Reason Roundup

Age May Trump Vaccination Status in Assessing COVID-19 Risk

Plus: Magical thinking about the spending bill, new rulings on mask mandates, and more...

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zumaglobaleleven093657 | Peerapon Boonyakiat/ZUMAPRESS/Newscom
(Peerapon Boonyakiat/ZUMAPRESS/Newscom)

Risk calculations must move beyond vaccinated/unvaccinated, age data suggests. Media coverage of the COVID-19 pandemic these days tends to focus a lot on outcome variance between vaccinated and unvaccinated people, gatherings, and locales. Meanwhile, we may be overlooking the continued salience of age in predicting risk and disease severity.

But "in assessing an individual's risk of dying from covid, age appears still as important—and maybe even more important—than vaccination status," David Wallace-Wells at New York magazine reminds us:

After 18 months of public-health guidance promoting universal vigilance, I think hardly any American has a clear view of just how dramatic these differentials are. All else being equal, an unvaccinated 66-year old is about 30 times more likely to die, given a confirmed case, than an unvaccinated 36-year-old, and someone over 85 is over 10,000 times more at risk of dying than a child under 10. And although many infections still go undetected (complicating any attempt at a universal calculation of risk), your chances of dying from a confirmed case roughly double with every five to eight years of age, as countless data across multiple countries demonstrated last year — an effect larger than even the most significant comorbidities. The "exponential growth" of mortality risk by age is, in other words, another aspect of the pandemic we have processed only poorly.

Over the past nine months, vaccination has utterly transformed the shape of the pandemic in the places where it has penetrated the whole population. The effect isn't just visible in countries like Portugal or Iceland — where the threat appears to be fast receding and which give an encouraging picture of our possible future — but in parts of the United States as well. But for all its transformative, liberating power, vaccination has not broken the basic age skew of the disease or offered anyone an exit ramp from it. Instead, in two profound ways, vaccination has confirmed the age skew: by producing severe breakthrough cases concentrated overwhelmingly in the elderly and by reducing the risk faced by individuals by an astonishing degree that is nevertheless smaller than the still more striking effect of age.

In the days of the delta variant, breakthrough cases among the vaccinated are pretty common. But they remain overwhelmingly mild in younger vaccinated populations.

Only 14 percent of deaths in vaccinated COVID-19 patients occur in people under age 65, according to the Centers for Disease Control and Prevention.

A Financial Times analysis found the COVID-19 mortality risk is about equal for vaccinated 80-year-olds and unvaccinated 50-year-olds, while an unvaccinated 30-year-old has less chance of dying than a vaccinated 45-year-old.

"It's a sign of just how large the age skew is to begin with that getting vaccinated doesn't deliver you into an entirely new category of pandemic safety — safer and more protected than anyone who hasn't gotten vaccinated — but simply pushes you down the slope of mortality risk by the equivalent of a few decades," Wallace-Wells writes.

On the happier side of things, this means severe risk to children is still incredibly low:

"In England, the incidence of hospitalization among unvaccinated kids was lower than that of those vaccinated aged 18-29, and in recent weeks, the hospitalization rate among kids ages 5 to 14 has been only about one per 100,000," notes Wallace-Wells:

Over the course of the entire pandemic, which has killed more than 135,000 Brits, just one boy and seven girls between the ages of 5 and 9 have died; between the ages of 10 and 14, nine girls and five boys have died. These are all tragedies — and each means many more years of life lost than with a death among the elderly — but they are nevertheless relatively few in number. As schools reopened on the backslope of the U.K.'s Delta surge, there were about seven times as many British kids under age 5 hospitalized with the respiratory disease RSV as there were with COVID.

This is not to say that unvaccinated children face absolutely no risk from COVID, given that many millions of Americans under the age of 18 have gotten sick, and almost 500 have died, over the course of the pandemic. It's just that the risk those 73 million minors do face is — relative to the risks faced by their parents and grand­parents — very, very small.

Numbers like these should influence the way we think about the risk to different populations. They also show how our calculations must extend beyond simply whether people are vaccinated or not.

"To believe that the vaccinated elderly are now perfectly safe, as can be tempting to all of us who are desperate for the unvaccinated to get with the program, is to raise an uncomfortable set of questions about the way we have processed risk by universalizing it," Wallace-Wells concludes:

If we want to believe, say, a vaccinated 75-year-old is safe, have we now simply normalized a higher level of individual risk than seemed moral to accept as recently as 12 months ago, given that they may not be any less in danger of dying than an unvaccinated 53-year-old? If we are now debating what we can do, in schools especially, to protect unvaccinated children, who are much safer still, should we not be discussing at the same time what measures can be taken, beyond boosters, to protect the vaccinated elderly? Mask wearing offers differential benefits, too: according to the much-applauded study in Bangladesh, cloth masks of the kind typically worn by children offer very little protection, and the strongest effects of surgical masks were observed among the elderly.

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