Elderly at Risk: Importance of Bivalent Vaccination to Reduce COVID-19 Severity and Complications in Puerto Rico

Less than a month after the World Health Organization (WHO) declared the end of the public health emergency for COVID-19, various countries around the world -including Puerto Rico- face a significant increase in infections of the dangerous virus and Again, the worst part in this story is borne by people over the age of 60.

This is confirmed by the data compiled by the Department of Health, as well as the experience of doctors consulted by Primera Hora, who warned about the trend of complications in patients over 60 years of age who, for the most part, suffer from other chronic conditions and do not have the vaccinations up to date. That is, they did not receive the bivalent booster dose.

“We are again seeing an increase in cases of COVID-19 and, in consensus with what I have discussed with other colleagues, the most affected are the elderly. And, at least from my experience, none of those hospitalized had or has the bivalent vaccine. And that is something that worries me, because most of them think that having two vaccinations that they received two or three years ago is enough, and this is costing them to be very ill and even death. I know that many people are tired, but the reality is that to be up to date and reduce the risks of a severity, you have to get the bivalent vaccine, ”infectologist Iris Velázquez, who cares for patients in hospitals in the western area, told Primera Hora.

The specialist explained that she is concerned that she has treated patients with a condition similar to those affected by the Delta variant, classified as one of the most dangerous in terms of disease severity. According to data from Salud, the variant with the greatest circulation continues to be Ómicron with its sublineages XBB.1.5 and XBB.1.16.

“At one point I was scared, because some cases are behaving very severe and similar to what we saw with Delta when they got very bad and complicated very quickly. And we have now seen one or another case like this, ”said Velázquez.

“Right now I have two very sick patients. One is on a ventilator and the other is on 100% oxygen and it is likely that he will end up on a ventilator… both people are older and without the bivalent (vaccine), “added the infectologist, explaining that the increase in infections has also been noticed among health professionals because, just last week, five nursing members infected with the virus were reported absent from an institution in the western zone.

Pulmonologist Luis Nieves Garrastegui, a doctor who has been vocal in providing updated data on COVID-19 throughout the pandemic, concurred with the information that the majority of patients who come to his office seeking help are from the 50-year-old demographic in ahead and no vaccinations up to date.

“Those vaccinated with bivalent are getting it, but very mild. Now, those who do not have their vaccines up to date are getting strong. They have body pain, problems in the upper respiratory tract (cough, congestion, irritated eyes). And if they have other conditions of the immune system, they are more affected”, pointed out the expert.

He emphasized that during the interviews with his patients there is a common denominator: “they all have the same story that they stopped wearing masks and were at crowded events, such as family activities, shopping or concerts.”

“And now I want to take the opportunity to make something clear. We are in another moment of the pandemic in which we have antivirals, support medicines, we know the enemy and there is an immune system exposed in some way or another to the virus, but the fact that the emergency is over and we are at this level does not means the virus is over. The infections will continue. So you have to have common sense and be very clear. If you are in a place where you suspect that there are sick people, coughing… well, look, keep your distance, put on a mask and wash your hands. This will protect you not only from COVID, but also from other diseases such as influenza, RSV (syncytial virus) and other respiratory viruses”, stressed the pulmonologist.

alarming data

Currently, the level of community transmission of COVID-19, based on the incidence rate, is high for the 78 municipalities on the island. The increase in cases is also reflected in the positivity based on molecular tests, which reflects a high state with 23.6%. A month ago the positivity fluctuated by 10%.

According to data from the Department of Health, by Tuesday 109 cases had been confirmed by molecular tests. Meanwhile, 134 hospitalizations in adults were reported and of these 22 were in intensive care. Likewise, there are 26 pediatric patients admitted and of these two are in intensive care. On the other hand, four deaths were recorded. Since the beginning of the pandemic in 2020 to date, 5,938 deaths linked to COVID-19 have been reported, and of these 4,906 (82.6%) have been in people aged 60 and over.

The daily average of cases is more than 800, a very high figure compared to the 300 cases on average that were registered at the beginning of April.

The metropolitan region is, to date, the one with the highest incidence of virus cases, followed by those of Caguas, Bayamón, Ponce, Mayagüez, Arecibo and Fajardo.

Although people over 60 years of age continue to be the group that suffers the most complications when contracting the virus, a Health analysis highlights that the demographic sector that is most infected is the 40 to 49 year old, followed by the 20 to 29 year old and from 30 to 39 years. Children between 0 and 4 years old are the group with the lowest positivity.

Nasal congestion, cough, tiredness, muscle pain, head and throat pain, fever and loss of smell and taste are the main symptoms presented by patients infected with the virus in the last month.

The latest COVID surveillance report, corresponding to week 19 (May 7-13) reports 337 active outbreaks investigated by the health authorities. These outbreaks include 1,371 identified cases, 992 identified close contacts, 4 hospitalizations, and one death. A total of 224 of the outbreaks occurred in family settings, while 82 originated in educational institutions and 16 in community settings. Other contagions in groups were perceived in work environments and in groups of travelers.

It should be noted that for the week of April 9 to 15, the outbreaks investigated by Health totaled 180, that is, about 44 infections in groups less than those currently reported.

health authorities continue to promote the use of masks indoors and facilities with high-risk populations as mitigation measures as, for example, in long-term care centers. It is also recommended hand washing, physical distancing, opting for activities in open spaces (not crowded), and continuing to promote up-to-date vaccinationsincluding the bivalent booster dose.

Only 10% of the population is vaccinated up to date

In terms of vaccination until this week, only 346,048 people in Puerto Rico are up to date with vaccinations. This represents 10.60% of the total population.

There are 2,462,370 people without vaccinations up to date and 455,166 who have never been inoculated.

When analyzing the mortality rates of COVID-19 by vaccination status in the last 12 months, it is reflected that 99.7 deaths per 10,000 occurred in unvaccinated people (454 deaths out of a population of 455,438 unvaccinated people).

Meanwhile, the report indicates that 39.7 deaths per 10,000 occurred in people without up-to-date vaccinations (979 deaths out of a population of 2,467,851 people without up-to-date vaccinations).

On the other hand, the report maintains that 30.6 deaths per 10,000 originated in people with up-to-date vaccinations (104 deaths out of a population of 340,295 people with up-to-date vaccinations).

When are we up to date with the vaccines?

• Everyone 6 years and older is considered current if they receive 1 current Pfizer-BioNTech or Moderna COVID-19 vaccine.
• Children 6 months to 5 years of age who have received the Pfizer-BioNTech COVID-19 vaccine are considered up to date if they are: 6 months to 4 years of age and receive three doses of the COVID-19 vaccine, including at least 1 updated dose of the COVID-19 vaccine and if you are 5 years old and receiving at least 1 updated dose of the COVID-19 vaccine.
• Children 6 months through 5 years of age who have received Moderna’s COVID-19 vaccine are considered up-to-date when they receive 2 doses of Moderna’s COVID-19 vaccine, including at least 1 updated dose of Moderna’s COVID-19 vaccine. COVID-19.
• Individuals who are unable or unwilling to receive a recommended mRNA vaccine are considered up to date when receiving the recommended doses of Novavax COVID-19 vaccine for their age group.
• Population 18 years and older are considered up to date if they have the bivalent booster.

Source: Department of Health