Weekly COVID-19 incidence among adults increased during Sep. 6, 2020 to Jan. 2021, and after this peak, incidence, followed by rates of ED visits, hospital admissions, and deaths declined among all adult age groups, according to a Morbidity and Mortality Weekly Report from the Centers for Disease Control and Prevention (CDC).
COVID-19 vaccination began in the United States in December 2020, and adults aged ≥65 years were prioritized in early phases.
During Sep. 6 to Dec. 14, 2020, before the commencement of vaccine administration, the rate ratios of COVID-19 outcomes among older adults to younger adults were either stable or increasing. The ratio for COVID-19 deaths began to decline in mid-December while rate ratios for COVID-19 incidence, ED visits, and hospital admissions began to decline in late December to mid-January. Comparing the two-week pre-vaccination period with two weeks in late April, declines were significantly greater among older adults, who had higher vaccination coverage, than among younger adults, who had lower coverage. These age-stratified results provide ecologic evidence of the likely contribution of vaccination coverage to reducing COVID-19 outcomes.These data are consistent with other preliminary reports showing a reduction in COVID-19 cases and severe illness in populations with high vaccination coverage. An ecologic study from Israel found the ratio of COVID-19 patients aged ≥70 years requiring mechanical ventilation to those aged <50 years declined 67% within three months of a nationwide vaccination campaign prioritizing persons aged >60 years. In separate studies analyzing Israeli surveillance data, COVID-19 incidence, hospitalizations, and deaths markedly declined across all age groups as cumulative vaccination coverage increased, and vaccine effectiveness of 46% for COVID-19 infection, 74% for hospitalization, and 72% for death, was observed during 14 to 20 days after the first dose. A CDC evaluation at 24 hospitals found that receipt of COVID-19 vaccine was 64% effective against COVID-19 hospitalization among partially vaccinated adults aged ≥65 years and 94% effective among fully vaccinated adults aged ≥65 years.
The greater decline in COVID-19 morbidity and mortality in older adults, the age group with the highest vaccination rates, demonstrates the potential impact of increasing population-level vaccination coverage.
Throughout the COVID-19 pandemic, older U.S. adults have been at increased risk for severe COVID-19–associated illness and death. On Dec. 14, 2020, the United States began a nationwide vaccination campaign after the Food and Drug Administration’s Emergency Use Authorization of Pfizer-BioNTech COVID-19 vaccine. The Advisory Committee on Immunization Practices (ACIP) recommended prioritizing health care personnel and residents of long-term care facilities, followed by essential workers and persons at risk for severe illness, including adults aged ≥65 years, in the early phases of the vaccination program.
By May 1, 2021, 82%, 63%, and 42% of persons aged ≥65, 50–64, and 18–49 years, respectively, had received ≥1 COVID-19 vaccine dose. CDC calculated the rates of COVID-19 cases, emergency department (ED) visits, hospital admissions, and deaths by age group during Nov. 29 to Dec. 12, 2020 (pre-vaccine) and April 18 to May 1, 2021. The rate ratios comparing the oldest age groups (≥70 years for hospital admissions; ≥65 years for other measures) with adults aged 18–49 years were 40%, 59%, 65%, and 66% lower, respectively, in the latter period. These differential declines are likely due, in part, to higher COVID-19 vaccination coverage among older adults, highlighting the potential benefits of rapidly increasing vaccination coverage.
From Nov. 29, 2020, to May 1, 2021, COVID-19 incidence, ED visits, hospital admissions, and deaths declined more in older adults, who had higher vaccination coverage, than in younger adults, who had lower coverage. Despite sufficient vaccine supply and expanding eligibility, administration of COVID-19 vaccines has steadily declined in adults since mid-April 2021. These results suggest that tailored efforts by state and local jurisdictions to rapidly increase vaccine coverage among all eligible age groups could contribute to further reductions in COVID-19 cases and severe outcomes. Such efforts include effectively communicating the benefits of vaccination, ensuring equitable access and convenience, empowering trusted messengers, including primary health care providers, and engaging communities.