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As the COVID-19 pandemic—caused by the novel coronavirus—continues unfolding around the globe, expert guidance continues changing as we learn more about the viral illness.
And while everyone should practice good infection-control practices, such as proper hand hygiene, it’s especially important for those at higher risk.
It appears that COVID-19 causes mild to moderate symptoms in most people who are infected, but a February World Health Organization report found that those older than 60 or with pre-existing medical conditions are at higher risk for severe disease and death. These medical conditions include high blood pressure, diabetes, cardiovascular disease, chronic respiratory disease, and cancer, among others.
Right now, it's difficult for researchers to determine what percentage of people with COVID-19 die, because they don't yet know exactly how many people have been infected. Estimates are as high as 3 percent, but some experts suspect the death rate could ultimately turn out to be less than 1 percent.
Still, death rates from COVID-19 are likely to be higher in older adults. The WHO report found that in China, where the novel coronavirus first arose, almost 22 percent of infected people ages 80 and above died. The numbers from the Chinese Center For Disease Control and Prevention were somewhat different but still concerning: That agency found that nearly 15 percent of infected people ages 80 and above died, along with 8 percent of those in their 70s and 3.6 percent of those ages 60 to 69.
“We know immune systems change with age, making it harder for you to fight off diseases and infection, even if you’re otherwise fairly healthy,” says Michael Hochman, M.D., director of the Gehr Family Center for Health Systems Science and Innovation at the Keck School of Medicine of USC in Los Angeles.
“When you have an underlying chronic condition, it can make it harder for your body to fend off and recover from infection,” he adds.
Given these factors, experts say that it’s imperative that anyone at higher risk for COVID-19 take specific precautions, even if there are no obvious outbreaks in their area.
“We just don’t know right now how many people in a given community have or have not been exposed to the virus,” says Sean Morrison, M.D., chair of the Brookdale Department of Geriatrics and Palliative Medicine at the Mount Sinai Health System in New York City. That’s why it’s best to err on the side of caution at this point, he stresses. Consider these steps if you or someone you love is at higher risk for COVID-19:
Stay Home
If you’re high risk, the Centers for Disease Control and Prevention recommend that you skip traveling for the moment and stay away from crowds, especially in poorly ventilated spaces with little air circulation, which makes it easier for the virus to spread.
It’s also wise to limit all outings—even those to the grocery store. A better bet is to order what you need online, or have a friend or family member run your errands for you.
If you must go out, the CDC advises that you avoid contact with “high-touch” surfaces, such as elevator buttons, door handles, and handrails. Use a tissue or your sleeve instead, then wash your hands as soon as possible.
Limit Your Visitors
For now, try to restrict access to your house to only the people who live with you, because even people without symptoms may unknowingly spread the virus.
Don't allow anyone who seems sick or who knows they've been exposed to the coronavirus to visit. And if you do have guests, “make it a rule that the first thing anyone does when they walk in your house is wash their hands,” advises Morrison.
If possible, maintain a distance of at least 6 feet away from them. Morrison also recommends that you clean and disinfect anything guests may have touched, including tables, doorknobs, light switches, faucets, even toilets, after they leave.
Sticking close to home and cutting back on guests for a long period of time can be challenging, so it’s important to find alternate ways to stay active and interact with others. “Social contact is important to maintaining overall well-being,” says Ronan Factora, M.D., a specialist in internal medicine and geriatrics at the Cleveland Clinic.
FaceTime or Skype with friends or family who live elsewhere, set up a virtual book or game club with neighbors, or consider enrolling in an online course to keep your mind occupied.
And move around: It’s fine, for example, to go for a walk outdoors and stop and say a quick hello to neighbors as long as they aren’t sick. But try to keep a safe distance, don’t shake hands, don’t touch your face, and wash your hands as soon as you go back inside.
Be Scrupulous About Hand Hygiene
“No matter how much you clean, you can’t disinfect everything—nothing is sterile unless you’re in the operating room,” Factora said. And all it takes is touching a hand, if contaminated, just once to your eyes, nose, or mouth for the virus to gain access to your body.
Generally, washing with soap and water is best, for at least 20 seconds (hand sanitizer with at least 60 percent alcohol will do if soap is unavailable).
The most thorough method: Wet your hands, put soap in the palm of one hand, rub both palms together, then rub the back of each hand with the palm of the other hand, interlocking fingers, says Igor Koralnik, M.D., chief of neuro-infectious diseases and global neurology at Northwestern Medicine in Chicago.
Follow by rubbing each thumb in a circular fashion before rubbing the tips of your fingers against the palm of your other hand. This will allow you to clean under your rings and nails.
Rinse and dry hands, and turn off the faucet using a paper towel, to avoid touching the handle.
The CDC recommends washing hands before eating, and after using the bathroom, blowing your nose, coughing, or sneezing, touching a pet or their food, or touching the garbage or its handle. You should also wash your hands whenever you’ve returned home, and after anyone has visited your home, says Morrison.
Skip Nonessential Healthcare Visits
Unless you have a pressing need to be seen by a doctor or provider, put it off or consider alternate ways of getting that care.
“If you have a routine appointment, cancel it, or see if you can conduct it instead via telephone or video,” says Morrison.
Note that Congress recently passed a bill that allows physicians and other health professionals to bill Medicare to cover telemedicine visits to seniors. It's not yet clear whether this is only for coronavirus-related concerns or any health issues.
Have a 'Sick' Plan
Put together an up-to-date list of emergency contacts for family, friends, neighbors, and healthcare providers—people you can reach out to if you or someone in your family falls ill.
It’s a good idea to also identify a few people who can check in on you by phone or email daily if you live alone.
In addition, keep at least a 30-day supply of your regular prescription medications on hand, advises Morrison.
Many private health insurance companies are now allowing people to get early prescription refills, and the Centers for Medicare & Medicaid Services is permitting Medicare Part D and Medicare Advantage plans to relax their “refill-too-soon” prescription rules.
Make sure you also have drugstore items you’ll need if you do get sick, such as a pain reliever like acetaminophen and a thermometer. As for other supplies, you don’t need to buy out the toilet paper aisle at Costco, but it is good to have enough household staples and groceries on hand. That way you can manage if you’re unable to have someone go out and get supplies for you. Or you can have them delivered, even just for a few days.
If you develop symptoms that may signal COVID-19, such as a fever, cough, or shortness of breath, the CDC recommends calling your doctor right away. Don’t simply show up; your doctor may have a specific protocol in place for anyone who may have COVID-19. “Our center immediately masks and isolates in a separate room anyone who has respiratory symptoms,” says Morrison.
Because there’s still a shortage of test kits, most healthcare providers won’t test you for coronavirus unless you have severe symptoms.
If your symptoms are mild, stay home, rest, and drink plenty of fluids. For aches and fever, Hochman suggests acetaminophen, which is less likely to cause stomach bleeding in older adults than some other over-the-counter pain relievers. If you live with others, stay in a specific room and use a separate bathroom, if possible, and if you have to interact with others (including your pets) wear a face mask if you have them.
Contact your doctor immediately if you or a family member experiences difficulty breathing, persistent chest pain or pressure, confusion, or bluish lips or face. If you think it’s an emergency, call your local emergency number immediately.
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