for our general predicament — the country spent a lot of time emphasizing what you could do to protect yourself, which left us without much of a vocabulary to describe what underlying vulnerability inevitably remained. Vaccine refusal was a cancer on the American experience of the Covid years — that is undeniable. But we got so comfortable equating personal choices and individual risk that even identifying vulnerabilities came to feel like an accusation of irresponsibility. And where does that leave older adults? In a pandemic of the unvaccinated, what do you say to or about the 41 percent of Americans who died in January who’d gotten their shots? Or the roughly 60 percent of them that died this summer?
Many of us were also turned off by dismissive rhetoric from the beginning of the pandemic, when those minimizing the threat pointed to the disproportionate risks to the very old as a reason to not worry all that much about limiting spread. The country as a whole may be ageist, without all that much empathy for the well-being of octogenarians and nonagenarians. But hearing the conservative commentator Ben Shapiro or the Texas lieutenant governor Dan Patrick so blithely dismissing the deaths of older adults in 2020 probably made the whole subject seem considerably more taboo to the rest of us than it might’ve been otherwise.
Throughout the last few years, the country has also struggled to consider individual risk and social risk separately. In the first year of the pandemic, we seemed to build our sense of individual risk backward from the social need to limit spread — underemphasizing some of the differential threat and focusing instead on universal measures like social distancing and mask wearing. With the arrival of vaccines, we began to build a collective picture of social risk in the opposite way, up from an individual basis instead.
The picture that resulted was hugely relieving to most of us without being, at the highest levels, misleading: Vaccination and natural immunity had indeed dramatically reduced the country’s overall mortality risk. But while it’s comforting to believe that protection is a choice, for some populations it isn’t. And in moving pretty swiftly from treating everyone as high-risk to treating everyone as low-risk, we neglected to pay much attention to the differential of risk: that even if the average American had reduced his or her chances of dying by a factor of five or 10, 300 or more Americans might still be dying each day for many months, and there were probably some targeted things to do about that.
What are they? There is no simple or silver-bullet solution, which may be another reason we’ve spent more energy on the need for vaccination than on the vulnerabilities of age (that is, the fix is far more straightforward). But clearer communication — from public health officials to politicians and the media — about differential risk could nevertheless help, emphasizing not just that more shots are good but that different groups probably need different approaches, and that even with up-to-date vaccination and bivalent boosting, infection represents a considerable threat to older adults.
More targeted guidance might also underline the way that boosters still deliver what would have seemed like mind-blowing reductions in risk two years ago, even if they don’t eliminate it entirely, and point to certain settings where rapid testing should continue or be reinstituted (nursing homes, say). And there is surely much more to be done to aggressively promote treatments like Paxlovid, which are being criminally underutilized given their efficacy in vulnerable populations. (Their efficacy for younger and healthier people remains a kind of open question.) And while infrastructure investments and other mitigation strategies do not come as cheaply as communication, there is a bundle of things we know could help reduce transmission almost invisibly, without really burdening individuals: higher indoor air quality standards, for instance. You might even choose to target those investments and improvements less in schools than in care facilities, too.
Would all that be sufficient? Probably not to eliminate some ongoing death toll, unfortunately, given how promiscuously the disease is spreading. But it would presumably reduce by some fraction those hundreds of deaths we’re seeing each day. At the moment, the country is treating those deaths as the cost of normalcy.
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