A new report released by Public Health Ontario this week provides the first data on COVID hospitalizations and deaths that both breaks down outcomes by patients’ vaccination status and includes a significant part of the Omicron wave.
The report details how the oldest seniors are still being hit disproportionately hard — those over age 80 accounted for about half of all reported deaths in the two-month period ending Jan. 16. But it also reveals a staggeringly higher proportional toll — 85 deaths — among the very few Ontarians over age 80 who are not yet vaccinated.
The fact those 85 deaths occurred in a population vastly smaller than the more than 650,000 Ontarians in that age cohort who are at least double vaccinated offers compelling evidence of how the vaccine has prevented the Omicron wave from becoming Ontario’s deadliest by far.
Without the vaccine, Omicron’s impact on older Ontarians would have been “catastrophic” and much worse than the carnage wrought by the first and second waves, said Dr. Amit Arya, palliative care lead at Kensington Health.
“For many older adults who are unvaccinated, the risk of death is actually very significant,” said Arya, who has watched many elderly patients die of COVID-19 throughout the pandemic.
“There’s a lot of emotional anguish that goes into caring for someone where you know that perhaps their death was preventable. We know that vaccines are in fact miraculous. This is not Wave 1 when we didn’t know about the virus and we didn’t have the technology and access to the vaccines.”
Age has been a strong determining factor in the most serious outcomes — hospitalizations and deaths — all pandemic. Provincial data shows that throughout the first four waves, the proportion of fatal COVID cases was highest in those 80 years old or older; more than 90 per cent of all deaths have been in those aged 60 and over.
But unpacking the number of lives saved by the vaccine is difficult, in part, because it is not clear exactly how many unvaccinated people there are in this province.
The province puts out a daily report on vaccination rates by age that claims 99.8 per cent of Ontarians over 80 had received at least two doses by Dec. 1 — a rate that suggests fewer than 1,500 Ontarians in this age group were unvaccinated in the period covered by the new report. If that were true, it would suggest the initial Omicron surge had already killed about one in every 20 unvaccinated people over 80 before even the current surge in fatal cases — a staggering, likely implausible, number more than 150 times worse than the death rate among those with two or more doses.
Another way to figure out the number of people 80 years old and over saved by the vaccine is to compare the province’s report of total doses in that cohort against Statistics Canada’s most recent population estimates. That difference suggests Ontario had about 20,000 unvaccinated people over age 80, a higher-end total that nevertheless still suggests the oldest unvaccinated Ontarians are dying more than 12 times as often.
Asked to provide a current estimate of how many very old seniors are still unvaccinated, a Public Health Ontario spokesperson said the information was not immediately available, but would be added to future reports.
The Public Health Ontario report said that 225 Ontarians aged 80 and over who were at least double vaccinated died of COVID in the same 60-day period ending Jan. 16. Whatever the exact number of unvaccinated Ontarians, the difference in the size of the two populations is large enough to suggest that thousands more would have died in the current wave, if not for the protection offered by the vaccine.
The absolute number of reported deaths in each group is not as important as controlling for the different denominators, said Arya, who added that the data “absolutely shows that in terms of people who are being hospitalized, people who are in the ICU, people who are dying, this is still a pandemic which is disproportionately impacting people who are unvaccinated.”
The higher death rate of older Ontarians shows the importance of getting a third shot, said Dr. Samir Sinha, director of geriatrics at Sinai Health and University Health Network.
“We know that if you’re 80 and older and you get vaccinated, you’re not going to have as robust an immune response on average as say if you were a 40 year old who also got vaccinated,” Sinha explained. “That’s why boosters have been so integral amongst our older population.”
Ontario’s Chief Medical Officer of Health, Dr. Keiran Moore, also emphasized boosters in a news conference Thursday, saying “the third dose is proving to be exceptionally protective — 88 to 95 per cent against severe outcomes.”
Sinha noted that there are many in the 80+ cohort who have not been vaccinated due to legitimate reasons, such as underlying medical conditions and barriers to accessing the vaccine, but also misinformation.
He recounted trying to convince the family of an older patient with dementia to vaccinate the patient. The family was hesitant because they were worried the vaccine might make the patient’s condition worse if there were any side effects, he said. The family decided not to go through with vaccination and the patient ended up getting COVID.
“I have these patients that will do everything else that I’ve asked them to do,” Sinha said, “but just on this front, I think they’ve just heard so much that they’re worried it may not be the right choice for them.”
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