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Older Adults Are Encouraged to 'Shelter in Place' as States Start to Reopen

New guidelines stress high-risk individuals should continue distancing measures

closed sign in the front window of a storefront with a handwritten note added that says til ban lifts referring to the stay at home order imposed by the state

SETH HERALD/AFP via Getty Images

En español | Older adults and people with chronic health conditions around the country should continue to stay home and practice physical distancing as much as possible, even as some states and cities move to relax restrictions around slowing the spread of the coronavirus.

The advice stems from a set of guidelines that President Donald Trump introduced on Thursday — a road map, of sorts, that state and local leaders can use to reopen their communities with “a phased and deliberate approach.” The guidelines, called “Opening Up America Again,” recommend a three-stage plan for “reentering into normality,” as White House coronavirus task force member Anthony Fauci, M.D., put it in a Thursday evening press briefing.

"The dominating drive” of the plan, said Fauci, who leads the National Institute for Allergy and Infectious Diseases, is to “make sure that this is done in the safest way possible” and to protect the country's most vulnerable, including older adults and people with underlying health conditions, who are at increased risk of serious complications from COVID-19, the illness caused by the coronavirus.

Trump emphasized that it will be up to the country's governors to decide when to reopen their states and that he expects some, including areas hit hardest by the virus, will take longer than others to do so. If state and local officials follow the guidelines, here's what things might look like:

Older adults, high-risk populations continue to distance

Once a state or county can demonstrate that the number of people who report symptoms and the number of positive tests for COVID-19 have declined for at least 14 days, leaders can move into three consecutive phases that gradually relax restrictions and slowly reopen schools, restaurants and other businesses, and permit visits to senior living facilities and elective surgeries. The plan specifies that hospitals also must be able to “treat all patients without crisis care” before starting the reopening process.

The guidelines, however, are based on the expectation that individuals continue to exercise good hygiene and stay home when they are feeling sick. Cloth face coverings in public also are advised. “You want to call it ‘the new normal’ — you can call it whatever you want. But even if you are in phase one, two, three, it's not, ‘OK, game over,'” Fauci said. Keeping up the everyday health precautions that public health officials have stressed since the start of the coronavirus outbreak is “going to be a way that we protect ourselves,” he added.

In the first two phases, older adults and people with underlying health conditions — including those with high blood pressure, chronic lung disease, diabetes, obesity, asthma and a compromised immune system — should continue to shelter in place, according to the guidelines. What does this mean? Stay home and away from other people as much as possible to limit your exposure to the virus.

The guidelines don't specify an age for these continued shelter-in-place recommendations. Data from the Centers for Disease Control and Prevention (CDC), however, show risk for severe illness and death from COVID-19 is highest in people 65 and older.

Employers are encouraged to make special accommodations for the high-risk population — telework is encouraged for all workers, if possible, during the first two phases — and people who live with someone considered at high risk are reminded that “by returning to work or other environments where distancing is not practical, they could carry the virus back home.” Therefore, “precautions should be taken to isolate from vulnerable residents.”


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'We're not out of the woods yet’

How long will these two phases last? That depends on where you live and what's happening in your community. Some states, Fauci said on Thursday, may be ready to start the first phase of the guidelines now. “It will be staggered. Not every state, not every region is going to do it at the same time; that's clearly obvious because of the very dynamics of the country,” he added.

As long as infection levels remain low and communities continue to meet the safety checkpoints outlined in the plan, areas can advance to the next phase. A rebound in cases, however, may require reinstating restrictions.

"We're not out of the woods yet,” said Laura Perry, a primary geriatrician and assistant clinical professor in the Division of Geriatrics at the University of California, San Francisco. “That's what I'm telling my patients: Keep up the precautions” even if some regulations are eased in your area.

These precautions include limiting trips out in public, or at least making “those trips as infrequently as possible,” Perry said. “It's better to do one big grocery shop every two weeks than to go every other day, because then you'll run into fewer people.”

If you do go out, wear a cloth mask or face covering, avoid touching your face, and wash your hands as soon as you can. Perry also suggested wearing an outer layer of clothing, such as a jacket or sweatshirt, that you can take off and leave by the door as soon as you get home to minimize the likelihood of bringing germs into the house.

"These kinds of personal activities or habits will continue to be really important for people at higher risk of severe illness,” agreed Caitlin Rivers, senior associate at the Johns Hopkins Center for Health Security and assistant professor in the Department of Environmental Health and Engineering at the Johns Hopkins Bloomberg School of Public Health.

As hard as it may be to continue missing out on visits with grandchildren and lunches with friends, “all of these behaviors and activities are going to continue to reduce your risk” of a coronavirus infection, Rivers said.

Phase three of the government's guidelines gives the green light for vulnerable populations to “resume public interactions.” Practicing physical distancing and limiting time spent in crowded environments, however, is still encouraged “because we know that we still have an issue with asymptomatic spread,” said Deborah Birx, M.D., the response coordinator of the White House coronavirus task force. Some experts say on-and-off physical distancing may be needed into 2022 to limit a resurgence of coronavirus cases.


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Testing, tracing will be key to reopening

Without a vaccine, testing people for coronavirus infections — and tracing those who are at risk for one — is crucial for getting the country back to normal.

"You can't just relax physical distancing interventions in the absence of knowing where you are in the epidemic because you'd lead to enormous resurgence and a lot of deaths,” Caroline Buckee, associate professor of epidemiology and associate director of the Center for Communicable Disease Dynamics at the Harvard T.H. Chan School of Public Health, said in a recent call with reporters.

Health officials are focused on two different types of tests when it comes to resuming normalcy: diagnostic and antibody. Diagnostic tests identify people who have a coronavirus infection. A positive result lets them know they need to self-quarantine so they don't spread the virus to others. And in hospitals, determining which patients are infected helps health care workers know when they need to wear personal protective equipment, which is in short supply.

Antibody tests can tell whether a person was already infected with the virus. Many people do not experience symptoms of COVID-19, and knowing who had the virus but wasn't sick can pinpoint people who may be in the clear to return to work. Though scientists are still working to better understand immunity to the virus, many speculate that someone who has been infected is less likely to catch the virus again and pass it on to others.

Under the president's new guidelines, states are responsible for setting up screening and testing sites for people with and without symptoms of COVID-19, and tracing the recent contacts of people who test positive. Many point out, however, that testing capacity is still lagging.

"What is key in this is the early alerts and getting in there before they even know they have a problem,” Birx said during Thursday's briefing. This is especially important “for asymptomatic individuals in communities that we know are particularly vulnerable,” such as senior care facilities.

Tracing close contacts of people who test positive for the coronavirus is also vital to containing its spread. Buckee said this public health practice is an “additional layer,” and that when used with other interventions, such as physical distancing, helps protect people who are most vulnerable for COVID-19 complications.

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