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Most Americans now know that the coronavirus that causes the respiratory disease COVID-19 is especially dangerous for the elderly and people in nursing homes.
Although people over 60 in good health might not consider themselves elderly or especially vulnerable, these are the individuals who should be central to efforts to reduce exposure and transmission of the disease.
It is important for governments to promote social distancing across every age group to break chains of transmission and slow the number of people who become sick. COVID-19 affects everyone.
The vast majority of people who have died from the infection have been over 60. In Italy, which has one of the oldest populations in the world, nearly three-quarters of deaths have been among people over the age of 70. Data from China also indicates that patients over the age of 60 were more likely to require intensive care.
If we could prevent these high-risk individuals over 60 (including the currently healthy ones) from becoming infected, it could greatly reduce strain on health care systems.
How do we know this?
One way is by learning from the experiences of South Korea and Singapore, which have experienced vastly different epidemics as compared with Italy. In both of these countries, cases have tended to occur in younger age groups. Correspondingly, fatality has been much lower.
What current data suggests is that we need active approaches to ensure that that the elderly don't become infected. It's good that states are posting guidelines for nursing homes, assisted living and other long-term care facilities and promoting policies that ban or limit visitors to these facilities, but this is not enough.
States should be actively monitoring these facilities to ensure that they are following guidelines and adhering to proper infection control practices. They should be proactively calling these facilities to determine how they are faring and what support they need.
We also need to ensure that these facilities are appropriately resourced to keep residents safe during the COVID-19 pandemic. These facilities should receive priority access to diagnostic testing. Staff should be regularly monitored to ensure that they are not ill.
Regulators must continually inspect to ensure these facilities have infection control specialists, enough staff to care for residents, and uninterrupted access to personal protective equipment and other medical supplies.
But importantly, we also need to protect seniors who live in our communities outside of long-term care facilities. We need much more public health messaging that is specifically tailored to older individuals.
While generic social distancing messages are helpful, these all-purpose messages can be more easily ignored than specific ones targeted to older adults.
Also, milquetoast messages like “try to stay home if you are over the age of 60” aren’t effective on their own without practical, actionable advice. An active 60- 70- or 80-year-old may not see himself or herself in this message or understand what it means to “try and stay home.”
In order to limit their circulation in public and stay home as much as possible, older adults may need assistance and support from employers, government, the private sector and younger individuals to help with food and necessity deliveries, assist with telework connections, and otherwise help facilitate online ways of connecting.
Seniors also need targeted and specific advice for how to protect themselves in the event that they do have to go out – such as frequent handwashing, consolidating trips, avoiding indoor places where people gather, using hand sanitizer and running errands during off-hours.
Beyond collective efforts to reduce a surge of cases, messages should also emphasize personal responsibility to protect themselves and reduce their potential need for hospitalization and scarce hospital resources.
Adults over 60 aren’t the only population at risk of developing severe illness, and potentially dying from COVID-19. Individuals of any age with underling health issues – such as lung and cardiovascular disease, hypertension, diabetes and cancer – are also at risk of severe outcomes.
More data needs to be gathered to have a better understanding of true risk factors for those with underlying health conditions. And as with other respiratory viral illnesses, there have been reports of deaths in otherwise healthy individuals.
But prioritizing resources and attention to the population most likely to produce the greatest number of severe illnesses has the best chance of preventing the overwhelming hospital surge we are seeing in the Lombardy region of Italy.
The intense social distancing interventions that have been put in place by governments across the country ask our society as a whole to join together in joint sacrifice to protect the most vulnerable.
Those most at risk should be given the resources to make sure they can protect themselves so that these unprecedented public health efforts are not wasted.
Dr. Tara Kirk Sell is an assistant professor in the Department of Environmental Health and Engineering at the Johns Hopkins University Bloomberg School of Public Health and a senior scholar at the Johns Hopkins Center for Health Security.