An Epidemiologist On How We Can Protect Vulnerable Populations During COVID-19
There's a lion's share of medical opinions when it comes to COVID-19. This understandably causes some anxiety—it can be stressful not knowing all the answers or having a sense of control. But at the same time, we at mbg welcome all the discourse. We believe science should be a conversation, not a mandate. Science is always evolving—that's what makes it so intriguing! It's imperative we make space for being wrong, for being right—for finding solutions that help people.
So when we discuss COVID, we're consulting a plethora of expert scientists who span the entire spectrum of opinions. Recently, we spoke to infectious disease public health researcher and co-author of the Great Barrington Declaration Martin Kulldorff, Ph.D., M.Sc., about how to protect vulnerable populations during the pandemic. His response? Focus on the vulnerable, specifically older individuals.
"While people of all ages can get infected, the mortality risk is a huge difference by age," he shares on the mindbodygreen podcast. "It's not just a twofold or fivefold or tenfold difference." In fact, one study shows that younger people had thirty- to a hundredfold lower risk of COVID-19 death than those over 65. That's not to say there aren't other at-risk populations vulnerable to this virus—we can't ignore other factors like underlying conditions and metabolic health—but older individuals do make up most of the ticket. In fact, the Centers for Disease Control and Prevention (CDC) states that the risk of getting severely ill from COVID-19 increases as you get older, with eight out of 10 COVID-19-related deaths reported in the United States among adults aged 65 years and older.
But here's the thing: We can't just slap an "older individuals" label on certain people and call it a day; there are a bunch of subgroups that live within this larger population, all of which may require slightly different plans of action. Kulldorff outlines them below, with action items to protect each at-risk group.
Group 1: Nursing home residents.
Kulldorff deems nursing home residents among the highest risk, "because they're already frail." The key to preventing an outbreak in this population, he notes, is having COVID tests readily available and often—not for the residents, per se, but for the nursing home staff. "It's much more important to test the staff than the residents," he says, as they interact with the most people on a day-to-day basis. "They need to be frequently tested so that they don't bring in the virus to the residents."
On that note, Kulldorff notes there should be less staff rotation in general: "Each resident should minimize the number of staff they actually interact with because that also minimizes the risk." Fewer interactions may equal less exposure.
However, Kulldorff mentions that that shouldn't scare family members away from visiting their loved ones. We can't brush mental health under the rug, and combating loneliness is key: Research has found that mild depression among older people can actually suppress the immune system, and feelings of loneliness and isolation have been linked to weakened immunity as well. Bottom line? You can (and should) spend quality time with your older loved ones! Just visit outdoors, wear a mask, and get tested beforehand: "Get a test, and if it's possible, just postpone the visit by a few weeks," says Kulldorff.
Group 2: Those who live on their own.
Of course, not every older individual resides in a nursing home. That's why Kulldorff highlights those who live on their own as well—either alone or with other older, at-risk individuals (a spouse, perhaps). He mentions this group should continue to isolate themselves and refrain from unnecessary ventures in public—even grocery trips.
"Being outdoors going for walks, hikes, bicycling, or whatever [exercise they choose] is important, but it's unnecessary for them to go to the supermarket and do the shopping," Kulldorff explains. After all, spending time outdoors does have real health benefits: Studies have shown that chemicals called phytoncides in some trees can reduce stress hormones, lower anxiety, and improve blood pressure and immunity.
However, Kulldorff encourages younger family members or friends to help them get groceries, do errands, and all other activities that involve interacting with others. Or, if they don't have that support system, perhaps there's a free delivery service in place for these necessities—we don't have all the answers, of course, but something of the sort would be helpful so these individuals don't have to risk exposure.
Again, that's not to keep you from visiting your loved ones at all. "They want to see children, grandchildren, and the like. The best way to do it is outdoors. But again, we should have testing available so that they can see their relatives because that's very important."
Group 3: Those 60 and above in the workforce.
Now, we're getting into the weeds a bit. It becomes a touch more difficult to protect older individuals in the workforce: "People in their 60s are also high risk," Kulldorff says. "Not as high-risk as those in their 70s and 80s, but people in their 60s are still at risk." That said, they fall under the umbrella of "older, at-risk individuals," and we need to have systems in place to protect them.
According to Kulldorff, "People in their 60s should, if they can, work from home. If they can't work from home, we should make it possible for them to take a sabbatical for a few months during times of high transmission, so that they are not exposed." Again, we don't have all the details—perhaps it's with Social Security money dedicated to a three- or four-month sabbatical—but the key here is keeping these individuals at home, isolated, and guarantee they can go back to work once transmission rates lower.
Group 4: Those in multigenerational homes.
"The most difficult group is the old people who live in multigenerational homes," says Kulldorff. Multigenerational living is a beautiful thing—in fact, according to longevity expert, National Geographic fellow, and Blue Zones founder Dan Buettner, those who live in multigenerational homes tend to live longer (called the "grandmother effect"). But unfortunately, this way of living is rather difficult amid the pandemic.
According to Kulldorff, those who live with those of working age face a 60% higher risk than those who live with other older individuals. "So all the people living in multigenerational homes with, say, a son or a daughter who is in their 40s, they are at higher risk. We have to help protect them."
How do we do so? Well, Kulldorff says that the WFH option helps: "If a son or daughter can work from home, that's good because then they can isolate themselves in the bubble." In terms of children, he notes that children actually frequently acquire COVID-19 from adults rather than transmitting it to them. That's not to say children can't transmit the virus at all, but perhaps it's less of a concern than it is for adults in the workforce.
If it's not possible for everyone to work from home, "then maybe the older people can live with an older sibling or an older neighbor for a while—maybe three or four months during times of high transmission," he notes. "And if that's not possible, maybe we can use empty hotel rooms, where they can be housed temporarily." It's not as simple as it sounds on paper, of course, but Kulldorff says it's time we start the conversation.
So how do we protect the older, vulnerable population during COVID-19? Well, there's not really a singular answer because there are a bunch of subgroups that reside in the "older individuals" category. Again, all of these scenarios are relevant only in times of major infection spikes (the CDC uses this table to measure and classify transmission rates by country and population size).
We should also emphasize here that Kulldorff's counsel is by no means the be-all and end-all. It's simply a new perspective to think about as we continue to learn more and more about this virus. It's imperative that we make space for these discussions, as it's conversations like these that will help us find solutions that hurt the fewest people.
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