WASHINGTON -- Covid-19 hospitalizations among older Americans have plunged more than 70% since the start of the year, and deaths among them appear to have tumbled as well -- dramatic evidence the vaccination campaign is working.
Now the trick is to get more of the nation's younger people to roll up their sleeves.
The drop-off in severe cases among Americans 65 and older is especially encouraging because senior citizens have accounted for about 8 out of 10 deaths from the virus since it hit the U.S., where the toll stands at about 570,000. Globally, more than 3 million people have died.
Covid-19 deaths among people of all ages in the U.S. have plummeted to about 700 per day on average, compared with a peak of more than 3,400 in mid-January.
"What you're seeing there is exactly what we hoped and wanted to see: As really high rates of vaccinations happen, hospitalizations and death rates come down," said Jodie Guest, a public health researcher at Emory University.
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The best available data suggests covid-19 deaths among Americans 65 and older have declined more than 50% since their peak in January. The figures suggest that the fall in deaths among senior citizens is driving the overall decline in lives lost to covid-19, vindicating the U.S. strategy of putting elderly people at or near the front of the line for shots when the vaccine became available over the winter.
The U.S. trends mirror what is happening in other countries with high vaccination rates, such as Israel and Britain, and stand in stark contrast to the worsening disaster in nations such as India and Brazil, which lag far behind in dispensing shots.
According to U.S. government statistics, hospitalizations are down more than 50%, but most dramatically among senior citizens, who have been eligible for shots the longest and have enthusiastically gotten them.
Two-thirds of American senior citizens are fully vaccinated, versus just one-third of all U.S. adults. More than 80% of senior citizens have gotten at least one shot, compared with just over 50% of all adults.
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At the same time, however, overall demand for vaccinations in the U.S. seems to be slipping, even as shots have been thrown open to all adults across the country. The average number of doses administered per day appeared to fall in mid-April from 3.2 million to 2.9 million, according to figures from the Centers for Disease Control and Prevention.
"My concern is whether the vaccine uptake will be as strong in these younger age groups," Guest said. "If it's not, we will not see the positive impact for vaccines in these younger age groups that we've seen in our older population."
Also, new virus cases in the U.S. have been stuck at worrisome levels since March, averaging more than 60,000 per day, matching numbers seen during last summer's surge. The new cases are increasingly among people in their 30s, 40s and 50s, who also make up a larger portion of hospitalizations.
With enough people vaccinated, covid-19 cases should eventually begin to fall as the virus finds fewer and fewer people to infect. Guest and other experts say Israel appeared to reach that threshold last month after it fully vaccinated roughly 40% of its population of 9 million people.
But the U.S. faces challenges in conducting mass vaccinations because of its far greater size, diversity, geography and health disparities.
On Tuesday, President Joe Biden announced new federal funding for small businesses so that employees can take time off with pay to get vaccinated or recover from the shot's side effects.
The challenge will be quickly vaccinating younger Americans, who feel they are less vulnerable but are mainly the ones spreading the disease.
"To really feel that we're out of the woods, we've got to see a lot less cases than we're seeing now," said Dr. Jesse Goodman, a vaccine specialist at Georgetown University. "It's going to take a wider, continuing effort."
In Chicago's Cook County, where 91% of adults 65 and older have had at least one shot, the patients in the hospital these days are younger and do better.
"That feeling of dread is definitely eased with older patients getting vaccinated," said Dr. Tipu Puri, a kidney specialist and associate chief medical officer for clinical operations at the University of Chicago Medical Center.
At some moments, there's even joy, he said. He recently stopped to help an elderly couple find the hospital's vaccination clinic. The woman was pushing her husband's wheelchair.
"Those are people you hope you won't see in the hospital," Puri said. "We're not going to see them in the emergency room or in the ICU."
He added: "This is what coming out of the pandemic feels like."
1-SHOT VACCINE
Meanwhile, federal health authorities are leaning toward recommending that use of the Johnson & Johnson vaccine resume, possibly as soon as this weekend -- a move that would include a new warning about a rare complication involving blood clots but probably not call for age restrictions.
The position would be similar to one taken by Europe's drug regulator, the European Medicines Agency, which said this week that the Johnson & Johnson vaccine should carry a warning but placed no restrictions on its use. It said the shot's benefits continue to outweigh the risks.
The current stance of U.S. authorities was described by two government officials who spoke on condition of anonymity to discuss internal deliberations. They said the position could be affected if there were a sudden flood of blood-clot cases or if other surprises emerged.
The fate of the Johnson & Johnson vaccine is scheduled to be discussed publicly in a pivotal meeting today of an influential advisory group to the CDC -- the Advisory Committee on Immunization Practices, an independent expert panel.
In interviews this week, the heads of the CDC and the Food and Drug Administration declined to say whether federal authorities are leaning toward recommending lifting the pause. But both Acting FDA Commissioner Janet Woodcock and CDC Director Rochelle Walensky offered encouraging news about the incidence of blood clots.
Walensky has said the government has received only a "handful" of additional cases. She added there are "more that are being adjudicated" and that a final number would be presented today. But, she noted, "we are not being inundated with things that we are concerned about. We didn't have hundreds and thousands of people coming in and saying, 'Oh wow, I had one of those.'"
Woodcock agreed that officials have not seen a "huge avalanche" of clot cases. "That's a great relief," she said.
The rarity of cases has persuaded many federal officials that the complication can be addressed by adding a warning that describes the groups at higher risk for the adverse event, and by working to ensure that doctors know how to spot and treat the problem. Most notably, physicians are advised to avoid using heparin, a common treatment for blood clots, because it can make the vaccine-related condition worse.
If the CDC advisory committee votes today that the vaccine pause should be lifted, the CDC and FDA could recommend the resumption of the shots within hours or days. That outcome would be good news for many state officials eager to begin using the one-dose vaccine again. But if the advisory panel has a different view -- and recommends, for example, that the vaccine not be used for certain age groups or not be used at all for now -- it is not clear what happens next.
'HAVES' AND 'HAVE-NOTS'
Globally, nations are quickly being split into vaccine "haves" and "have-nots," creating a gap that may define the next phase of the pandemic.
Using publicly available figures from Our World in Data, The Washington Post found that 48% of all vaccine doses administered so far have gone to just 16% of the world's population in what the World Bank considers high-income countries.
Through the summer and fall of last year, wealthy nations cut deals with vaccine-makers, buying up a disproportionate share of early doses -- and undermining a World Health Organization-backed effort, called Covax, to distribute shots equitably.
So now, in a small number of relatively wealthy nations including the United States, doses are relatively plentiful and mass immunization campaigns are progressing apace. But much of the world is still struggling to secure enough supply. For many, herd immunity is many months if not years away, which could extend the crisis.
A team at Duke University's Global Health Innovation Center found that high-income countries locked up 53% of near-term vaccine supply. They estimate that the world's poorest 92 countries will not be able to reach a vaccination rate of 60% of their populations until 2023 or later.
The Biden administration faces growing calls from public health advocates and activists to share, either by donating doses to countries in need, transferring technology to boost manufacturing capacity, or easing export restrictions.
Among countries that the World Bank classifies as either lower- or upper-middle-income, vaccination campaigns are for the most part going slowly.
Though Serbia -- an upper-middle-income country that cut deals for both Chinese and Russian vaccines -- has fully vaccinated about 27% of its population, few others come close.
Brazil, a populous, upper-middle-income country, is losing thousands of people a day. Less than 12% of its people have had a dose, and the nation's variant-fueled outbreak is turning into a regional super-spreader.
Another worrying case is India, a leading maker of coronavirus vaccines that is struggling with its domestic rollout during a surge in cases. Less than 8% of the population has had at least a dose and just 1% is fully vaccinated, according to Our World in Data estimates.
With supply tight, China and Russia have engaged in vaccine diplomacy, donating or selling doses to countries in need in an apparent bid for influence. Pakistan, for instance, has received doses from Chinese vaccine-makers and is expecting a small shipment of Russia's Sputnik V vaccine. So far, less than 1% of its population has been vaccinated.
For many countries, vaccination campaigns are just getting started.
Ghana received its first doses in February, but like most lower-middle-income economies, has significantly less than it needs. Just about 3% of people have received a dose, according to an Our World in Data estimate.
In Nigeria, where officials are battling both a shortage of supplies and vaccine hesitancy, less than 1% of people had a dose.
Information for this article was contributed by Matthew Perrone, Carla K. Johnson and Tom Murphy of The Associated Press; and by Laurie McGinley, Lena H. Sun, Atthar Mirza and Emily Rauhala of The Washington Post.
