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As the coronavirus pandemic continues its relentless spread around the world, the greatest worry has been for older people. But experts stress that age is not the sole determinant of risk for severe illness or death.
"The elderly and people with chronic diseases have the highest risk. If you're not sure if you're at a higher risk, talk to your doctor," said Dr Susan Bleasdale, a spokesperson for the Infectious Diseases Society of America.
Even then, not everyone within a high-risk category faces the same level of risk. Dr Eduardo Sanchez, chief medical officer for prevention at the American Heart Association, said the risk exists on "a continuum".
For example, having heart disease is often cited as a risk factor. Heart disease encompasses a lot of conditions, including having a past history of heart attack, heart failure, irregular heart rhythms, peripheral artery disease, and even high blood pressure.
'Be more careful'
So, while people with any of those conditions has an elevated risk, typically, someone who's older and has severe heart failure is at a much higher risk of developing complications from a Covid-19 infection than a middle-aged person with high blood pressure.
Sanchez said he would even recommend that people who have conditions that increase the risk of heart and blood vessel disease – such as high cholesterol, diabetes or even prediabetes – "be more careful".
Groups at greater risk from the new coronavirus include:
Older people
Dr Lindsey Gottlieb, director of infection prevention at Mount Sinai Morningside in New York City, said, "Age seems to be the greatest consideration when considering who gets most sick from this virus."
She said that the risk appears to start going up around age 50 and just goes up from there, with the oldest people facing the highest risk.
Bleasdale explained that, "as we age, our immune system is altered, so it's important to stay as healthy as you can. Someone who's 70 and very active and healthy is probably at a lower risk than a less active person that age, but will still be at a higher risk than someone who is 45 years old."
But, that doesn't mean people who are younger aren't increasing their risk with unhealthy behaviours. For example, a 45-year-old chain smoker likely has a much higher risk of coronavirus complications than a healthier peer does.
People with lung diseases
This category includes a number of lung conditions, Bleasdale said. Some examples are:
- Asthma
- Chronic obstructive pulmonary disease (COPD), including emphysema and chronic bronchitis
- Pulmonary hypertension
- Smoking
"People who smoke can probably be thought to have some degree of lung disease. Smoking puts you at risk because it affects your defence mechanisms. Smoking affects the tiny little hairs – the cilia – [that help protect your airways]. They become somewhat paralysed from smoking," Bleasdale said, and when that happens, those little hairs can't help keep germs out.
People with heart and blood vessel diseases
Sanchez said, "For Covid-19 infections, we should be broad with what we consider cardiovascular [heart and blood vessel] diseases and cerebrovascular [brain and blood vessel] diseases that put people at risk."
- Heart disease, including a history of heart attack
- Chronic heart failure
- Build-up of plaque on the blood vessels
- A history of stroke
- Heart valve disease, with or without artificial heart valves
- Heart rhythm conditions, including atrial fibrillation
- Peripheral artery disease
- High blood pressure
- High cholesterol
"All of these constitute folks who need to be more vigilant and exercise a bit more care," Sanchez said.
People with diabetes
Bleasdale said that all types of diabetes can increase the risk of complications from a Covid-19 infection.
"Diabetes affects the immune system. Variability in blood glucose [sugar] affects the cells that help fight off infections," she explained.
The main types of diabetes include:
- Type 1 diabetes
- Type 2 diabetes
- Gestational diabetes
- Prediabetes
People with compromised immune systems
Bleasdale said that people who have weakened immune systems – and people taking medications designed to dampen their immune system – are at a greater risk from the coronavirus. Some examples include:
- People with cancer
- People with HIV/Aids
- People who had an organ transplant
- People taking high doses of steroids or medications called biologics, often for autoimmune conditions
Protect yourself and your loved ones
The steps that people with a higher risk need to take don't differ a lot from the standard advice. Wash your hands frequently and well. Try to keep your distance from other people, and don't touch your eyes, nose or mouth. Keep often-touched surfaces in your home clean – that includes door knobs, light switches, faucet handles, toilet flushes, remotes, keyboards and phones.
If you're having trouble finding hand sanitizer and need to go out, Sanchez suggested putting soap and water on paper towels and putting the wet paper towels in a sealable plastic bag that you can bring out with you.
Though it's not always easy, Gottlieb said, isolating is a good way to protect yourself. It's best to stay home and don't have people over right now. It's impossible to know right now if someone has been exposed to the virus.
If you have a doctor's visit scheduled, call ahead to make sure they still want you to come. Sometimes routine visits can be done over the phone or via telehealth. Gottlieb said it's also important to be up-to-date on vaccines, such as the flu shot.
Sanchez recommended making sure you have a supply of any medications you take on hand. A 90-day supply is ideal, but try to have at least a 30-day supply.
Forego visiting loved ones
Sanchez said it's important to try to stay as active as you can, too. "No one said you can't walk or exercise outside. It's really important for both physical and mental health. You can wave or talk to other people at a distance and enjoy the sunshine and greenery."
Gottlieb advised anyone going to visit a loved one to stay home if they have even an inkling that they might not be well.
One particularly difficult aspect of this isolation is the restrictions that long-term care facilities have had to implement. Many are asking friends and family to forgo visiting loved ones in nursing homes and assisted living facilities to protect these older people from the virus.
According to a statement from the American Health Care Association/National Center for Assisted Living: "Our priority right now is to prevent Covid-19 from getting into long-term care centres and if it does get in, to prevent it from spreading. We know it is difficult for friends and family to limit visiting, which is why we're encouraging remote communication, which can include Skype, texting, phone calls or messaging on social media."
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