By Marcel Gemme ~
What we know and what we don’t
As COVID-19 spreads and overtakes America, all eyes are watching its toll and wondering what will happen next. Unfortunately, we have a pretty good idea of what that will be, and it doesn’t look good. We’ve been able to track the virus since its initial human transmission in Wuhan, China. We know how it will spread, rates of infection, and, most importantly, rates of mortality. One thing we’ve known since China is that it will hit seniors the hardest. Older people and those with underlying health conditions are at a much higher risk of death should they contract the virus. But why is this?
Merely stating that people’s immune systems decline as they age doesn’t explain why or how this is happening. And it doesn’t do anything to help us be more informed so we can worry less or increase our chances of survival.
As senior housing facilities see record-low admissions and occupancy, many people are wondering what to do. Those in the middle of transitioning to retirement communities or long-term care facilities probably pumped the brakes and aren’t sure if or when they can move forward. Adult children may be unsure how to protect their parents and, if they care for them, scared that they will lose them or be the cause of their death. Fear exists at a palpable level. But what’s missing is real information on why older people are at higher risk, and how to best care for them during this time.
Factors in declining immunity
The first factor that comes into play is pre-existing conditions. These would be any chronic health conditions the person already had before contracting COVID-19. Respiratory and cardiac illnesses certainly don’t help one’s chances in a fight against a virus that attacks the lungs, but these conditions don’t just add to the risk themselves. They seem to say something about the body and its ability to fight off disease. Anyone who has a chronic, underlying condition is already operating with a compromised immune system because it’s busy fighting a war and has less available resources for something like COVID-19.
So, while age is a factor, maybe even more so is the person’s overall health and any pre-existing conditions. An eighty-year-old with few or no health problems has a much better chance of surviving the virus than someone who is 70 and has multiple chronic health problems. It isn’t age alone that sets risk. But why do older people develop these underlying conditions?
The Biology of Immunity
Older people’s immune systems aren’t as good at reacting to microorganisms they haven’t encountered before. The body has two primary attacks when it comes to invading pathogens and viruses. The first line of defense is known as leukocytes, which attack within minutes or hours of exposure. Leukocytes are essentially white blood cells and are the colorless cells that circulate in the blood and body fluids.
The next line is the T cells, which arrive as long as days later. These are another type of leukocytes which has targeted response for killing viruses and recruiting other cells to do so. As people age, their bodies produce fewer T cells, which produce virus-fighting chemicals. By puberty, people have ten times fewer T cells than they did during earlier youth. By the time we’re forty or fifty, there’s another tenfold decrease. And some of these remaining T cells are what is known as “memory T cells,” which means they’ve learned from previous exposure and can protect the person for decades. But as the body’s capacity declines for inexperienced T cells, which can learn and destroy new pathogens, there’s just less capability for winning more new battles.
Another factor that comes into play is the signal speed to the T cells to provide this targeted response. As people age, this communication becomes slower, which causes the T-cells to arrive too late. On top of this, the T-cells signal to other cells to mount an attack, resulting in inflammation.
While usually thought to be a bad thing, inflammation is an increase in blood and fluids which contain these pathogen-fighting cells to an injured or infected area. The chemical trigger they use to signal this flood is a group of proteins known as cytokines.
Arriving late and with bad communication, the T cells can get stuck, releasing too many cytokines. This phenomenon is known as a cytokine storm. Some health professionals believe this “storm” to be one of the leading causes of death among patients with coronavirus. The overproduction of cytokines leads to an exaggerated response, which results in hyper inflammation, which can kill, especially if that area is your lungs.
Other risks and helpful guidelines
Because of the above, conditions like obesity and heart problems are proving to be as dangerous as underlying respiratory conditions. Even diabetes is showing to lower people’s chances of surviving COVID-19. Anything which affects the body’s ability to absorb or transport oxygen, or mount an immune response, will increase one’s risk of mortality from the virus.
Recognizing these risks, the CDC has recently issued guidance that gives senior living facilities recommendations for how to deal with this pandemic. While the focus seems to be on restricting visitation and limiting non-essential workers and volunteers, it also includes sanitation guidelines.
Some may shortsightedly think that these businesses should close, but the need for senior housing is real, and most of the occupants have no other options. Anyone who has a loved one that’s already in a senior living facility should understand that the recommendation not to visit is for the safety of your loved one and the other residents. Senior living facilities maybe some of the safest environments so long as they remain isolated from visitors.
What can be done
Those taking care of an aging parent or loved one at home would be well advised to familiarize themselves with the new CDC guidelines for senior living facilities and follow their recommendations. Even if you aren’t worried about it, depending on the condition of your loved one, it may be necessary. If they’re at higher risk due to an underlying condition, their life may depend on it. Operating your home as though it were a long-term care facility may not sound fun, but it can make the difference between them surviving and not.
Similarly, treating oneself as a resident or worker will help ensure you don’t bring in the virus. Understanding how COVID-19 works can help make sense of the statistics. While it’s true that seniors are in a higher risk category should they contract the virus, this generality fails to account for individual health factors. Measuring a senior’s risk by their current physical health and existence of any underlying health conditions is more accurate. Senior living communities are needed, and safe so long as you follow proper guidelines. For those caring for their aging loved ones during this crisis, you are the healthcare front.
Sources:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3928693/
https://www.statnews.com/2020/03/30/what-explains-coronavirus-lethality-for-elderly/
https://www.vox.com/2020/3/12/21173783/coronavirus-death-age-covid-19-elderly-seniors
https://medium.com/@tomaspueyo/coronavirus-act-today-or-people-will-die-f4d3d9cd99ca
https://www.newscientist.com/term/cytokine-storm/
https://en.wikipedia.org/wiki/T_cell
https://www.cdc.gov/coronavirus/2019-ncov/community/retirement/guidance-retirement-response.html
