Older adults and people with chronic underlying health conditions are more likely than younger, healthier people to experience serious illness from COVID-19, the disease caused by the coronavirus. Severe illness means that the person with COVID-19 may require hospitalization, intensive care or help breathing to overcome the illness. There is no specific age at which risk increases. Rather, the Centers for Disease Control and Prevention (CDC) says “risk increases steadily as you age” with the greatest risk for severe illness being among those age 85 and older. Eight out of 10 COVID-19 deaths reported in the U.S. have been in people 65 and older.
Part of the reason risk increases with age is that people are more likely to have other health issues later in life, and underlying health conditions are a huge driver of complications that arise from COVID-19. A June report from the CDC found that hospitalizations for people with COVID-19 were six times as high for patients with chronic health conditions, compared to otherwise healthy individuals; deaths among this population were 12 times as high.
People of any age with the following conditions are at increased risk of severe illness from COVID-19, according to the CDC:
- Serious heart conditions, such as heart failure, coronary artery disease or cardiomyopathies
- Chronic kidney disease
- COPD (chronic obstructive pulmonary disease)
- Obesity (BMI of 30 or greater)
- Sickle cell disease
- Immunocompromised state from solid organ transplantation
- Type 2 diabetes
People with the following conditions might be at increased risk for severe illness from COVID-19:
- Asthma (moderate to severe)
- Cerebrovascular disease
- Cystic fibrosis
- Hypertension or high blood pressure
- Neurologic conditions, such as dementia
- Liver disease
- Pulmonary fibrosis (having damaged or scarred lung tissue)
- Thalassemia (a blood disorder)
- Type 1 diabetes
- Weakened immune system from blood or bone marrow transplant, immune deficiencies, HIV, use of corticosteroids, or use of other immune-weakening medicines
The CDC has issued specific guidance for older adults and people at high risk for serious outcomes. Here’s what the agency recommends:
Avoid close contact with others
The best way to dodge a coronavirus infection is to avoid being exposed to the virus. Older adults and people with underlying health conditions are encouraged to limit interactions with people outside their household as much as possible and to take preventive measures when interactions do take place. Keep a distance of at least 6 feet from others; wash your hands often with soap and water (or use an alcohol-based hand sanitizer if soap and water are not an option); cover your coughs and sneezes; and disinfect high-touch surfaces often.
The CDC also recommends wearing a cloth face covering over your nose and mouth in public to help slow the spread of the virus. Widespread use of face coverings can help to slow or stop the transmission of the virus in communities.
It’s a good idea to draft a plan in case you do become sick, experts say. Identify a designated sickroom in your home that can be used to separate sick household members from healthy ones. And locate aid organizations in your community that you can contact for help should you need it.
Older Americans and adults who routinely take medications should make sure they have at least a 30-day supply of prescription medicines on hand to cut down on the number of trips you need to make to the pharmacy. It’s also important to have over-the-counter medications in the house to treat fever, cough and other symptoms, as well as tissues and common medical supplies.
If you need to run out for necessities, the CDC has guidance on how to do so safely. On the list:
- Wear a mask.
- Stay at least 6 feet away from others while shopping and while in line.
- Consider running your errands first thing in the morning or at the end of the day when fewer people are likely to be shopping. Some stores have special shopping hours for high-risk individuals.
- Disinfect your shopping cart or basket with disinfectant wipes.
- Use hand sanitizer right away if you handle money, a card or a keypad.
- Wash your hands when you get home.
- When getting gasoline, use disinfectant wipes on handles and buttons before you touch them; use hand sanitizer immediately after.
- Headed to the bank? Use drive-through banking services, automated teller machines (ATMs) or mobile banking apps for routine transactions that do not require face-to-face assistance as much as possible.
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What about travel?
Before you make travel plans be sure to double check any rules pertaining to your destination and mode of transportation. Several countries and states have travel restrictions or guidelines in place that could affect your trip — the same goes for airlines. It’s also important to note that “travel increases your chance of getting and spreading COVID-19” and that “staying home is the best way to protect yourself and others” from the virus, the CDC says.
If you do decide to travel, the CDC encourages travelers to study the current situation ahead of their trip to “learn if coronavirus is spreading in your local area or in any of the places you are going.”
For older adults and others at high risk for severe illness from a coronavirus infection, traveling can be dangerous, especially if you are in close contact with others. “People at higher risk for severe illness need to take extra precautions,” the CDC says.
There are a number of questions you should ask if you are thinking about traveling; if you decide to go forward with travel plans, the CDC has steps you can take to reduce your chances of getting sick:
- Avoid contact with others and keep a distance of at least 6 feet from people.
- Avoid touching your eyes, nose or mouth with unwashed hands.
- Wash your hands often with soap and water for at least 20 seconds or use an alcohol-based hand sanitizer that contains at least 60 percent alcohol.
- Wear a cloth face covering in public settings.
- Avoid contact with anyone who is sick.
Some travel-related activities are considered higher risk than others, including: going to a large social gathering like a wedding or funeral, attending a big event such as a concert, and traveling on a cruise ship or riverboat. If you participated in a higher-risk activity, you may want to get tested for COVID-19 afterward and take extra precautions to protect others around you.
The CDC also recommends making sure that you are up to date with your routine vaccinations before you travel, including the measles-mumps-rubella (MMR) vaccine and the seasonal flu vaccine. And do not travel if you are sick or if you have been around someone with COVID-19 in the past 14 days.
The virus is thought to spread mainly between people in close contact with one another by respiratory droplets when an infected person coughs, sneezes or talks, according to the CDC. Those droplets can land in the mouths or noses of nearby people or be inhaled into the lungs. And emerging research shows aerosol transmission (tiny exhaled particles that can linger in indoor air) may play an important role in the spread of the virus, which reinforces the importance of mask wearing, experts say.
According to the CDC, “the virus may be spread in other ways,” including by touching a contaminated surface or object and then touching your mouth, nose or eyes. However, this is not thought to be the main way the virus spreads, the agency maintains.
More and more studies show that COVID-19 can be spread by people before they start showing symptoms of COIVID-19 (presymptomatic) or even if they never develop symptoms (asymptomatic). Regardless, the CDC says the coronavirus is spreading “very easily and sustainably between people,” and “the more closely a person interacts with others and the longer that interaction, the higher the risk of COVID-19 spread.”
People with COVID-19 have reported a wide range of symptoms that typically appear two to 14 days after exposure to the virus. Here is the latest list of symptoms, according to the CDC:
- Fever or chills
- Shortness of breath or difficulty breathing
- Muscle or body aches
- New loss of taste or smell
- Sore throat
- Congestion or runny nose
- Nausea or vomiting
The CDC acknowledges this list is not exhaustive; skin rashes or lesions may also be a sign of the virus.
Health experts are asking anyone who experiences symptoms to call their health care provider or local health department for advice before seeking care to avoid spreading germs to others. Those who are feeling sick and are unsure of their symptoms can also check the CDC’s interactive guide for advice on appropriate medical care.
However, if you develop emergency warning signs — pain or pressure in the chest, new disorientation or confusion, a blue tint in your face or lips, difficulty breathing, or an inability to wake or stay awake — get medical attention immediately, health officials warn.
The CDC also has tips for what to do if you are diagnosed with COVID-19.
What do we know about minority populations?
Communities of color are disproportionately being affected by the virus and the illness it causes.
Black Americans, and American Indians/Alaska Natives and Hispanics, for example, are about five times as likely to be hospitalized for COVID-19 as their white counterparts, according to the CDC.
What’s more, these populations are experiencing higher rates of death from the coronavirus.
Experts point to several factors to explain these troubling trends. Minority populations are more likely to have jobs that put them at risk for exposure to the virus and chronic conditions that increase the likelihood of COVID-19 complications. They also have more barriers when it comes to accessing health care and testing, and are more likely to experience discrimination that puts them at increased risk for COVID-19, the CDC points out.
How is it treated?
Researchers are continuing to study potential and effective treatments for COVID-19. However, several promising developments have taken place:
The World Health Organization (WHO) on Sept. 2 issued new guidelines that strongly recommend the use of inexpensive and common corticosteroids such as hydrocortisone and dexamethasone for the treatment of patients “with severe and critical COVID-19.” The guidelines come after an analysis of several different clinical trials found that corticosteroids cut the risk of death in patients hospitalized with COVID-19. The data was published Sept. 2 in the Journal of the American Medical Association. The new guidelines emphasize that steroids should not be used to treat patients with mild symptoms of the disease. Additionally, the U.S. Food and Drug Administration (FDA) has granted emergency use authorizations (EUAs) for a few therapies to be used on some patients hospitalized with COVID-19.
Gilead Sciences’ antiviral drug remdesivir received an EUA from the FDA on May 1, shortly after the National Institutes of Health (NIH) announced preliminary results from an international clinical trial testing remdesivir as a potential treatment for COVID-19. Researchers found that patients with severe illness who received the drug recovered faster than those who received a placebo. “Results also suggested a survival benefit,” the NIH said in a news release. The mortality rate for the group that received remdesivir was lower than for the placebo group.
The EUA — which is not the same as official FDA approval — was broadened on Aug. 28 to include treatment of all hospitalized adult and pediatric patients with suspected or laboratory-confirmed COVID-19, irrespective of their severity of disease. “The data show that this treatment has the potential to help even more hospitalized patients who are suffering from the effects of this devastating virus,” FDA Commissioner Stephen M. Hahn, M.D., said in the latest announcement.
A second EUA for the treatment of COVID-19 came on Aug. 23 for the use of convalescent plasma in some hospitalized patients. This therapy injects a component of blood that contains antibodies from people who have recovered from a coronavirus infection into someone currently sick with COVID-19.
“The FDA determined that it is reasonable to believe that COVID-19 convalescent plasma may be effective in lessening the severity or shortening the length of COVID-19 illness in some hospitalized patients,” the agency said in a statement on the EUA. The FDA added that it also “determined that the known and potential benefits of the product, when used to treat COVID-19, outweigh the known and potential risks.”
What are prospects for a vaccine?
Several clinical trials testing the safety and effectiveness of potential vaccine candidates are underway, and three promising candidates are in phase 3 clinical trials: a vaccine from Moderna and the National Institutes of Health (NIH); one from BioNTech and Pfizer; and one from AstraZeneca and the University of Oxford. A phase 3 clinical trial is when researchers study the safety and effectiveness of the vaccine candidates against a placebo in a large population.
It’s hard to pinpoint when a vaccine will get the go-ahead from the FDA — that all depends on when scientists are able to collect enough data from the phase 3 clinical trials to know for sure whether the vaccine is safe and effective at preventing a coronavirus infection or decreasing its severity in at least 50 percent of vaccine recipients. (For comparison, the influenza vaccine is between 40 percent and 60 percent effective.) That said, most health experts say it’s reasonable to expect an approved vaccine by the end of 2020 or early in 2021.
The U.S. government, through its Operation Warp Speed project, has so far invested billions of dollars to ensure that if and when a vaccine is approved, hundreds of millions of doses will be readily available to the public. However, that does not mean everyone who wants a vaccine will be able to get one immediately. In a mid-September hearing before a Senate committee, CDC Director Robert Redfield predicted it will take six to nine months to get the public vaccinated. Public health experts and government leaders are working on distribution and prioritization plans; experts predict older Americans will be among some of the first to get the vaccine.
Will a flu shot provide protection?
There is no evidence that the flu shot or the pneumococcal vaccination will provide any protection from the coronavirus. Both, however, will increase your chances of staying healthy and out of the hospital during the pandemic, which is one reason why public health experts are strongly encouraging that Americans get their flu shots this fall.
Another reason? It is possible to get COVID-19 and the flu at the same time, since the two illnesses are caused by two different viruses, and that would likely mean “the severity of respiratory failure would be greater,” says Michael Matthay, M.D., professor of medicine at the University of California San Francisco.
Need a flu shot this year? Pharmacies, doctors’ offices and health departments around the country are offering them this year, and experts say mid-September through October is the best time to get vaccinated.
How can I take care of a sick friend?
Health officials stress that it’s important to take care of sick friends and neighbors in the community — and there’s a way to do so safely. If you are taking food to a neighbor, consider leaving it at the door. Since COVID-19 is most likely passed by respiratory droplets, this will eliminate the chance of the virus spreading.
If you are caring for someone who has COVID-19, keep a safe distance. Wash your hands often, wipe down high-touch surfaces and remind the person who is sick to wear a face mask. You should wear a face mask too. Offer to help with groceries and errands, if possible.
Finally: Watch for warning signs of serious illness. Call the doctor if the person’s condition worsens, and seek immediate medical attention if they have difficulty breathing, pain or pressure in the chest, new confusion, an inability to wake or stay awake, or blueish lips or face.
What if a loved one is in a nursing home?
Adults living in nursing homes and long-term care facilities are at high risk for severe sickness if infected with the coronavirus, which is why many facilities across the country are continuing to limit visitation. (You can check the status of nursing home visits in your state on AARP.org.)
If you have a loved one in a nursing home or long-term care facility, visit with them virtually: Stay in touch through videoconferencing, emails and phone calls. Send pictures or letters or drop off a care package. (Not all facilities may allow this, so check first.)
Also: Identify a point of contact on staff for when you have questions and concerns. Facilities are required by the federal government to alert residents, their families and the CDC within 12 hours if a case of COVID-19 is confirmed.
AARP has a list of six key questions to ask about circumstances at your loved one’s nursing home and questions for assisted living facilities — plus extensive coverage on the crisis in nursing homes. You can also track coronavirus cases and deaths in specific nursing homes on a website that the federal government unveiled on June 4. AARP is also keeping track of this data.
What is the advice on face masks?
The CDC is encouraging all Americans to wear cloth face masks or homemade face coverings in public settings and when around people who don’t live in their household — especially in situations when it’s difficult to maintain physical distancing — in an effort to help slow the spread of the coronavirus. Masks with one-way valves or vents that allow exhaled air to be expelled through holes in the material are not recommended, since they can facilitate in the spread of the virus. The same goes for surgical masks and N95 respirators, which should be reserved for health care professionals.
AARP has a tutorial on how to make a face mask at home.
What, exactly, is the coronavirus?
Coronaviruses, named for their crownlike shape, are a large family of viruses that are common in many species of animals. There are types of human coronaviruses, too, including some common ones that cause cold-like symptoms.
The virus at the center of the latest outbreak is being referred to as a novel (new) coronavirus, since it’s something that health officials have not seen before.
This story will be updated periodically with new developments in the global outbreak. Check back regularly.