For Older Americans, the Pandemic Is Not Over

The demographic divide reflects a debate that continues as the pandemic wears on: What responsibility do those at lower risk from the virus have to those at higher risk — not only older people, but those who are immunosuppressed or who have chronic conditions?

Should individuals, institutions, businesses and governments maintain strategies, like masking, that help protect everyone but particularly benefit the more vulnerable?

“Do we distribute them among the whole population?” Dr. Raifman asked of those measures. “Or do we forgo that, and let the chips fall where they may?”

Nancy Berlinger, a bioethicist and research scholar at the Hastings Center, made a similar point: “The foundational questions about ethics are about what we owe others, not just ourselves, not just our circle of family and friends.”

Three years in, the societal answer seems clear: With mask and vaccination mandates mostly ended, testing centers and vaccination clinics closed and the federal public health emergency scheduled to expire in May, older adults are on their own.

“Americans do not agree about the duty to protect others, whether it’s from a virus or gun violence,” Dr. Berlinger said.

Only 40.8 percent of seniors have received a bivalent booster. Some who have not believe they have strong protection against infection, a C.D.C. survey reported last month (though the data indicated otherwise).

Others worry about side effects or feel unsure of the booster’s effectiveness. Seniors may also find it difficult to locate vaccination sites, make appointments (especially online) and travel to the sites.

In nursing homes, where the early pandemic proved so devastating, only 52 percent of residents and 23 percent of staff members were up-to-date on vaccinations last month. Early on, a successful, federally funded campaign sent health care workers into nursing homes to administer the original vaccine doses. Medicare also mandated staff vaccinations.

But for boosters, nursing homes were permitted to develop their own policies — or not.

“It makes absolutely no sense,” said David Grabowski, a health policy professor at Harvard Medical School. “This is the group that should have the highest vaccination rate in the country. Everyone there is very susceptible.”

The Covid costs for older people extend beyond the most extreme dangers and include limited activities, diminished lives and continuing isolation and its associated risks.

In Hillsboro, Ore., Billie Erwin, 75, feels particularly vulnerable because she has Type 1 diabetes. She and her husband have forgone concerts and theater performances, indoor restaurant meals with friends, moviegoing and volunteering. Her book group fell apart.

“We used to spend a lot of time on the Oregon coast,” Ms. Erwin said. But because the trip involves an overnight stay, they’ve gone just twice in three years; annual visits to the Oregon Shakespeare Festival ended for the same reason.

The ongoing constraints have exacerbated the depression Ms. Erwin also contends with; some days, she doesn’t bother getting dressed.

“I’m disappointed we don’t consider other people as much as we ought to,” she said. “I don’t know that most people even think about it.”

Eleanor Bravo, 73, who lives in Corrales, N.M., lost her sister to Covid early in the pandemic; two years passed before the family could gather for a memorial. “I had this inordinate fear that if I got Covid, I would die too,” Ms. Bravo said.

She did develop Covid in July, and recovered. But she and her partner still avoid most cultural events, travel and restaurants. “Our world has gotten much smaller,” she said. An organizer with Marked by Covid, a national nonprofit organization, she is working to build a memorial to the 9,000 New Mexicans who have died of the virus.

Of course, many older Americans, too, have resumed their prepandemic routines. In Charlotte, N.C., Donna and David Bolls, both 67, fell ill with Covid in May — “the sickest I’ve been that I can remember,” Ms. Bolls said.

But afterward, they returned to restaurants, concerts, shopping, her part-time retail job and his church choir, without masks. “It’s a risk I’m willing to take,” she said. “I feel like I’m living life on my terms, doing the things I want to do.”

Though the political viability of mandates for masks, vaccination or improved indoor air quality appears nil, policymakers and organizations could still take measures to protect older (and immunocompromised) people without forcing them to become hermits.

Health care systems, pharmacies and government agencies could start renewed vaccination campaigns in communities and in nursing homes, including mobile clinics and home visits.

Remember the “senior hours” some supermarkets instituted early in the pandemic, allowing older customers to shop with smaller crowds and less exposure? Now, “public spaces are not accessible to people concerned about infections,” Dr. Raifman said.

They could be. Markets, libraries and museums could adopt some masks-required hours. Many Off Broadway theaters already designate two or three masked performances each week; others could follow suit. Steven Thrasher, author of “The Viral Underclass,” organized a masked book tour last fall with stops in 20 cities.

“Between the extremes of closing everything to mitigate transmission and doing nothing, there’s a middle ground,” Dr. Raifman said. “We can mitigate transmissions in smart and inclusive ways.”

Yet Vic Caretti, who has found a grief support group helpful, encounters comments from strangers in Salt Lake City because he wears a mask in public.

“I don’t think people understand how Covid affects older Americans,” Mr. Caretti said with frustration. “In 2020, there was this all-in-this-together vibe, and it’s been annihilated. People just need to care about other people, man. That’s my soapbox.”