OMICRON and older people in low and middle-income countries: update 20 December 2021
(Co-signatories listed at end of piece).
This piece draws on the latest WHO Global Omicron Technical Brief, dated 17 December 2021 [link]. We will aim to update this piece on a frequent basis, but strongly advise all readers to refer to the latest version of this WHO Guidance, since it is likely to change over time.
This piece takes a selection of excerpts from the WHO Guidance that we feel have particular significance for older people in LMICs and provides some brief additional commentary. However, we strongly encourage readers to refer to the full Guidance Report, which provides much more comprehensive and detailed information.
General global status of the Omicron variant risk.
The overall threat posed by Omicron largely depends on four key questions, including: (1) how transmissible the variant is; (2) how well vaccines and prior infection protect against infection, transmission, clinical disease and death; (3) how virulent the variant is compared to other variants; and (4) how populations understand these dynamics, perceive risk and follow control measures, including public health and social measures. Public health advice is based on current information and will be tailored as more evidence emerges around those key questions.
Experience with other COVID-19 variants indicates that older people will be at especially high risk. Until there is robust evidence on severity of disease and case fatality by age group for comparable national settings, governments should continue to assume this to be the case.
Public health advice should include tailored communication strategies for those older people and other groups who have limited access to digital technology and lower health literacy.
Protecting older people from Omicron.
More data are needed to understand the severity profile and how severity is impacted by vaccination and pre-existing immunity… Despite uncertainties, it is reasonable to assume that currently available vaccines offer some protection against Omicron, particularly against severe disease and death… Efforts should be intensified by public health authorities to accelerate COVID-19 vaccination coverage in all eligible populations, but with priority for populations at high risk for serious disease who remain unvaccinated or are not yet fully vaccinated. These include older adults, health care workers and those with underlying conditions putting them at risk of severe disease and death. Delta is still by far the predominant variant globally against which vaccines are highly effective, and vaccines are likely to have some effectiveness against Omicron, particularly for severe disease, even if the performance is reduced compared with other variants.
Vaccine nationalism is reflected in large disparities in COVID-19 vaccination availability between richer and poorer countries. All things being equal, the current data indicate that unvaccinated populations face a significantly higher risk of severe symptoms, a need for hospital care and mortality. It is likely that the impacts of Omicron will be considerably greater in these poor countries.
Vaccine ageism is reflected in large disparities between countries in vaccine coverage of older people relative to younger adults [link]. In several countries, coverage of people aged 18-59 is higher than for people aged 60+ [link]. This failure to reach groups designated a “priority population” by WHO will increase the numbers of severe cases of Omicron, as well as associated hospitalisations and deaths.
The use of well-fitting masks, physical distancing, ventilation of indoor spaces, crowd avoidance, especially during holiday periods, and hand hygiene remain key to reducing transmission of SARS-CoV2 with the emergence of the Omicron variant. Enhanced surveillance with rapid testing and stricter contact tracing of cases suspected to be infected with a variant of concern.
Populations in LMICs have less access to PPE and, especially in crowded urban environments, less opportunity to distance. This includes older people, many of whom continue to work and to attend crowded health care settings. Specifically, staff and residents in long-term care facilities [link] continue to have little or no assistance from government agencies in the provision of tests, PPE and hygiene materials.
Pressure on health care systems and older people.
Hospitalizations in the UK and South Africa continue to rise, and given rapidly increasing case counts, it is possible that many healthcare systems may become quickly overwhelmed… In anticipation of increased COVID-19 caseloads and associated pressure on the health system, ensure mitigation plans are in place to maintain essential health services and necessary health care resources are in place to respond to potential surges. This would include surge capacity plans for health workers as well as plans for providing additional practical support to health workers, with particular attention to the needs of mothers and single parent families.
Unmanageable pressure on health services will affect people of all ages in all countries. However, the effects on older people in LMICs are likely to be especially severe. This is because (i) health services are already more limited relative to population need and (ii) because older people require more access to these services. A reduction in access to necessary health services is likely to generate additional deaths among older people for conditions not directly related to COVID-19.
Liat Ayalon, Bar Ilan University.
Mario Barbagallo, University of Palermo,
Jane Barratt, International Federation of Ageing.
Rafael Bengoa, Former Head of Health Systems World Health Organisation; Institute for Health & Strategy, Bilbao.
AB Dey, Venu Geriatric Center.
Jagadish K. Chhetri, Nepalese Society of Gerontology and Geriatrics.
Adelina Comas Herrera, London School of Economics.
Stephen Connor, Worldwide Hospice Palliative Care Alliance.
Nicole Dubuc, Université de Sherbrooke.
Luigi Ferrucci, National Institute of Aging.
Leon Geffen, Samson Institute for Ageing Research.
Adam Gordon, University of Nottingham.
Ishtar Govia, University of the West Indies.
Aravinda Guntupalli, University of Aberdeen.
Hans Hobbelen, Hanze University of Applied Sciences.
Mikel Izquierdo, Public University of Navarra.
Alexandre Kalache, International Longevity Centre Brazil
Arvind Mathur, Indian Society of Geriatrics.
Reshma Merchant, National University of Singapore.
Karl Pillemer, Cornell University.
Jean-Yves Reginster, WHO Collaborating Center for Epidemiology of Musculoskeletal Health and Aging, Liège.
René Rizzoli, University Hospital of Geneva.
Cornel Sieber, Friedrich-Alexander-Universität Erlangen-Nürnberg.
Alan Sinclair, Kings College London.
Luis Eugenio Souza, Federal University of Bahia.
Camilla Williamson, HelpAge International.