How Coronavirus Affects Older Adults

Everyone is concerned about possible infection with the coronavirus, but the health stakes are highest for older adults. Normal aging of the immune system and underlying medical conditions make people 60 and up more vulnerable to severe respiratory illness from COVID-19. Although most people who are infected with the coronavirus only have a mild case that feels like a common cold, others can become very sick.

"The elderly are going to be the ones who become symptomatic," says Karen Hoffmann, an infection preventionist and immediate past president of the Association for Professionals in Infection Control and Epidemiology, or APIC. In particular, she says, older adults who also have existing conditions including lung disease, cardiovascular disease, cancer, diabetes or a transplant history are most likely to experience severe COVID-19 symptoms such as shortness of breath and fever.

"When they get an infection, any respiratory infection -- but particularly this new coronavirus, probably because they haven't seen this strain before -- they're going to have more severe disease, as they would with influenza," says Hoffmann, who is also a clinical instructor in the division of infectious diseases at the University of North Carolina School of Medicine at Chapel Hill. "That's what we're seeing so far."

[ SEE: Signs of a Cold You Shouldn't Ignore.]

Last week, the Centers for Disease Control and Prevention updated its traveler guidance in light of the increased risk of person-to-person spread of infectious diseases including COVID-19.

Older adults and those with underlying health issues are explicitly advised to avoid crowded places, nonessential travel like long plane trips and especially embarking on cruise ships.

"I would echo what has come out from both the CDC and Dr. (Anthony) Fauci at the National Institute of Allergy and Infectious Diseases, which is older adults -- and I think most of us -- should probably avoid areas where there are many, many people in extremely close contact," says Dr. R. Sean Morrison, a professor of geriatrics and palliative medicine at Mount Sinai Health System in New York City. "And the model for that is a large cruise ship."

If you're an older adult living within the community, extra vigilance and commonsense precautions help reduce your risk of being exposed to the coronavirus. This is the latest advice from health experts on how to protect yourself (and others) in public:

-- Hand-wash, hand-wash, hand-wash. Wash your hands frequently and rigorously. It takes at least 20 seconds to thoroughly wash your hands, ideally with soap and tap water. "If soap is not available, then (use) hand sanitizer with 60% alcohol," Morrison says.

-- Stay away from large gatherings. Avoiding mass gatherings and crowded settings, such as concerts, conferences and parades, is not only a self-precaution for older adults, but also a proactive measure that many locales and organizations are now taking by canceling or postponing planned events. Some workplaces and schools are temporarily turning to virtual classes and more telecommuting options to keep workers and students healthy.

-- Avoid sick people. If someone has symptoms such as sneezing, coughing or a fever, don't put yourself in the line of airborne droplets. " We are obviously telling older adults to stay away from people who have respiratory illnesses, even if it looks to be a minor cold or a seasonal upper respiratory infection," Morrison says.

-- Observe social distance. If you go out, maintain at least a 3-to-6-foot distance between yourself and others, particularly if someone seems sick. That's how far the coronavirus appears to spread when someone is coughing or sneezing, Hoffmann explains.

-- Use a barrier on public surfaces. That door handle or shopping cart bar has already been touched by countless strangers. Before you grab that surface, use a clean tissue as a barrier, Hoffmann suggests, and throw it away afterward. Or some grocery stores provide disinfecting wipes at the entrance, so wipe down the bar before grabbing your cart.

-- Practice respiratory etiquette. Cover your mouth when you cough or sneeze, either with a tissue or your inner elbow (not your hand). If you're sick, stay home or wear a mask in public settings like waiting rooms to protect those around you. (Handwashing is also a respiratory etiquette mainstay.) This isn't new, but standard for preventing the spread of infectious diseases including common colds, flu, pneumonia and now COVID-19.

-- Don't touch certain areas of your face. Your hands come into contact with many surfaces carrying thousands of germs throughout the day. While you're in public spaces, avoid touching the "T-zone" of your face -- your mouth, eyes and nose, which are mucous membranes where viruses can thrive, Hoffmann says. (However, it's OK to scratch you ear, touch your hair or rub your chin.)

-- Avoid any air travel if you can. "I'm recommending to my patients that if they don't have necessary air travel, to avoid it if at all possible until we know a little more about this," Morrison says. "You have a lot of people in confined spaces and you don't know how many people have sat and touched the seat that you're getting into."

-- If you must travel, go prepared. Morrison recommends taking alcohol wipes along, wiping down areas of the seat you'll be touching and leaving those sections wet for up to 30 seconds. Also, wash your hands carefully and routinely hand-sanitize. When you're in airport lounges or waiting areas, sit off by yourself rather than mingling with large groups of people.

-- Look at the situation where you live. Keep up to date on how the coronavirus is affecting your area. Take extra care everywhere, but be particularly mindful where current conditions indicate the infection is spreading. In addition to local media, you can check the CDC page on COVID-19, updated daily at noon with the latest case information.

-- Stock up on supplies and medications. Make sure you have everyday household items, groceries including non-perishable food and medical supplies on hand in case you need to stay home for a prolonged period. Ask your health care provider about getting extra prescription medications to tide you over.

Wearing a mask if you're sick may keep you from spreading infected droplets when you cough or sneeze. However, although masks are getting a lot of attention as potential preventive options, they're not particularly useful for healthy people.

"Wearing a mask, if you don't have symptoms, is not likely to protect you from getting ill," Morrison says. "Because, unless you've been well-fitted for one, there are enough gaps that the virus gets in."

If anything, wearing a mask as prevention could be counterproductive. "Every time you touch your mask with your hands, you're potentially transferring virus to a surface that is right up against your nose and mouth," Morrison says. "And it's staying there."

[ See: 8 Ways to Reduce Hospital Readmissions.]

For some people with a confirmed coronavirus case, symptoms have been mild or minimal. However, others have been hospitalized with severe breathing problems and have needed support from a ventilator. Some have died. As of Thursday, in the U.S., there have been 36 deaths from COVID-19.

Coronavirus testing is in relatively early stages in the U.S., with a lack of available testing supplies, so national statistics are probably still preliminary, Hoffmann says. However, she adds, more information can be gathered from what's happened in other countries like China, where there have been tens of thousands of coronavirus cases.

In China, the reported mortality rate from coronavirus infection has varied from 2.3% to 4%, slightly above the global mortality rate of 3.4% reported by the World Health Organization. However, the fatality rate is still changing as more cases are confirmed. Rates differ by country: In South Korea, the mortality rate is somewhere around 1%.

Age-related mortality differences in the U.S. may be similar to those in other countries. In a summary of findings on the outbreak in China, published Feb. 24 in Journal of the American Medical Association, although the overall mortality rate reported was 2.3%, that rate increased to 8% in those ages 70 to 79, and nearly 15% in those ages 80 and older.

For nursing home residents, maintaining proper infection control and a clean environment are essential for limiting the spread of infectious diseases. Semiprivate rooms in nursing homes, with two residents sharing a single bathroom and their living space separated only by a curtain, pose a challenge in terms of infection prevention. In addition, visitors may unintentionally spread infections.

If you have a loved one in a nursing home or other long-term care facility, you play a part in keeping them safe. To help protect against the spread of disease, you should:

-- Look around the room for any signs of uncleanliness, such as a dirty counters or overflowing trash.

-- Observe whether staff members wash their hands, for instance after working with your resident's roommate.

-- Ask about precautions being taken to protect against COVID-19 and speak up as needed.

-- Disinfect or wash your hands thoroughly when you arrive and leave. If you're visiting with children, make sure they wash their hands as well.

-- If you're experiencing any respiratory symptoms, even a mild cold, delay your visit.

This week, the Centers for Medicare & Medicaid Services issued revised guidance on coronavirus disease prevention and infection control in nursing homes. That includes stronger recommendations for restricting or limiting visitors. Recommendations include the following:

-- Facilities should actively screen and restrict visitation by those who meet criteria including: signs or symptoms of a respiratory infection such as fever, cough, shortness of breath or a sore throat; recent international travel to countries with sustained community transmission of COVID-19; recent contact with someone who has or is under investigation for COVID-19; and residence in a community where the coronavirus is spreading.

-- Facilities in or near counties where a COVID-19 case has occurred should limit visitation to certain situations to meet residents' unique needs. Other facilities nationwide are advised to allow but discourage routine visits. Facilities can consider offering alternative means of communication in lieu of visits.

-- In addition, facilities should increase visible signage at entrances and exits, offer temperature checks for visitors, increase hand sanitizer availability and personal protective equipment, like face masks, if they're available. Facilities should also provide instruction on hand hygiene and on limiting surfaces touched before visitors enter the facility and residents' rooms.

-- If visitation is allowed, facilities should suggest limiting physical contact with residents and others, and practicing social distance. If possible, facilities should create dedicated "clean rooms" near the entrance where residents and visitors can meet in a sanitized environment, after which the rooms would be disinfected.

-- Health care providers with signs and symptoms of a respiratory infection -- such as a fever, cough and sore throat -- should not report to work at a long-term care facility.

-- Any staff member who develops symptoms while on the job should immediately stop work, put on a face mask, self-isolate at home, inform the facility's infection control personnel and give details on people, equipment and locations with which they've come into contact. In addition, they should reach out to their local health department and follow recommendations on testing and treatment locations.

-- If a resident has a suspected or confirmed COVID-19 infection, facilities should contact the local health department and determine whether the resident's symptoms are severe enough to require transfer to a hospital or evaluate other options. In the meantime, infected or possibly infected residents should be isolated in a room with the door closed.

Nursing homes that have a higher number of skilled nursing beds (capacity to provide specialized treatment) for people who are extremely ill -- for instance, facilities that take more residents who need ventilators -- could see the worst cases of COVID-19 occur, Hoffmann says. "The more severely ill you are before you get this virus, the more likely it is that you're going to have a worse outcome."

[ See: Must-Ask Questions When You're Choosing a Nursing Home.]

Healthy older adults who don't have underlying medical conditions represent a gray area, in that their level of risk isn't certain. With only a few months of experience dealing with the new coronavirus in the U.S, much still remains unknown, Morrison says.

"We're erring on the side of caution until we know a little bit more, rather than assuming the best-case scenario: that healthy older adults are at the same risk as younger people," Morrison says. "That is in the best interests of our patients, our families and our community."