En español | In a pandemic filled with grim statistics, one of the grimmest has gone largely unnoticed: 95 percent of COVID-19 deaths in the U.S. have occurred among people who were 50 or older. This even though the majority of coronavirus cases have been reported in people under age 50.
The unnerving numbers don't end there. About 8 in 10 deaths have been among people 65 and older, according to the latest demographic data available from the Centers for Disease Control and Prevention (CDC). Overall, in just a matter of months, the coronavirus has infected 9 million Americans and killed more than 229,000.
"It's devastating, what's happening,” says Sharon Inouye, a professor of medicine at Harvard Medical School and a geriatrician at Hebrew Senior Life in Boston.
The 95 Percent
Coronavirus cases and deaths by age group
Warning signs emerged early
It was an already trying spring evening — at the peak of New York's coronavirus crisis — when medication, morale and masks were all running low at Brooklyn Hospital Center. Yet sick patients kept coming in, “one after another, after another,” recalls James Gasperino, M.D., the hospital's chair of medicine and chief of critical care.
"I just couldn't believe how many new people were coming in that night, incredibly sick, requiring mechanical ventilation,” he says. “It was overwhelming."
Over time, Gasperino saw the entire hospital transform into a makeshift intensive care unit to accommodate all of the critically ill coronavirus patients. While some were indeed young, the vast majority of those bearing the brunt of COVID-19's wrath were older adults.
More than 1,600 miles away from Brooklyn Hospital Center, Faisal Masud, M.D., has dealt with a similarly dire situation at Houston Methodist Hospital, where he is the director of critical care. Masud describes the COVID-19 patients he's seen as “very complex” and “very, very sick.”
"They needed so much care,” he says. They have also needed emotional support. Similar to Brooklyn Hospital Center, a large share of patients who have received intensive care for COVID-19 at Houston Methodist were 60 or older. And despite being able to connect with their loved ones virtually, they are unable to see or say goodbye to their spouses, children, grandchildren, nieces or nephews in person once they enter the hospital.
"They don't get to hug them. They don't get to hold their hands,” Masud says.
COVID-19 runs rampant in nursing homes
As difficult as the situation has been in hospitals nationwide, long-term care facilities are shouldering an even larger burden. More than 61,000 nursing home residents have died from COVID-19 in the U.S., according to data from the Centers for Medicare and Medicaid Services (CMS). Factor in residents and staff from assisted living and skilled nursing facilities, and the number shoots up to about 84,000, according to the Kaiser Family Foundation — or nearly 40 percent of all U.S. coronavirus deaths. And the death toll continues to climb.
Since the beginning of the pandemic, AARP has called on policymakers to improve transparency, collect consistent data and prioritize testing and quality care for residents and staff in nursing homes. As a continuation of its efforts, AARP's Public Policy Institute, in partnership with the Scripps Gerontology Center at Miami University in Ohio, recently launched the AARP Nursing Home COVID-19 Dashboard to aggregate and analyze data pertaining to cases, deaths, necessary equipment and staffing shortages in facilities throughout the country.
"Transparency has never been more important,” says Susan C. Reinhard, senior vice president and director of the AARP Public Policy Institute. “We created the dashboard with data updated monthly to provide a window into states’ progress in protecting nursing home residents and staff from this deadly disease."
Chronic conditions, aging immune systems create perfect storm
One reason COVID-19 seems to be especially lethal in older adults is the prevalence of chronic disease. Eighty percent of older adults have at least one chronic health condition, and a number of these common diseases — from obesity to cancer — are known to complicate a coronavirus infection and worsen the severity of COVID-19.
Another explanation: immune function. The immune system naturally weakens with age, making older adults more susceptible to infections and less capable of fighting them off.
"Every organ system changes,” Harvard's Inouye explains. “Our lungs don't have as good ventilatory and clearing capacity, our kidneys don't function quite as well, our liver doesn't function quite as well. And so once we get sick with COVID, we don't have all those layers and layers of resiliency that we do as a younger person."
Introduce a new virus to the mix — one the body hasn't met before and has no defenses against — and “it can just overwhelm the system,” Inouye adds.
As far as long-term care centers go, the CDC says their “communal nature” — with a lot of people living and working together in a confined, indoor space — creates an environment ripe for rapid spread of a pathogen like the coronavirus. Plus, residents in these facilities tend to be frailer and have more complex health conditions than older adults living on their own, making it more difficult for them to fend off a new infection.
What's more, nursing homes across the country have reported shortages of medical-grade masks, gowns, gloves and other forms of personal protective equipment that help to block the transmission of the virus, an AARP analysis finds. Staffing shortages are also on the rise in these facilities, which is not ideal when it comes to limiting person-to-person contact.
"Older Americans are taking COVID very seriously and are paying very close attention to the news on this, and we are seeing that show up in poll after poll,” says Bill Sweeney, senior vice president of government affairs at AARP. “They are demanding that their elected officials take this pandemic seriously, as well."
Improvements in treatment bring hope
One reassuring trend: While COVID-19 infection rates are greater now than they were between April and June, and hospitalizations continue to remain highest among older adults, the death rate has declined since the first few months of the outbreak, according to CDC data. “We're getting better at knowing how to treat COVID,” Inouye says.
The Food and Drug Administration recently approved the antiviral drug remdesivir for the treatment of COVID-19 in some hospitalized patients, and a handful of other therapies have been shown to help some seriously ill patients recover, including common corticosteroids, such as dexamethasone. Techniques such as proning (positioning patients on their stomachs) and the use of nose prongs or face masks to deliver oxygen have also aided in the recovery of hospitalized patients.
"We just know a lot more now clinically about the disease and how to manage it,” Inouye says. And with the likelihood that a vaccine will prove safe and effective in the not-too-distant future, things are “looking hopeful,” she adds.
But there's still a lot to learn about how patients — particularly older ones — recover from COVID-19 after hospitalization. A growing number of coronavirus survivors report lingering symptoms of the illness, long after the virus has run its course. Houston Methodist's Masud says many older adults “can't function” the way they used to before COVID-19. “They can't walk around, they still can't catch their breath. We're finding out that the lungs take a hit with scarring. We're finding out that a lot of them have memory issues,” he adds.
Determining the types of ongoing care these patients need and the best way to provide it has become a focus for many doctors now. “How are we going to manage these patients who made it alive, but [the virus] still has so much impact on their lives?” Masud asks.
Older adults must ‘remain vigilant’
In the meantime, older adults can take a number of steps to reduce their risk of illness and death from COVID-19. Continue to limit in-person interactions as much as possible, and when you do need to go out in public, avoid crowded indoor areas, wear a mask and keep at least 6 feet of space between yourself and others.
"I would say our greatest impact on quelling the COVID pandemic, certainly in New York, was through non-pharmacological interventions,” Brooklyn Hospital Center's Gasperino says.
Also: If you have a chronic health condition, make sure you are managing your disease. Stay on top of the medications your doctor has prescribed you, and be sure to eat healthy, manage your stress and get plenty of exercise, says Paula Lester, a geriatrician at NYU Langone Health.
In addition to physical health, the pandemic has taken a toll on the mental health of many older adults. A new report from the University of Michigan's National Poll on Healthy Aging shows more than twice as many older adults reported feeling isolated from others between March and June of this year, compared to 2018. And the proportion of people 65 and older who say worry or stress related to the coronavirus has had a negative impact on their mental health increased from 27 percent in March to 47 percent in July, research from the Kaiser Family Foundation shows.
Lester says staying connected with friends and family “in a way that's safe” is crucial during these trying times. In March, AARP launched its Community Connections platform to help older adults who are feeling isolated, depressed, overwhelmed or anxious connect with friends, family and volunteers.
"We may need to be physically isolated, but we don't have to feel alone,” says Andy Miller, senior vice president of AARP Innovation Labs. “Through this innovative platform, people in need of help from — or who want to offer help to — their communities are empowered to engage. In this unprecedented time, AARP remains committed to helping the 50-plus population, and AARP Community Connections is one more way we're innovating to improve our communities."
In addition to maintaining social connections, keeping up with prevention measures, no matter how tiring they get, is equally important for older adults, Lester says.
"We still have to remain vigilant. And it's hard. It's hard to stay vigilant and separate for so long,” she says. “But the better we do it now, the shorter we will have to deal with it in the long term.”
COVID-19 and underlying medical conditions
People with the following conditions are at increased risk for severe illness from COVID-19:
- Serious heart conditions, such as heart failure, coronary artery disease or cardiomyopathies
- Chronic kidney disease
- Chronic obstructive pulmonary disease (COPD)
- Obesity (BMI of 30 or greater)
- Severe obesity (BMI of 40 or greater)
- Sickle cell disease
- Type 2 diabetes
- Weakened immune system from solid organ transplantation
People with the following conditions might be at increased risk for severe illness from COVID-19:
- Asthma (moderate to severe)
- Cerebrovascular disease
- Cystic fibrosis
- High blood pressure
- Neurologic conditions, such as dementia
- Liver disease
- Overweight (BMI between 25 and 30)
- Pulmonary fibrosis (having damaged or scarred lung tissue)
- Thalassemia (a type of blood disorder)
- Type 1 diabetes
- A weakened immune system from blood or bone marrow transplant, immune deficiencies, HIV, use of corticosteroids or other immune-weakening medications