Mack Follmer, a 90-year-old living independently in Eugene, made it through more than a year of the coronavirus pandemic in good health – albeit very isolated beyond trips to the grocery store, the pharmacy and the occasional socially distanced coffee klatch with friends.
His own efforts to secure a COVID-19 vaccine through his doctor went nowhere.
But his daughter managed to snag an appointment for him for Feb. 9, the day after seniors his age became eligible to be inoculated in Oregon.
The week following his first injection of the two-dose regimen, hours after his housekeeper had left him making a cake in the kitchen, Julie Holmes found her father collapsed on the bathroom floor of his home. He was hospitalized, tested positive for COVID-19 and eventually sent to a nursing home in Roseburg to quarantine.
He seemed to recover from the virus, even tested negative. But by that point, he had contracted pneumonia and a staph infection. Thirty pounds disappeared from his 6-foot-4 frame.
Follmer died March 24 due to complications of COVID-19, victim No. 2,387 on the anonymous and growing state list of 2,457 Oregonians through Friday who have succumbed to the disease.
“I don’t think he would have died if he hadn’t gotten COVID, so I’m blaming that 100%,” said Holmes. “The vaccination is a godsend, but it didn’t come soon enough for him.”
It might have, in fact, but for Gov. Kate Brown’s highly controversial decision to prioritize vaccinations for teachers over seniors, starting Jan 25. That decision delayed the rollout for seniors 65 and older living outside long-term care facilities by anywhere from two to five weeks.
Public health officials say it’s impossible to know for sure what the ultimate impact of that decision will be due to a number of complicating factors, from initial vaccine shortages to the difficulty seniors had trying to secure appointments online, not to mention the unknown number who are hesitant to get the shots.
But the decision to delay eligibility for some 700,000 seniors living independently undoubtedly took a toll, experts say. And the number of fatalities could increase, as deaths trail cases and hospitalizations – both of which are on the rise again.
At least 148 individuals 65 and older have died this year who tested positive for COVID-19 after Jan. 25, according to an analysis by The Oregonian/OregonLive of death information disclosed by the state. They tested positive an average of 27 days after the date Brown originally made teachers instead of seniors eligible. More than half of those seniors tested positive after their actual eligibility date for a vaccine – an average of three weeks afterward.
It’s impossible to say how many of those deaths were preventable, how many people would have sought earlier vaccinations or succeeded in finding one. While supplies continued to improve, there clearly wasn’t enough vaccine on hand to address the entire population over 65 immediately.
But the quantification of senior deaths adds new context to Brown’s decision prioritizing teachers for vaccinations amid her push to get kids back in classrooms. More than 270,000 students are now receiving some in-person learning, or about 47% of those enrolled in K-12 schools. Those numbers keep rising.
Meanwhile, the number of COVID-19 deaths in Oregon has plummeted across all ages after a devastating December and January. For seniors, the 148 deaths among those who tested positive after Jan. 25 is a markedly lower rate to the roughly 1,900 senior fatalities from previous 11 months.
More contagious coronavirus variants could wipe away recent progress, although the likelihood of significantly more deaths is diminished by increasing inoculations using highly effective vaccines. But advocates say much work is still needed to reach the state’s 200,000 unvaccinated seniors, who are most vulnerable to die from COVID-19 until they’re inoculated.
About three quarters of Oregonian seniors are now at least partially vaccinated against COVID-19. According to the Centers for Disease Control Prevention, the state ranks 30th in the country in its vaccination rate for individuals in that demographic.
Charles Boyle, a spokesman for Oregon’s governor, said the state has some of the nation’s lowest death rates for seniors. Vulnerable seniors living in long-term care, where infections can spread like wildfire, were eligible for shots under a national program beginning in December.
“Every death from COVID-19 is a tragedy, and from the beginning of this pandemic, Governor Brown has taken action to protect our most vulnerable seniors,” Boyle said in an email. “Those decisions have saved lives.”
Chunhuei Chi, a professor in Oregon State University’s College of Public Health and Human Sciences,
said the governor’s decision to delay shots for seniors had an impact, “but it would be very difficult to pinpoint the number of preventable deaths.”
Chi said supply challenges, technological barriers, transportation inequities and operational obstacles all likely influenced how many seniors would have been able to be vaccinated more quickly.
“After taking all these other factors into account, it was probably relatively small,” he said. “At the same time, a preventable death is a valuable life lost.”
Oregon and Idaho were the only two states that chose to give priority to teachers over seniors in an effort to get kids back into classrooms sooner.
Brown in January briefly considered making seniors eligible for vaccines along with child-care, preschool and K-12 employees, but reversed course when expectations of more vaccine supply from the federal government fell through.
Instead, she made about 150,000 teachers, school staff and childhood educators eligible for its limited supply of vaccines starting Jan. 25, a population that would require some 300,000 vaccine doses to fully inoculate.
A federal program separately prioritized nursing homes starting Dec. 21 and other congregant care settings on Jan. 18 — important because such facilities account for about half of all Oregon deaths. Not all the residents of those facilities are seniors, but as of April 12, that program had fully vaccinated about 60,000 residents and staff.
Oregon has roughly 767,000 residents over the age 65. Those that live outside congregant settings became eligible on a staggered basis starting Feb. 8 for those over 80, then lowering the bar by five years each week until everyone over 65 was eligible on March 1.
The timeline left Oregon as one of the last states in the country to begin vaccinating seniors and meant it lagged some states by more than two months. California made everyone over 65 eligible for vaccination Jan. 13, and Washington a few days later — six weeks before Oregon would do the same.
“It was a cluster,” Mary Rita Hurley, chair of the Governor’s Commission on Senior Services, said of the state rollout. “They should have all been in phase 1a” of eligibility, beginning far earlier.
On a practical level, that meant the earliest an Oregonian living independently over the age of 80 would be considered fully vaccinated – after two doses and a two-week buffer – was March 15. The date stretched to early April for those over 65.
But even a first dose could have offered protections to scores of vulnerable seniors. A study released last month by the Centers for Disease Control and Prevention showed that one dose of the Pfizer-BioNTech or Moderna vaccine is 80 percent effective in preventing infections two weeks after administered. The vaccines effectiveness jumped to 90 percent two weeks after the second dose.
The decision to delay garnered deep criticism given the lethality of the disease among seniors and the domino effect it might create vaccinating the state’s most vulnerable.
The governor’s full Commission on Senior Services sent a letter Jan. 25 asking her to reverse the decision.
Maureen Hoatlin, a retired biochemistry professor at Oregon Health & Science University, wrote to Brown a week later pleading the same. Hoatlin said it was clear that new, more infectious coronavirus variants were already circulating in Oregon, making it even more urgent to revise the priorities in advance of an anticipated wave of new infections – a wave that has since arrived.
“Each day this delay continues for Oregonians 65+ will be measured in lives lost,” she wrote. “What is our overarching goal in vaccinating Oregonians if not to preserve life? … It is inexcusable to continue to delay for even one day.”
Michael Osterholm, an influential epidemiologist from the University of Minnesota and member of President Biden’s Coronavirus Transition Team, told the Oregon Legislature’s COVID-19 committee much the same thing two weeks ago.
He said 70 percent of seniors nationally have had at least one shot, a number fairly close to Oregon’s at the time. But he lamented the fact that in order to keep their vaccination numbers high, states were opening up their programs to the general population before covering the people who need it the most.
“That’s not a victory,” he said. “It’s a defeat.”
Judy Davis, a 78-year-old Clackamas County resident, certainly felt defeated.
Davis said she didn’t begrudge teachers or front-line workers being vaccinated if they were going to be out in public, but if they weren’t going back to school immediately, she said seniors should have been given priority. Even when she became eligible Feb. 15, she found the process confusing and frustrating.
“There was no direct communication as to how to get an appointment and not enough sites,” she said. “I was getting up at 3 in the morning. I was getting up at 5 a.m. I heard that appointments were opening up at 9 o’clock Monday and Thursdays, but I was getting nothing.”
She eventually got a call back from a Clackamas County employee who helped her schedule an appointment for a shot on March 27.
“As a senior I was competing with a lot of people and I swear to god I was giving up,” she said, “‘cause I just couldn’t handle the stress of it.”
Carlos Crespo, a professor at the OHSU-PSU School of Public Health, says it is possible to model various vaccination scenarios and calculate if any particular decision led to an increase in mortality among particular groups. But he said there were a number of intangibles in play.
“This is an art, more than a science,” he said. “We’ve never been here before, releasing three vaccines at once, but with the number controlled by the federal government. There were shortages.”
He said the initial CDC push properly focused on congregant care facilities, where the state was seeing the biggest outbreaks among the elderly and where they were at higher risk of death. Seniors living independently, many distancing at home, were likely at lower risk, Crespo said, and the vaccinations of other groups, including teachers, likely saved lives among those workers.
“Getting kids back to school is not a life-or-death decision, but it’s a human development issue,” he said. “There were older adults who wanted to be vaccinated but couldn’t get one. You end up making an ethical decision.”
Finding those left out
While vaccines are now more widely available, advocates for the elderly said early accessibility problems compounded as successive waves of younger and tech savvier Oregonians became eligible in the past month and swooped in to snap up new appointments as they appeared online.
And they’re worried about virus variants as well as the fact that vaccination uptake among seniors seems to be slowing down well short of the rates needed for her immunity. Kids can bring any version of coronavirus home.
Patrick Allen, director of the Oregon Health Authority, told lawmakers last week that the increase in senior vaccination rates has clearly slowed down, and was below 50% in many rural areas of the state.
“This is not due to lack of availability,” Allen said. “This is really a question of whether people want the vaccine” or in some cases were waiting for the since-halted Johnson & Johnson one-shot dose.
Pam Latta, a Wallowa County resident and member of the Governor’s Commission on Senior Services, said her county has done an excellent job rolling out the vaccine so far, with nearly a third of its 7,000 residents fully vaccinated. The OHA says about two-thirds of seniors there have been at least partially vaccinated. But Latta says a fair number of people have declined to get one.
A common refrain: “They don’t feel the time between the development and administration of the vaccine was long enough,” she said.
It’s unclear how much demand there will be among seniors in the weeks ahead. OHSU has modeled vaccinations flatlining at about 80% for the elderly and other populations, although an opt-in survey of some 2,000 AARP members in Oregon last month showed that 89% of members wanted a vaccine.
For seniors who haven’t been vaccinated, competition will increase come Monday, when Oregon opens up vaccine eligibility to anyone 16 or older.
“I hear story after story of people waiting for someone to call them,” said Hurley, chair of the senior services commission. “Everything was pushed online. There was no outreach to churches, faith leaders, community groups. Unless you had a computer and someone tech savvy who was ready to go, you got left behind.”
The next phase, she said, is finding those individuals and going house to house to vaccinate them.
Rudy Owens, a spokesman for the OHA, said in an email that the agency continues to work in collaboration with local public health authorities to reach all older adults and encourage them to get a vaccine. It is sending mailers, working with community organizations and insurers, and determining how it can overcome transportation challenges as well as vaccine hesitancy among people concerned about safety.
Owens stressed that the death rate among Oregonians 80 and over with COVID-19 is 20%, meaning one in five has died.
We will continue to encourage those in this group to schedule a vaccination appointment,” he said, “particularly before all Oregonians become eligible to schedule appointments.”
Holmes, whose father died last month before he could be fully vaccinated, said she’d urge seniors to get the shots as soon as possible. She said her dad started pushing her to get vaccinated immediately after he had his own, conscious of the heart ablation procedure she’d had in early February. She followed his advice.
“Just get it,” she said. “And if you don’t have access to the internet, wait on hold or have someone help you.”
Her dad’s memorial, with 12 people coming, is this weekend, with an outside gathering at his house to follow. In preparation, she spent the last few weeks cleaning out the house. She’s a bit exasperated at the number of household items held together with duct tape, a reminder of how frugal he was despite having plenty of money. She’s finding notes from her dad to her mom, who died two years ago. And as condolences come in from friends extolling what a great guy he was, she’s remembering how loud and opinionated he was — a trait she says she inherited.
She’s still upset he died when he did, more than a year into the pandemic, after the biggest peaks in cases, after being partially inoculated.
“He was 90 and had a really great life prior to that,” she said. “I thought he’d dodged the bullet. But he didn’t.”