The Coronavirus, or COVID-19, continues to grab daily if not hourly headlines throughout the Rhode Island, Massachusetts and Connecticut area. COVID-19 stands for coronavirus disease 2019 and is caused by a virus named SARS-CoV-2. SARS is an acronym for severe acute respiratory syndrome.
As the hysteria continues over COVID-19, we are being treated to hourly updates on the number of those testing positive as if we are keeping score at a sporting event. For most people, this virus appears to be handled rather well by their bodies, and they exhibit mild symptoms that do disappear after a week or two. But rather than focus on this aspect of COVID-19, the press chose instead to sensationalize the virus, which has led to fear and the spread of misinformation.
At last, the press has begun reporting that COVID-19 overwhelmingly affects the elderly and those with serious pre-existing conditions. Although this has been known for weeks, press reports focused on the general population as a whole and seemed to ignore what was obvious in countries where the virus was running rampant. The problem with that is that anxiety was created among the public leading to panic buying of sanitation products. These resources should have been initially aimed at the most vulnerable targets of COVID-19, mainly the skilled nursing community, assisted living residences and affordable housing programs for the elderly and disabled, and seniors living in the community. Instead, many in this group are now unable to find these products.
Before we discuss this further, let's look closer at COVID-19 and why it attacks seniors and especially those with underlying health conditions.
The first symptoms of COVID-19 are similar to all respiratory illnesses — fever, a dry cough and shortness of breath. Dr. Carlos del Rio, a professor of medicine and global health at Emerson University, has been in close contact with colleagues who were treating virus patients in Europe and Asia. "Some people also get a headache and sore throat," del Rio stated. Fatigue has also been reported — and less commonly, diarrhea. It may feel as if you have a cold. Or you may feel that flu-like feeling of being totally destroyed.
Doctors in these countries report that most patients have very mild symptoms and some infected may not have any at all, but suggested that seeing a doctor even if it is just a cold is important to make sure the infection doesn't progress to something more serious. But they note that the true numbers of those infected may never be known because some individuals feel they have nothing more than a slight cold and the numbers infected with COVID-19 are being skewed by this fact, which could make the death rate much lower than is being reported.
Although we don’t want to minimize the effect on the general population of this virus, keeping things in perspective while focusing on those who are most at risk is what we should be doing as a society at this point. Keeping the spread of COVID-19 at bay by addressing cases as they pop up is indeed important, but the facts are that other countries have tried to do this with little or no success and the virus has spread rapidly and probably is more widespread than we will ever know.
Is Quarantining Large Areas the Answer?
If we look at those countries where this virus has a strong foothold, such drastic measures appear not to have been effective. Many in the healthcare community feel that it wouldn't be a stretch to say that thousands, if not hundreds of thousands -- or even more -- people around the globe have been exposed to or have had COVID-19 and cleared it.
Because its symptoms in many people are benign, often mimicking a minor cold, they continue to attend events, go to work and school, and go to the gym. Because of this, the virus is being introduced in many settings before the individual with it is even aware they are sick. In one case, a person in New Hampshire, who exhibited symptoms of COVID-19, was told to self-quarantine and instead went to a social event. This has led to calls by some of "using force" to keep these people isolated. But the idea that we can contain this by reporting each case and quarantining them is in many ways like spitting into the wind.
Italy, which has been especially hard hit by the virus is having little success in its hardnosed attempts at containing it. Authorities there have come to grips with this reality as the virus has killed and continues to kill scores of elderly people in that country, overwhelmingly aged between 63 and 95 with underlying serious illnesses. The youngest patient to die was 55 and suffering from a chronic disease. A 61-year-old doctor who was not known to have underlying health problems has also died.
Massimo Galli, the director of infectious diseases at Sacco Hospital in Milan, stated, “Italy is a country of old people, the elderly with previous pathologies are notoriously numerous here. I think this could explain why we are seeing more serious cases of coronavirus here, which I repeat, in the vast majority of cases start mildly and cause few problems, especially in young people and certainly in children.”
But, Galli questions the effectiveness of quarantines, limiting travel and other extreme precautions his country has taken. “Some countries have accused us of taking too drastic measures. Yet even taking drastic measures, proactively, does not seem to have been enough. What is certain is that we had no way of predicting the outbreak in the so-called red zone or identifying it before sick people appeared,” he said.
So what makes more sense again is to focus on the most vulnerable populations that we know are being severely affected by COVID-19. Our next plan of action, given what we do know, needs to be allocating resources to those who may be most at risk of dying from COVID-19, mainly seniors and the disabled.
During a news conference this past Monday, Tom Frieden, former director of the Centers for Disease Control and Prevention acknowledged as much. At that conference, he warned that “Older populations of people and people with health conditions may have much bigger problems.” Adding to that a staggering statistic - in the United States, about 60% of adults have an underlying condition that could affect the severity of COVID-19.
Why Are Seniors Dying From COVID-19?
Based on what we know about related illnesses, including severe acute respiratory syndrome (SARS), experts hypothesize that the difference between a lethal infection caused by COVID-19 and one that feels like a bad cold probably hinges on the interaction between the virus and the strength of the person’s immune system.
Doctors state that the virus, once in the lungs, begins to multiply rapidly. As we stated in our blog two weeks ago, coronaviruses are implicated in several types of common colds and attack the upper airway. COVID-19, however, seems to go deeper into the lungs. As it gains strength, the dead cells are sloughed off and collect in the airway as heavy mucous and make breathing difficult.
Because it can replicate quickly, it takes time for the body's immune response to kick in and prepare the battle. For those with a healthy immune system, the response will catch up and control the virus. But, for those with compromised immune systems, as in those with diseases like HIV, undergoing cancer treatment or the elderly, the virus grows out of control filling the lungs with thick, mucousy deposits and becomes pneumonia.
At that point, it's not just the virus that is causing problems, it's the entire immune system, which begins to wreak havoc on the body. Secondary infections begin to develop that further stresses the immune system and sets off -- for lack of a better description -- a perfect storm.
When this occurs in the body, the problems begin to stack up, and as COVID-19 grows deeper into the lungs, it begins to damage the air sacs, called alveoli, which limits the intake of oxygen. As damage continues, the tissue in these areas begins to stiffen, causing the heart to work much harder to deliver needed oxygen to the other organs of the body. Those with previous cardiovascular issues such as heart attacks or heart failure are affected.
In the end, when a person's lungs do not function appropriately, a strain is put on every organ in the body. Any organ that is compromised will also begin to fail. Hence the death rates in the elderly and those with underlying health conditions.
One other behavior has also been implicated in poor outcomes of those affected by COVID-19 -- smoking. In research initially coming out of China, it appears that long term smokers fare far worse than others because the lung tissue is already damaged and vulnerable to infection.
How is COVID-19 Spread?
Much like other respiratory viruses, COVID-19 is spread when an infected person sneezes or coughs, spraying droplets through the air. The sick person might sneeze directly in another person’s face or expel droplets widely, contaminating surfaces that healthy people touch before unknowingly spreading germs to their mouths or noses. Health-care workers are at especially high risk because they are exposed to very high doses of the virus and also perform procedures, like putting infected patients onto ventilators, that can spread it.
The Frenzy is Now Placing More at Risk
The media frenzy and misinformation has caused a panic that is actually creating more problems for the elderly and those with pre-existing conditions. The young and healthy are buying up sanitation supplies and emptying shelves of these products in stores across the country. Things have gotten so out of hand that most retailers are sold out of hand sanitizer, face masks, and even deep cleaning supplies – and this is having a real effect on those programs and organizations that provide services to the group that is most vulnerable to COVID-19.
“We have tried to buy supplies of hand sanitizers for our facilities,” said a staff member at an affordable housing provider for seniors and the disabled in a local town. “We usually buy them by cases at [one of the big box stores], but they had none left. The warehouse manager told me they are selling them by the pallet loads. We then went to a local grocery store and were unable to find any single bottles left on the shelf.”
She then went online to try and buy some but was shocked at what she found. “The retailers were sold out but there were private sellers that offered 4-packs of hand sanitizer that usually go for under $20 at most stores now listed online for $250. Our agency can't afford that. Imagine the seniors we serve on limited incomes who struggle monthly to make ends meet, how could they afford to buy these products?”
And on some sites, a two-pack of 12-ounce bottles of Purell is selling for $149. A single container of Clorox wipes is selling for $44.25 plus shipping. One report even stated that a shopper wanted a rush delivery of sanitation supplies and was quoted a price of $500 for ground shipping and an eye-popping $5000 for next-day air.
And the lack of hand sanitizers and face masks for these programs have sparked other concerns. “We have hand sanitizer available for our residents year-round,” said the staff member. “Our population includes not only elderly but disabled individuals with compromised immune systems. With our inability to get sanitizing products, we're not only worried about the coronavirus but about the seasonal flu as well, which is an annual battle we face and we end up losing people every flu season. This is a serious situation and not just about the coronavirus.”
And when it comes to the flu, just how does it stack up against the COVID-19 hysteria? Well, you may be surprised.
As of this week, the flu has had much more of an impact on Americans than COVID-19 - by far. In the weekly flu surveillance report from the CDC, so far this season there have been at least 34 million flu illnesses, 350,000 hospitalizations and 20,000 deaths from flu. Of the 20,000 deaths, 136 have been children. The highest death rates are among seniors over the age of 65 and children under the age of 2. Again, underlying health issues are present for the majority of those who died. Without sanitation supplies for seniors living in elder housing complexes or in the community, there could be a resurgence in the flu and its complications for that group.
When it comes to COVID-19, however, the death toll has hit just 19 with an estimated 600 cases confirmed. And as a reminder, nearly all fatal cases occurred in seniors with co-existing medical issues while the flu has affected and killed people of all ages. Again, putting things into perspective, to date, we have 20,000 flu deaths versus 19 COVID-19 deaths. Yet, COVID has dominated the headlines and caused fear among all segments of the population.
How is Connelly Law Offices, an elder law firm, handling this COVID-19 crisis? By using "common sense and restraint," said Attorney Connelly.
"Last week, our firm checked in with all of our fiduciary clients who live in the community, most of them alone, just to see how they were doing. The majority said they were doing fine but there was a tremendous amount of apprehension with the ongoing hysteria over the virus, and some were even afraid to leave their homes and go food shopping or attend medical appointments," said Connelly.
"We reminded them of one thing, keep this in perspective. The media loves the hype, more so today than ever. I tell them that fear is more contagious than COVID-19 and not to get involved with the rumor spreading," continued Connelly. "But I am concerned about the inability for them to purchase hand sanitizer and other cleaning supplies. This certainly places them at a higher risk of not only contracting the current coronavirus but the seasonal flu as well. Those in authority really need to tone down this hysteria a bit and focus on the demographic most affected. This includes making supplies of hand sanitizer and cleaning agents available for them."
The good news is that it appears the coronavirus has peaked with the World Health Organization reporting last week that new infections in China dropped by 13,000 over the previous week. But again, the key to this is perspective. In recent years we have managed to survive the "bird flu", the "swine flu" and "ebola" -- and odds are we will survive this as well. In time, this will pass and life will return to normal...until the next media frenzy.
NOTE: On Thursday, March 13, 2020, a special edition of Connelly Law's "Southcoast Seniors Radio Show", heard live on WPRV, AM790 from 4:00 pm to 5:00 pm, will feature Scott Fraser, President and CEO of the Rhode Island Healthcare Association. Mr. Fraser will discuss the impact that COVID-19 has had upon the skilled nursing community.