Publisher Health

In early December, Aldo Caretti developed a cough and, despite all his precautions, came up positive for Covid on a home test. It took his family a couple of days to persuade Mr. Caretti, never fond of doctors, to go to the emergency room. There, he was sent directly to the intensive care unit.

Mr. Caretti and his wife, Consiglia, both 85, lived quietly in a condo in Plano, Texas. “He liked to read and learn, in English and Italian,” said his son Vic Caretti, 49. “He absolutely adored his three grandchildren.”

Aldo Caretti had encountered some health setbacks last year, including a mild stroke and a serious bout of shingles, but “he recuperated from all that.”

Covid was different. Even on a ventilator, Mr. Caretti struggled to breathe. After 10 days, “he wasn’t getting better,” said Vic Caretti, who flew in from Salt Lake City. “His organs were starting to break down. They said, ‘He’s not going to make it.’”

At least, this late in the pandemic, families can be with their loved ones at the end of life. When the family agreed to remove Mr. Caretti from the ventilator and provide comfort care, “he was alert, very aware of what was happening,” his son said. “He was holding everyone’s hand.” He died a few hours later, on Dec. 14.

For older Americans, the pandemic still poses significant dangers. About three-quarters of Covid deaths have occurred in people over 65, with the greatest losses concentrated among those over 75.

In January, the number of Covid-related deaths fell after a holiday spike but nevertheless numbered about 2,100 among those ages 65 to 74, more than 3,500 among 75- to 84-year-olds and nearly 5,000 among those over 85. Those three groups accounted for about 90 percent of the nation’s Covid deaths last month.

Hospital admissions, which have also been dropping, remain more than five times as high for people over 70 than for those in their 50s. Hospitals can endanger older patients even when the conditions that brought them in are successfully treated; the harmful effects of drugs, inactivity, sleep deprivation, delirium and other stresses can take months to recover from — or can land them back in the hospital.

“There continue to be very high costs of Covid,” said Julia Raifman, a public health policy specialist at the Boston University School of Public Health and a co-author of a recent editorial in The New England Journal of Medicine.

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 foregone 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.”