Susannah Fox, Barbara’s daughter, had been warning her exceptionally healthy mother for weeks of the need to stay inside as much as possible and limit contact with other people. Everyone 65 and older is at high risk of complications from covid-19 and should adopt these measures, the Centers for Disease Control and Prevention recommends.
“At one point, when I was pushing her to limit her activities, my mother said defiantly, ‘Well, I’m going to die of something,’ ” said Susannah, an adviser to health-care and technology companies. “And I said, ‘Well, that’s true, but let’s not rush it.’ ”
Are precautions of the sort the CDC advises really necessary, even in areas where the new coronavirus doesn’t yet appear to be circulating very widely? What about disease-free adults in their 60s and 70s? Do they need to worry about going to a food store, pharmacy or a close friend’s house for dinner? Are all outside activities ill-advised?
I asked several geriatricians for their advice. All cautioned that what they told me could be upended by unforeseen developments. Indeed, in the past week, the governors of about a dozen states — including California, Delaware, Illinois, Indiana, Louisiana, Michigan, New Jersey, New York, Ohio, Oregon and Washington — have told residents, and not just older adults, to stay inside, in an aggressive effort to stem the spread of the coronavirus.
Here’s what geriatricians think is reasonable right now, and why.
Know the odds
Current warnings were originally based on data from China, which has reported that 80 percent of deaths from covid-19 occurred among people 60 and older.
The latest data from CDC shows that people 65 and older are hardest hit — among deaths, intensive care unit admissions and hospital admissions. Those 85 and older suffered the worst outcomes.
Data from China, the United States and other countries also indicate that people with illnesses such as heart disease, diabetes, kidney disease and lung disease, and those with compromised immune systems, are more likely to become critically ill and die if they become infected. The CDC recommends that these patients stay inside and practice strict precautions.
What is not yet known: lots of details about the underlying health status of older adults in China and other countries who’ve died of covid-19.
“We just don’t have this kind of information yet,” said Carla Perissinotto, associate chief for geriatrics clinical programs at the University of California at San Francisco.
As a result, considerable uncertainty about the true nature of risk remains. What is clear, however, is that older adults have less robust immune systems and are less able to mount a protective response against the coronavirus.
Uncertainty also surrounds the degree to which the coronavirus is circulating in communities across the country because testing has been so limited.
Some people don’t develop symptoms. Others will not realize they have contracted the coronavirus until becoming symptomatic. Both groups may unwittingly transmit the virus, which can live on some surfaces such as door handles or store shelves for up to 72 hours.
Given how little is known about the extent of the virus’s community spread, caution is advised.
Michael Wasserman’s 82-year-old mother, Fern, called Wasserman, a doctor, and asked him: Could she go pick up a prescription at the pharmacy? No, he said, “the last place you want to go is a pharmacy or a doctor’s office where there are sick people next to you.” What about the grocery store? No, get deliveries, he urged.
But Wasserman, who is 60 and a triathlete, isn’t as strict with himself. “Would I go for a walk? Yeah. The way I see it, I’m in a gray zone. I can go out, but I have to be careful.”
Consider your health
Wasserman isn’t alone in making a distinction of this kind.
“What a number of physicians are saying is, you should consider whether you’re frail” in assessing your personal risk, said John Morley, a physician who is a professor of geriatrics at St. Louis University School of Medicine.
He ticked off the questions that entails. “F: Are you consistently fatigued? R, for resilience: Can you climb a flight of stairs? A, for aerobic: Can you walk a block? I, for illnesses: If you’ve got five or more, that’s bad. L, for loss of weight: That’s not good.”
If you answer yes to three or more of those questions, you should be “really careful and self-isolate,” Morley said.
Even if you score 1, “you should be taking some care,” he continued.
“I’ve been telling people, this is about how healthy you are, not how old you are,” said William Dale, director of the Center for Cancer and Aging Research at City of Hope, a cancer center in Duarte, Calif.
But even healthy people — of all ages — are becoming sick and, “honestly, I think we’re all trying to figure out how worried to be,” Dale said.
Of course, older adults should follow guidance from state and local health departments, as well as the federal government. But the advice varies across the country, adding to people’s uncertainty.
“I don’t think it’s as simple as ‘Don’t go out’ for all older adults. Social contact is still really important,” Perissinotto said. “If you’re healthy and over 60, with prudence, hand hygiene and being aware of your surroundings, you should still be able to go about some activities,” such as taking a walk or visiting with a neighbor while maintaining a safe distance, which the CDC says is at least 6 feet
Leslie Kernisan, a San Francisco geriatrician and the founder of the geriatrics advice website BetterHealthWhileAging.net, offered several concrete suggestions. If you’re going to the store, consider wearing cloth gloves, because viruses don’t survive as well on soft surfaces. Try not to handle your smartphone when you’re out of the house. “A phone is a hard plastic surface that can easily get contaminated,” she said.
If you’re worried that older parents aren’t following rigorous enough precautions, don’t lecture them, Kernisan said. Instead, ask how they’re feeling about the coronavirus. What do they know about it? What plans have they made?
This column is produced by Kaiser Health News, an editorially independent news service that is not related to Kaiser Permanente.