In this week’s episode, we speak with Sara Harrison of Wired.  Sara discusses the issues our senior population have with the coronavirus and why they are more at risk for serious health complications than the rest of us.

TRANSCRIPT

Jeffrey Friedman: Hello and welcome to the RP Health Cast by RooneyPartners. I am your host, Jeffrey Friedman.

Jeffrey: As her country begins to move forward from the pause we took due to the pandemic. We must try to find a balance between safety and normalcy as we open up our economy. We still have a large highly vulnerable population. That is at high risk of serious illness if they get infected and this includes her senior citizens.

Jeffrey: To talk more about this is our guest this week, Sara Harrison. Sara’s a healthcare reporter for Wired and has been covering health and technology-related stories there for the past four years.

Jeffrey: Sara recently wrote a fantastic piece about the serious risk issues our elderly have and why they are so vulnerable and more at risk than the rest of us.

Jeffrey: Sara, it is great to have you with us today.

Sara Harrison: Thank you so much. I am happy to be here.

Jeffrey: So your recent story for Wired about COVID-19 severe impact on seniors was a fantastic piece but before we dive into this. Let us talk a little bit about how you got here, and how you started covering health care.

Jeffrey: In the past, you have written about many different topics. What is it like refocusing your coverage almost exclusively on health care during the pandemic?

Sara: Yes. It has been really interesting. I do not have a science background. I was an English major in college but I love writing about science. I love learning about it.

Sara: It has been really challenging. I think especially during the pandemic because the information is coming so quickly and it has been really challenging to weed out, what is important. What is a big discovery and what is maybe just a theory?

Sara: So I think especially for people who are non-scientists like me, it feels very challenging and that is one of the things I try to focus on. My coverage is providing some actionable easy-to-understand information for people who are not trained in the sciences but really need to understand what is going on around us.

Sara: That is something that I tried to do in all my reporting but I think it is particularly important now.

Jeffrey: Yeah, absolutely and you bring an almost humanistic, if I will, humanistic approach to the writing and if we could turn now to the article you wrote about the COVID-19’s overwhelming impact on seniors.

Jeffrey: Now, it is a topic that hits home for everyone with elderly loved ones. The subhead to your story really summarizes the issue and I quote, “It is not one thing. It is everything. Older people are more likely to catch the disease to suffer from it more severely and to have a tougher recovery.”

Jeffrey: Now, let us take all that in smaller bites by having you start with why seniors are more at risk of contracting COVID-19.

Sara: Yeah. Seniors are at risk for two reasons: One is biological, and one has more to do with their social living situations. The first is that they are just more physically vulnerable. Many seniors who are more likely to have comorbidities like hypertension or diabetes, which have been linked to increase susceptibility to coronavirus.

Sara: They also generally have weaker immune systems which we can go into more depth later but they are not as able to mount a really strong immune response to this virus. They are also, you know, carrying around all these other physical ailments that make them more at risk.

Sara: The other issue is that not only are they more physically vulnerable but they are also more likely to live in congregate living settings like a nursing home or an assisted living facility.

Sara: So that means that they are just around more people. Many of them, even if they live at home, they need physical help with basic tasks like feeding themselves; going to the bathroom; taking a bath; walking around, and none of that care can be delivered through a Telehealth call.

Sara: It all has to be done, you know, physically by someone else and so it is really hard for them to physically isolate or socially distance. It is basically impossible and so that makes it more likely that they will contract the virus just because of where they are living and what kinds of health needs they have.

Jeffrey: You use a term and I hope I am pronouncing it correctly, Immunosenescence. What is that? What is its role in contributing to the vulnerability of the seniors?

Sara: Yeah. So Immunosenescence is a natural part of the aging process. It happens for different people at different times. So I should specify that being like more talking about seniors. It does not necessarily mean somebody in their eighties or nineties. It really depends on what you are sort of physical well-being is. This could be true of people in their seventies

Sara: Immunosenescence is basically the slow deterioration of the immune system. So when the immune system sort of grows in three phases. When we are young, you know small children. We are full of T and B cells. These are the frontliner of our immune defense there. They recognize foreign pathogens and viruses and bacteria and they gobble them up and they protect us from them.

Sara: And when you are young, you have a huge reservoir of what are called naive T and B cells. Basically, they have not specified to a specific pathogen or infection. So you may get more sick; more colds; imminent infections; things like that but you are able to ammount an immune response and yourselves learn.

Sara: So by the time you are in your twenties and thirties, you have this full healthy and immune system. That is ready to fight off lots of imminent infections and also still has lots of naive cells that are ready to learn and adjust to new pathogens.

Sara: But starting in your fifties or sixties, generally, there starts to be this decline where you run out of naive cells and you just cannot adapt as quickly as you might have. So the older you get the fewer cells you have basically, to pull on and it is harder to adapt.

Sara: So for seniors, that means that they are just much slower to mount an immune response and their immune response will be much weaker.

Sara: It also means that their symptoms will look very very different because the virus will be reacting to their immune system in different ways.

Sara: So instead of, say, having a very high fever. Most seniors do not get high fevers in general. They might present as being like, very confused or delirious, or eating more and eating less, and sleeping more.

Sara: And so, it can be very difficult to diagnose coronavirus in those patients because they have these very atypical symptoms.

Jeffrey: Well, now besides the immune response. I know that chronic low-grade inflammation is another health condition found predominantly in seniors, and use a term called, Inflamm-aging. Explain how that affects the body.

Sara: Yeah. This is another sort of part of the dysregulation of the immune system as people age. Again, it is not true for all people and it can happen at different times in their life for different people but essentially, inflamm-aging is a condition under which you stop being able to control or there is a dysregulation in the control of cytokines, which are these very small things and among other tasks that they perform. They help regulate the immune system.

Sara: That means that basically, you are always sort of releasing cytokines and you are always at the sort of like chronic low level inflammation. That can potentially and I should specify that there is still a lot we do not know about coronavirus.

Sara: And so I do not want to say that this is like an absolutely proven fact. One of the thoughts, is that these cytokines have also been associated with some very severe COVID infections where patient’s immune systems will sort of spiral out of control. And they will have these very big overreactions in the immune system will start attacking healthy organs.

Sara: At that point the body is not just fighting off the infection, it sort of attacking itself. And so, if you are a senior and you have more cytokines already in your system that may make you more susceptible to these cytokines storms.

Jeffrey: Got it. Now, in the news we hear about the coronavirus and the need for respiratory and respirators respiratory equipment, but it is not just a respiratory disease. It is a lot more complicated you write about.

Jeffrey: So, you want to talk about how it can affect the vascular system or other organs and different ways that the COVID-19 can attack?

Sara: Yes. Yes. The more that we learn about this virus, the more complicated it becomes. I think. There have been reports, you know, in addition to all of the respiratory problems. 

Sara: There have been reports of like very young people who have mild infections or may not even know they have infections suddenly having a stroke.

Sara: There have also been these reports of something called COVID Toe which is like where your toes become very swollen and red. It looks kind of like chilblains and the thought is that the virus, in addition to attacking the respiratory system. It is also getting into the vascular system and attacking your blood vessels.

Sara: They have also found and there have been quite a few papers and autopsies showing lots of blood clots in COVID patients. So that means that the virus is affecting so many other parts of your body. It is not just your lungs. This is pressing cause problems in your toes; in your brain; in your heart.

Sara: There are lots of lots of scary scenarios, and this can be especially dangerous for seniors because many seniors already have wear-and-tear on their blood vessels. They may already have hypertension or other vascular issues. And so this is just like yet another way in which the virus could affect them or severely than younger populations. 

Jeffrey: Yeah, I guess it just shows how little we still know about this disease and how it affects us.

Sara: Yeah. It is pretty incredible like given how much it has changed our lives. How little we understand about what it is doing inside our bodies.

Jeffrey: Yeah. Now, you touched upon this a little bit earlier. Public health officials have been requiring social distancing as part of the regime to protect us from contracting the coronavirus but seniors as you said, they need caregivers, some.

Jeffrey: They may be residents in nursing homes, or they have family members that are needed to be able to check in on them and help take care of them.

Jeffrey: This does not work with social distancing, right? The elderly, they cannot do this. So, how do we square the circle here?

Sara: Yes. This is a very very complicated question and that I should specify that I do not have a clear answer and I do not think that many people do.

Sara: I think there are some basic things, you know, like we need to make sure there is enough PPE in nursing homes and assisted living facilities. Enough so that all the staff and residents can wear their in a mask so that they do not have to worry about, you know, when to put on a full kit to protect themselves.

Sara: So that is one big thing. Another thing is that in long-term care facilities. They have started in some cities, universal testing where they will test the staff and the residents whether or not they show symptoms and this is potentially another way that we could sort of make sure that nobody in that setting is infected and that they can touch each other and provide the care that people need without this constant fear of getting infected.

Sara: Commonly, with something like the flu for example. They will often, you know, nursing home vaccinate the entire staff and so whenever there is a vaccine, that would be a great way to protect people as vaccinating caregivers. Vaccinating the seniors in the facility but also like all of the staff.

Sara: Anyone who helps out, family members if they are caregivers. But honestly, I do not think that there is a very simple solution to this, and when I talked to geriatricians, especially people who work in long-term care facilities. They are very very scared and they are very worried about reopening their facility to the public because it is hard.

Sara: It is virtually impossible to sort of keep a distance and provide good quality of care and make sure that everyone is safe.

Jeffrey: It is scary. It really is. You mentioned vaccines and about vaccinating the staff and we are all waiting the day when a vaccine is available. It is considered probably the optimal way to reach herd mentality in the community but your reporting reminds us that seniors are not apt to benefit substantially from the development of a vaccine.

Jeffrey: Now, from the seniors that are patients but why is that the case?

Sara: It goes back to this, if you would reduced immune response because seniors do not melt this like big immune response and do not have like lots of cells that are ready to learn this new disease.

Sara: They sometimes do not respond to vaccines in the same way that younger populations do. That is not to say that we could not create a vaccine that would work for older people.

Sara: They have created, you know, food doses that have a higher dose of the actual flu that sort of elicits a greater immune response. Older adults also respond very well to the shingles vaccine but the big issue is that.

Sara: In order to create those specialized vaccines for older populations. We need to include older people in clinical trials and that often does not happen and I will quote one of the doctors I talked to.

Sara: He’s a geriatrician at UCSF. His name is Eric Widera, and he said that one of their big worries is that we will be looking at potential treatments and vaccines but not actually testing them on the people who are most at risk of developing this disease.

Sara: So that is all to say that, he is not that they could not benefit but we have to be mindful about making sure that they do benefit and including them in the research that we do now.

Jeffrey: Yes. Well, then let us talk about recovery and you report that despite high mortality rates, many seniors do recover but their recovery is going to take a lot longer and it is much more difficult than younger or healthier people.

Jeffrey: Why is that? Is that the immuno suppression issue?

Sara: It is a little different. I mean, I think in general like seniors just have, they are less resilient than younger populations. So, yes. Many do recover.

Sara: I think we have all seen like heartwarming videos of hundred-year-old people who survived and it is great to see but you know? The longer that they are in the hospital, the longer that they are stuck in bed and are not able to move around. That reduces their overall health.

Sara: So people who spend a lot of time in the hospital usually if they are seniors, they will be weaker. They will lose muscle mass more quickly and they need a lot of time and rehab to regain the skills that they had before they started their hospitalization.

Sara: And as one person I talk to, you mentioned like that can be really challenging in the hospital setting right now because you know, the hospital gyms are closed. The physical therapy centers might be closed. Some long-term care facilities which is where someone who has been in the hospital for a long time and need some rehab might go.

Sara: They are afraid to take COVID positive patients because they do not want to bring an infection into their facility. So that can make it really, really hard for someone to make the transition from the hospital to home safely.

Jeffrey: Now, the issue you talked about with their being in the hospital or in bed or isolated so long. I mean that is part of what we are told, right? As citizens, be socially distant, you know? Be isolate. Keep isolated. Reduce your activity. Stay inside but that is so bad for seniors, right?

Sara: Yes. It is really, really hard for them. I mean, if I take a day and I lie down in bed. My muscles will be fine but for a senior though, their muscles will deteriorate faster. And so, they really need to be active.

Sara: The other issue is that you know, whether you are in a nursing facility or not. I should phrase this a different way. In nursing homes, a lot of nursing homes have sort of reduced the amount of mobility that people have because they are trying so hard to reduce the spread of the virus.

Sara: So that means that people are spending more time in their rooms and less time walking around which obviously is not great for their physical health but for also, for people who live at home, like most of the places they would go to socialize or exercise like a senior center or a library or like a church or temple or synagogue. They are all closed.

Sara: So not only are they losing like the sort of fit impetus to get up and go out and be out in the community, but they are also very isolated.

Sara: Isolation and depression are, I mean, they are bad for everyone but they are very very bad for seniors and they are linked to a host of very big health problems including worst cognitive function, higher blood pressure, higher risk of heart disease.

Sara: So even though it seems like kind of a nicety but it is actually very much part of their physical health that seniors are able to get out. To be active. To be intellectually simulated and connected to people around them and not stuck in home alone.

Jeffrey: Right. Well, as we all start to come out of this quarantine and emerging to society. We all have to bear in mind that they are our most vulnerable and we do need to always keep guard against that.

Jeffrey: Sarah, this has been very educational, very thought-provoking. Thank you so much for taking the time to be with us today.

Sara: Thank you for having me.

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Jeffrey: Thank you, and we hope you enjoyed the RP HealthCast.