COVID-$% CONTAINMENT MEASURES ANALYSIS, ISSUE -
Selected COVID-19 Health Outcomes by Age Group
Evidence-Based Public Health (ZIG 2) | Center for International Health Protection (ZIG) Robert Koch Institute
Selected COVID-19 Health Outcomes by Age Group Robert Koch Institute, 2021
Funding
This report was developed under the project Analysis of international epidemiological data and response measures, a project funded by the German Federal Ministry of Health (BMG).
Authors
Thurid Bahr, Evidence-Based Public Health, research scientist, Evidence-Based Public Health, Centre for International Health Protection
Nina Klein, Evidence-Based Public Health, student assistant, Evidence-Based Public Health, Centre for International Health Protection
Hanna-Tina Fischer, research scientist, Evidence-Based Public Health, Centre for International Health Protection
Prof. Dr. Dr. h.c. mult. Lothar H. Wieler, president
Prof. Dr. Johanna Hanefeld, director, Centre for International Health Protection
Dr. Charbel El-Bcheraoui, head, Evidence-Based Public Health, Centre for International Health Protection
Acknowledgements
The authors gratefully acknowledge the Public Health Intelligence team for their valuable input and feedback on this report.
The icons on pages 5 and 10 stem from https://allthefreestock.com.
Suggested Citation
Bahr, T., Klein, N., Fischer, H.-T., Wieler, L. H., Hanefeld, J. and El-Bcheraoui, C., 2021. Selected COVID-19 Health Outcomes by Age Group. Report. COVID-19 Containment Measures Analysis, Issue 7, Robert Koch Institute, Berlin.
Disclaimer
The content of this report expresses the opinions of its authors and does not necessarily represent the views of the Robert Koch Institute.
Summary
Vaccinations against COVID-19 are a critical measure to reduce the risk of transmission and rates of hospitalization with severe disease. Even though vaccination uptake was initially high in countries with vaccine availability, a slowing down of the rate of vaccination is observable in numerous countries where data is available.
The desired levels of vaccination in the general population have, with a few exceptions, not yet been reached.
As demand for vaccinations is steadying, decision-makers need to inform individuals who are not, or not yet fully, vaccinated of the benefits of receiving a COVID-19 vaccination and completing the full vaccination course. Such benefits would be illustrated, for example, by a comparison of the vaccination status of hospitalized COVID-19 patients by age group. This data, however, is currently insufficiently available.
We report on COVID-19 incidence, hospitalizations and vaccination coverage stratified by age as a proxy for vaccination status, as vaccination campaigns in most countries began inter alia with the oldest age groups. We cover five countries: Chile, Germany, Spain, the United Kingdom and the United States. Across all five countries, full vaccination coverage is highest in the oldest population groups. Vaccination coverage is particularly high at 80% or above in the oldest age group in Chile, England, Germany and Spain. Vaccination coverage is particularly low at less than 20% in the youngest age group in Spain and the United States. Weekly hospital admissions or weekly hospital occupancy is highest in the oldest age groups in all countries. However, data contained in this report from Germany and Spain shows that as vaccination coverage in the oldest age group increased over time, hospital occupancy or admissions have steadied or decreased. Across all countries, weekly COVID-19 incidence is currently lower in older age groups than in younger age groups. However, the age-stratified data on incidence and hospitalization contained in this report does not reveal the vaccination status of those infected and hospitalized.
Existing research has shown that receiving a full COVID-19 vaccination course is effective both in preventing COVID-19 infection and in reducing the severity of COVID-19 disease, including in older adults.[1, 2] Analysis from Germany has demonstrated that between early June and late August 2021, fully vaccinated individuals in the age groups 18-59 and 60 and older showed consistently lower hospital occupancy than those in the same age groups who were not vaccinated.[3] Despite higher hospital occupancy and admissions in the oldest age group, full COVID-19 vaccinations are therefore an effective tool to prevent severe disease in younger and older adults.
The data presented in this report can be used by decision-makers to inform the adjustment of COVID-19 containment measures and to mobilize unvaccinated members of the population.
Zusammenfassung
Impfungen gegen COVID-19 sind eine wichtige Maßnahme zur Verringerung des Übertragungsrisikos des Virus und der Zahl der COVID-19 bedingten Krankenhausaufenthalte mit schweren Verläufen. Die Impfgeschwindigkeit war in den Ländern, in denen Impfstoffe zur Verfügung stehen, anfänglich hoch. Jedoch ist in zahlreichen Ländern, für die Daten vorliegen, eine Verlangsamung der Impfgeschwindigkeit zu beobachten. Die gewünschte Durchimpfungsrate in der Allgemeinbevölkerung wurde, von wenigen Ausnahmen abgesehen, noch nicht erreicht.
Da die Nachfrage nach COVID-19 Impfungen abnimmt, müssen Entscheidungstragende die Öffentlichkeit weiterhin über die Vorteile einer COVID-19-Impfung informieren, um ungeimpfte oder unvollständig geimpfte Personen zu erreichen. Der Nutzen der COVID-19 Impfung ließe sich zum Beispiel durch einen Vergleich des Impfstatus hospitalisierter COVID-19-Patienten verschiedener Altersgruppen veranschaulichen. Diese Daten sind jedoch derzeit nur unzureichend verfügbar.
Wir berichten über COVID-19-Inzidenz, Hospitalisierungen und Durchimpfungsrate (2. Dosis) nach Alter als Proxy für den Impfstatus. Dies begründet sich darin, dass die Impfkampagnen in den meisten Ländern unter anderem mit den ältesten Altersgruppen begannen. Der Bericht deckt fünf Länder ab: Chile, Deutschland, Spanien, das Vereinigte Königreich und die Vereinigten Staaten. In allen fünf Ländern ist die Durchimpfungsrate (2. Dosis) in den ältesten Bevölkerungsgruppen am höchsten. Besonders hoch ist die Durchimpfungsrate (2. Dosis) mit 80 % oder mehr in der ältesten Altersgruppe in Chile, England, Deutschland und Spanien. Besonders niedrig ist die Durchimpfungsrate (2. Dosis) mit weniger als 20 % in der jüngsten Altersgruppe in Spanien und den Vereinigten Staaten. Die wöchentlichen Krankenhauseinweisungen oder die wöchentliche Krankenhausbelegung sind in allen Ländern in den ältesten Altersgruppen am höchsten. Die in diesem Bericht enthaltenen Daten aus Deutschland und Spanien zeigen jedoch, dass mit dem Anstieg der Durchimpfungsrate (2. Dosis) in der ältesten Altersgruppe im Laufe der Zeit die Zahl der Krankenhauseinweisungen oder -belegung gleichgeblieben oder zurückgegangen ist. In allen Ländern ist die wöchentliche COVID-19-Inzidenz in älteren Altersgruppen derzeit niedriger als in jüngeren Altersgruppen. Die in diesem Bericht enthaltenen altersgeschichteten Daten zur Inzidenz und zu Hospitalisierungen geben jedoch keinen Aufschluss über den Impfstatus der Infizierten und der hospitalisierten Personen.
Untersuchungen haben gezeigt, dass eine vollständige COVID-19-Impfung sowohl zur Verhinderung einer COVID-19-Infektion als auch zur Verringerung der COVID-19-Krankheitsschwere wirksam ist, einschließlich unter älteren Erwachsenen.[1, 2] Eine Analyse deutscher Daten hat gezeigt, dass zwischen Anfang Juni und Ende August 2021 vollständig geimpfte Personen in den Altersgruppen 18-59 und 60 Jahre und älter durchweg eine geringere Krankenhausbelegung aufwiesen als nicht geimpfte Personen derselben Altersgruppen.[3] Trotz der höheren Krankenhausbelegung und -einweisungen in der ältesten Altersgruppe ist die vollständige COVID-19- Impfung daher ein wirksames Mittel zur Verhinderung schwerer Erkrankungen unter jüngeren und älteren Erwachsenen.
Die in diesem Bericht vorgestellten Daten können von Entscheidungstragenden genutzt werden, um nicht geimpfte Bevölkerungsgruppen zu mobilisieren und COVID-19-Eindämmungsmaßnahmen anzupassen.
1. Problem Statement
Vaccinations against COVID-19 are a critical measure to reduce the risk of transmission and rates of hospitalization with severe disease. Even though vaccination uptake was initially high in countries with vaccine availability, a slowing down of the rate of vaccination is an observable trend in numerous countries where data is available. The desired levels of vaccination in the general population have, with a few exceptions, not yet been reached.
As demand for vaccinations is steadying, decision-makers need to inform individuals who are not, or not yet fully, vaccinated of the benefits of receiving a COVID-19 vaccination and completing the full vaccination course. Such benefits would be illustrated, for example, by a comparison of the vaccination status of hospitalized COVID-19 patients by age group. This data, however, is currently insufficiently available.
We report on COVID-19 incidence, hospitalizations and vaccination coverage stratified by age group as a proxy for vaccination status in five countries: Chile, Germany, Spain, the United Kingdom and the United States. The data presented in this report can be used by decision-makers to inform the adjustment of COVID-19 containment measures and to mobilize unvaccinated members of the population.
2. Epidemiological Situation
2.1 Weekly COVID-19 Incidence in Chile, Germany, Spain, the United Kingdom and the United States, Weeks 15- 35 2021 (Figure 1)
Weekly COVID-19 incidence per 100,000 population has been increasing in the United Kingdom since the end of May 2021 and started decreasing mid-July 2021. In August 2021 it started increasing again. In Germany, Spain and the United States weekly COVID-19 incidence has been decreasing since mid-April, but has increased since late June (in Spain and the United States) and early July 2021 (in Germany). Since early August 2021, it is decreasing again in Spain. Weekly COVID-19 incidence has been increasing and decreasing in Chile in April and May, but has been decreasing since June 2021. As of 5 September 2021, weekly COVID-19 incidence is at 17.06 in Chile, 87.84 in Germany, 98.27 in Spain, 346.25 in the United States and 364.78 per 100,000 population in the United Kingdom.[4]
2.2 Full COVID-19 Vaccination Coverage in the Total Population in Chile, Germany, Spain the United Kingdom and Spain, Weeks 15-35, 2021 (Figure 1)
As of 5 September 2021, full vaccination coverage was at 53.2% in the United States, 60.9% in Germany, 64.0% in the United Kingdom, 71.9% in Chile and 73.3% in Spain.[5]
3. COVID-19 Health Outcome and Full Vaccination Coverage by Age Group in Chile, Germany, Spain, the United Kingdom and the United States, Weeks 15-35, 2021 (Figures 2-4)
Across all five countries, weekly COVID-19 incidence is currently lower in older age groups and higher in younger age groups (figure 2).[6-10] Weekly hospital admissions or weekly hospital occupancy is highest in the oldest age group (figure 3).[7, 10-13] Full vaccination coverage is highest in the oldest population groups, ranging from around 70% in the United States to more than 90% in Chile and England. Vaccination coverage is particularly low at less than 20% in the youngest age groups in Spain and the United States (figure 4). However, data from Germany and Spain shows that as vaccination coverage in the oldest age group increased over time, hospital occupancy or admissions have steadied or decreased. [7, 14-17]
Figure 1: Weekly COVID-19 Incidence per 100,000 Population and Full COVID-19 Vaccination Coverage in the Total Population in Chile, Germany, Spain, the United Kingdom and the United States, Weeks 15-35, 2021
Figure 2: Weekly COVID-19 Incidence by Age Group in Chile, England, Germany, Spain and the United States, Weeks 15-35, 2021
Figure 3: Weekly COVID-19 Hospital Admissions, Hospital Occupancy and Cumulative Hospitalizations by Age Group in Chile, England, Germany, Spain and the United States, Weeks 15- 35, 2021
Figure 4: Full COVID-19 Vaccination Coverage by Age Group in Chile, England, Germany, Spain and the United States, Weeks 15-35, 2021
4. Selected evidence on differential disease severity among vaccinated and unvaccinated hospitalized COVID- 19 patients
Existing research has shown that receiving a full COVID-19 vaccination course is effective both in preventing COVID-19 infection and in reducing the severity of COVID-19 disease, including in older adults.[1, 2] Analysis from Germany shows that between early June and late August 2021, fully vaccinated individuals in the age groups 18-59 and 60 and older showed consistently lower hospital occupancy than those in the same age groups who were not vaccinated.1[3] A study from the United States shows that hospital admissions declined more in older population groups, who have higher vaccination coverage, than in younger population groups, who generally have lower vaccination coverage.[2]
5. COVID-19 containment measures in Chile, Germany, Spain, the United Kingdom and the United States, 1 May – 1 September 2021
This section only reports on COVID-19 containment measures regarding school closures and international travel. For a full overview of COVID-19 containment measures in the countries between early May and early September 2021, see the heatmap in Figure 5.2
School closures – Measures remained the same between May and September in Spain, the United Kingdom and the United States. In Germany, measures were loosened from June onwards, but tightened again in September. In Chile, measures were loosened in August.[18]
International travel measures –Measures remained the same from May until September in the United Kingdom and the United States. In Chile, Germany and Spain they were loosened in August.[18]
6. Variants of Concern
In Chile, variant of concern (VOC) Gamma (P.1) comprises approximately 33%, VOC Delta (B.1.617.2) approximately 29% and Variant of Interest (VOI) Mu (B.1.621) around 22% of sequenced cases.[19] In England, Germany, Spain and the United States, VOC Delta is predominant, comprising more than 90% of circulating variants.[20-23]
1 Data stems from notifications submitted by local health departments to Robert Koch Institute.
2 Due to the coding scheme applied by Our World in Data, the loosening and tightening of COVID-19 containment measures at the subnational level does not fully display in Figure 5.
1 May 2021 1 June 2021 1 July 2021 1 August 2021 1 September 2021
Chile
School Closures Required (all levels) Required (some levels)
Workplace Closures Required (all levelS9 Cancellation of Public Events Required cancellations
Restrictions on Public Gatherings <10 people 10-100 people
Stay-at-Home Requirements Required (few exceptions) Required (except essentials)
Public Transport Closures Required closing Recommended closing (or
reduce volume) Restrictions on Internal Movement Restrict movement
International Travel Controls Total border closure Quarantine from high-risk
regions
Germany
School Closures Required (all levels) Recommended Required all levels
Workplace Closures Required (some levels) Cancellation of Public Events Required cancellations
Restrictions on Public Gatherings <10 people 10-100 people
Stay-at-Home Requirements Required (except essentials) Recommended Required (except essentials)
Public Transport Closures Recommended closing (or reduce volume)
Restrictions on Internal Movement Recommend movement restriction
No measures
International Travel Controls Ban on high-risk regions Quarantine from high-risk
regions
Spain
School Closures Recommended
Workplace Closures Required (some levels) Recommended
Cancellation of Public Events Required cancellations Restrictions on Public Gatherings <10 people
Stay-at-Home Requirements Required (except essentials) Recommended Required (except essentials)
Public Transport Closures No measures Recommended closing (or
reduce volume)
Restrictions on Internal Movement Restrict movement No measures
International Travel Controls Ban on high-risk regions Quarantine from high-risk
regions
United Kingdom
School Closures Recommended
Workplace Closures Required (some levels)
Cancellation of Public Events Required cancellations Recommended
cancellations Restrictions on Public Gatherings <10 people
Stay-at-Home Requirements No measures
Public Transport Closures Recommended closing (or reduce volume)
Restrictions on Internal Movement Recommend movement restriction
Restrict movement No measures
Figure 5: Heatmap COVID-19 Containment Measures in Chile, Germany, Spain, the United Kingdom and the United States, 1 May – 1 September 2021 International Travel Controls Ban on high-risk regions
United States
School Closures Required (some levels)
Workplace Closures Recommended Required (some levels) Recommended
Cancellation of Public Events Recommended cancellations
Required cancellations Recommended cancellations
Required cancellations
Restrictions on Public Gatherings <10 people 10-100 people <10 people
Stay-at-Home Requirements Recommended
Public Transport Closures Recommended closing (or reduce volume)
Restrictions on Internal Movement Recommend movement restriction
Restrict movement International Travel Controls Ban on high-risk regions
7. Synthesis
This report describes COVID-19 incidence, hospitalizations and vaccination coverage stratified by age as a proxy for vaccination status, as vaccination campaigns in most countries began inter alia with the oldest age groups.
We covered five countries: Chile, Germany, Spain, the United Kingdom and the United States. Across all five countries, full vaccination coverage is highest in the oldest population groups. Vaccination coverage is particularly high at 80% or above in the oldest age group in Chile, England, Germany and Spain. Vaccination coverage is particularly low at less than 20% in the youngest age group in Spain and the United States. Weekly hospital admissions or weekly hospital occupancy is highest in the oldest age groups in all countries. However, data contained in this report from Germany and Spain shows that as vaccination coverage in the oldest age group increased over time, hospital occupancy or admissions have steadied or decreased. Across all countries, weekly COVID-19 incidence is currently lower in older age groups than in younger age groups. However, the age-stratified data on incidence and hospitalization contained in this report does not reveal the vaccination status of those infected and hospitalized.
Existing research has shown that receiving a full COVID-19 vaccination course is effective both in preventing COVID-19 and in reducing the severity of a COVID-19 infection, including in older adults.[1, 2] Analysis from Germany has demonstrated that between early June and late August 2021, fully vaccinated individuals in the age groups 18-59 and 60 and older showed consistently lower hospital occupancy than those in the same age groups who were not vaccinated.[3] Despite higher hospital occupancy and admissions in the oldest age group, full COVID-19 vaccinations are therefore an effective tool to prevent severe disease in younger and older adults.
The data presented in this report can be used by decision-makers to inform the adjustment of COVID-19 containment measures and to mobilize unvaccinated members of the population.
8. Methodology and Evidence Rating
The epidemiological evidence presented in this report builds on public data collected from a variety of sources.
Weekly COVID-19 incidence per 100,000 of the total population was calculated by the report authors on the basis of the dataset by Appel et al. from Our World in Data.[4] COVID-19 cases in the Our World in Data-dataset stem from the Center for Systems Science and Engineering at Johns Hopkins University. Vaccination coverage in the total population was calculated by the authors on the basis of Our World in Data’s vaccination dataset by Mathieu et al.[5] Data on COVID-19 containment measures stems from the Oxford COVID-19 government response tracker by Hale et al.[24] Readers should bear in mind that data on containment measures does not reflect actual implementation and adherence to measures at the population level and may not accurately represent differences in measures at the sub-national level. National data on weekly COVID-19 incidence, hospital occupancy, hospital admissions and cumulative hospitalizations as well as vaccination coverage by age groups stems from national data sources and was supplemented with data from the CoverAGE database.[25]
Population data required to calculate values per 100,000 population stems from the Human Mortality Database and was supplemented with national data, where required.[26-29] Data on variants of concern was collected from public national data sources.
Data on total population weekly COVID-19 incidence and vaccination coverage was complete for five out of five countries. Data on age-stratified weekly COVID-19 incidence, hospital admissions/hospital occupancy/cumulative hospitalizations and age-stratified weekly full vaccination coverage was complete for five out of five countries. Data on variants of concern was complete for five out of five countries (Table 1).
Table 1: Data Availability on Health Outcome by COVID-19 Vaccination Status in Chile, Germany, Spain, the United Kingdom. Green = data available, grey = no data.
Total Population Weekly COVID-19 Incidence and Vaccination Coverage
Age-Stratified Weekly COVID- 19 Incidence
Age-stratified Weekly Hospital Admissions/Hospital
Occupancy/Cumulative Hospitalizations
Age-Stratified full Vaccination Coverage
Variants of Concern
Chile Germany SpainUnited Kingdom
United States
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