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Coronavirus: ‘Elderly should avoid visiting hospitals for routine follow-ups’

Indian Express 2020-03-26 02:57:29

Written by

Astha Saxena

| New Delhi |

Updated: March 26, 2020 2:57:29 am Older people, especially those who are 80-plus and not vaccinated against flu or pneumonia, and those residing in old-age homes or long-term care facilities, are at high risk of developing severe disease due to COVID-19.

Dr Prasun Chatterjee, associate professor at the Department of Geriatric Medicine in AIIMS, on precautions the elderly need to take during the COVID-19 outbreak.

Among the elderly, what are the red flags to look out for?

Older people, especially those who are 80-plus and not vaccinated against flu or pneumonia, and those residing in old-age homes or long-term care facilities, are at high risk of developing severe disease due to COVID-19. Symptoms are fever, cough (dry and persistent) and shortness of breath, which are not due to a known chronic disease like COPD, bronchial asthma or heart disease. Other atypical symptoms could be headache, sore throat, nausea, diarrhoea, myalgia or arthralgia, nausea or vomiting, nasal congestion, and haemoptysis. However, the most important consideration is contact history with someone who has travelled to countries where COVID-19 has already become a pandemic.

What makes the elderly more susceptible?

Possible explanations for the observed higher morbidity and mortality rates among older patients are due to multiple factors like low physiological reserves due to the biologic changes that accompany ageing, frequent presence of multi-morbidity (more than 2 chronic diseases), and a fading immune system. When there is a challenge by the virus, the response by an older person’s immune system faces a higher chance of an overreaction known as cytokine storm, on top of chronic low-grade inflammation due to multi-morbidity and ageing itself. Cytokines are proteins that serve as signals to the body to mount its infection-fighting machinery. The cause of death of this virus is respiratory failure and septicemia due to the cytokine storm.

This is also flu season. What should one do if she has fever, cold and cough? Should the person go for testing? And if she can’t get freely tested, what’s the option?

Initially, if an elderly person is suffering from symptoms like fever, dry cough, throat congestion without any contact history, they should take rest, stay at home, maintain cough etiquette (coughing and sneezing in tissue), sanitise their hands frequently. They can call the helpline provided by the central or state government; no need to panic. However, if they show any alarming signs related to organ failure like shortness of breath, decreased urine, chest discomfort, diarrhoea with fever, they should immediately visit the hospital. The elderly should not visit a hospital for routine follow-up of chronic non-communicable diseases.

What explains the rapid spread of the disease?

In epidemiology there is a term called reproduction number, which in case of the coronavirus is 2. This means a person who has it affects an average of 2-2.5 persons. They in turn can infect 2-3 persons… the chain will go on without interruption if most of them are asymptomatic. However, we need not panic, mortality is not that high as per data from various countries. However 10-15% may suffer from severe symptoms and require ICU care.

ANJU an English teacher and District Mentor for English in the Parho Punjab Project (Jalandhar district), said that teachers have formed WhatsApp groups with the senior students and with the parents of the junior classes.

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