COVID-19: If you’re older and have chronic health problems, read this

By now, you’ve probably heard this warning about the new coronavirus pandemic: those who are older and have a chronic medical condition are at increased risk for severe disease and death. If you fall into this category, here’s important information about the coronavirus outbreak tailored to you.

If you look at the data, older adults and those with chronic health problems who get COVID-19 are more likely to require hospitalization and admission to an intensive care unit. And so far in the US, 80% of the deaths from the new coronavirus virus have occurred in people who were older.

But this raises a number of questions:

• What do they mean by “older”?
• Which chronic diseases are most important?
• Why does older age and chronic disease increase your risk?
• What are you (or your loved ones) supposed to do if you’re at increased risk?

“Older” is more than a number

When it comes to coronavirus, the CDC’s magic number is now set at 65. That’s the age at which risk of severe disease, complications, and death from COVID-19 appears to rise. But while risk does rise with age, infants, children and adults under age 65 have become infected in significant numbers, and some have severe disease, so everyone needs to take precautions.

Which chronic diseases put people at higher risk from COVID-19?

What do health experts mean when they talk about chronic diseases that put some people at increased risk of severe disease with COVID-19? It varies, but generally includes people who have

• heart disease
• high blood pressure
• diabetes
• asthma or other chronic lung diseases
• HIV
• a suppressed immune system due to a disease or a treatment

Within these groups, there is much uncertainty. For example, if you had cancer years ago but are now in remission, are you at increased risk? What if your diabetes is mild and well controlled?

Why do older age and chronic disease increase risk for severe illness if a person gets COVID-19?

It’s not entirely clear, but here are some possibilities:

• An immune system weakened by age or illness is unable to fight off the virus, which could lead to an overwhelming infection.
• The immune system “misfires” or has an exaggerated response in some people, triggering so much inflammation and tissue damage that the immune reaction itself causes complications.
• Organ damage due to existing or past illness might make additional damage caused by the virus more than a person can handle; one example is smoking-related lung disease complicated by respiratory infection from the new coronavirus.
• The stress of a viral infection can increase demand on already damaged or aging organs (such as the heart).
• Medications taken to treat chronic conditions could increase the severity of infection. One suggestion (unproven so far) is that a family of medicines called ACE inhibitors allows more viral organisms to enter cells. ACE inhibitors are commonly taken by people with diabetes and hypertension, perhaps explaining why these conditions are linked to more severe disease.

We need more research to understand whether one or more of these is most important, or whether there are other factors at play.

What are you or your loved ones supposed to do to lower your risk?

While there is no way to completely eliminate risk, it makes sense to:

• Carefully follow the recommendations of health experts that apply to everyone, regardless of age or other risk factors, including:
  • Frequent handwashing (reminding others around you, also) and avoiding touching your face as much as possible
  • Social distancing (six feet of distance between you and anyone you don’t live with daily)
  • Avoid “emotional distancing” by using phones and apps to stay connected (some grandchildren or children can provide tech support by phone)
  • Wipe down “high-touch” areas of your home with approved household disinfectants
  • Stay home as much as possible
  • Avoid anyone who you know is sick
• Be especially attentive to managing your medical conditions
  • Take your medications exactly as prescribed
  • If possible, keep a 90-day supply of your medications on hand
  • Monitor your condition frequently (for example, talk to your doctor about home blood pressure monitoring, home blood sugar checks, or tests of lung function you can do at home)
  • Don’t smoke!
• Make sure your routine medical and nutritional needs are met by keeping adequate health supplies (such as a thermometer, acetaminophen, and a first-aid kit) and several weeks’ supply of nonperishable foods on hand.
• Maintain connections to family, friends, and your doctors so you don’t feel isolated.
  • Talk early and often about your medical or other needs with friends and family by phone or online.
  • Socialize! Whether by phone or online, connect with friends and family to commiserate, discuss current events, or play games.
  • Arrange to have someone check in on you regularly by phone, online, or in person.
  • Keep a “who-to-call” list on your refrigerator with phone number of close family members, caretakers, doctors, pharmacy, and the local board of health.
  • Give a set of keys to your home to a neighbor that you or your family members can call in case of emergency.

The bottom line

Much of what is recommended for older adults with chronic medical conditions is the same as what would be recommended even without the pandemic.

Yet there are still lots of things you can do to keep busy, maintain morale, and keep from going stir crazy. Get outside and go for walks. Call friends and family you’ve been meaning to call before this outbreak. Write that novel or haiku or letter to the editor you’ve been thinking about.

These are unusual times. Hearing that you’re at increased risk of severe illness from a rapidly spreading and potentially serious virus is frightening to say the least. One way to manage the fear and uncertainty is to take action: be prepared, take the advice of experts, and keep a positive attitude. That’s about the best you can do.

Follow me on Twitter @RobShmerling

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