There’s much we don’t know about COVID-19, the new coronavirus, but one thing is clear: The risk for death rises with age.
A report from the Chinese Center for Disease Control found that the fatality rate for people with coronavirus was under 0.5% for people under age 50. But it rose to 3.6% for 60- to 69-year-olds, 8% for 70- to 79-year-olds, and a whopping 14.8% for people 80 and older. (Those rates are likely inflated because many people with mild coronavirus have not been identified.)
The death rate was also higher for people with underlying conditions like heart disease, diabetes, chronic respiratory disease, high blood pressure, and cancer, all of which are more common with age.
Those frightening numbers have organizations that work with groups of people over age 65 preparing for a potential onslaught of illness. People in nursing homes, who are often old, weak, and sick, are at particularly high risk.
“It could be even worse for the people that we ... take care of,” Mark Parkinson, president and CEO of the American Health Care Association (AHCA), which represents nursing homes, said Wednesday. The group met Wednesday with Vice President Mike Pence and Seema Verma, administrator of the Centers for Medicare and Medicaid Services, to talk about how the virus could affect its members.
Retirement communities, assisted-living facilities, and senior centers must also consider how to keep seniors informed and minimize risk.
A COVID-19 outbreak at a nursing home in Washington state has driven home how serious the situation could be. As of Wednesday, seven residents of the Life Care Center of Kirkland had died of the new virus.
The potential epidemic is hitting at a time when facilities that serve older adults have trouble recruiting and retaining staff. Widespread staff illness could make things worse.
While it is not yet known how long sick people can spread the virus, Steve Alles, director of the Philadelphia Department of Public Health’s disease control division, said employees should stay home at least until they no longer have symptoms, which could be a week or more.
“It’s not going to be easy,” he said.
Retirement communities and nursing facilities are accustomed to dealing with other dangerous viruses, like the flu and norovirus, as well as weather that can disrupt staffing, said Dee Pekruhn, director of life plan communities services and policy, and Jodi Eyigor, director of nursing home quality and policy, for LeadingAge. The group, which represents nonprofit retirement communities and aging services providers, has called for “calm preparedness.”
“We have experience,” said Lisa Holloway, vice president of health services for Kendal Corp., a Kennett Square-based operator of senior communities and LeadingAge member. “We’re used to dealing with this season, because it’s a flu season for us, too. … We do this every day.”
LeadingAge’s members are activating emergency plans that include increasing attention to infection control; making sure they have enough food, cleaning, and personal care supplies; coordinating plans with hospitals and home care providers; limiting group activities; and communicating with residents, families, and staff about protecting themselves and others.
Senior-care organizations are emphasizing what’s important for everybody. Wash your hands thoroughly and frequently. Stay home if you’re sick. Cover coughs. Keep your hands away from your face, because the virus spreads through contact with the mouth, nose, and eyes.
In guidelines released last weekend, the AHCA recommended placing sick residents in the same room or wing. Protective gear like masks and medical gowns are on back order in some places, say leaders, who have asked for government help with distribution.
Retirement communities, where the average age is 80 to 85, may also stop offering salad bars and buffets, opting instead for table service in dining rooms or even food delivered to individual apartments, Pekruhn said. If staff are out sick, administrators and marketing and human resources personnel may pick up duties like cleaning or food service.
“It’s going to require some flexibility and some creativity on behalf of our staff,” Pekruhn said.
Tammy Berry, director of quality for the Visiting Nurse Association of Philadelphia, said her agency, which serves up to 900 home-care patients, has 150 telehealth monitors in patients’ homes and has ordered more. That could help, she said, if staffers are sick.
At this time of year, retirement communities often advise people with flu symptoms not to visit and that will likely be true as well for people with symptoms of COVID-19, which are similar.
Eyigor said it is difficult to stop visits completely at nursing homes. Facilities have to balance residents’ safety with their rights. “Having access to loved ones is one of their rights,” she said.
AHCA said that facilities can help families “visit” in other ways, like Skype, phone calls, or email.
AHCA’s Parkinson said Pence and Verma assured AHCA leaders that nursing facilities “have the duty and ability to exclude visitors from our facilities.” Government leaders also told the group they would step up efforts to enforce infection-control procedures.
Acts Retirement-Life Communities, based in Fort Washington, said it will be monitoring the health of all residents, employees, vendors, and visitors who have traveled to or plan to travel to high-risk areas. It is also limiting all nonessential business air travel by employees.
Alles, a preventive medicine specialist who is heading Philadelphia’s response to COVID-19, said the city is now focused on detection and containment of the virus.
Older people, he said, should be especially diligent about washing hands and other infection control measures. He recommends against traveling to countries now experiencing outbreaks of COVID-19 and thinks seniors should avoid the Seattle area. Avoiding large crowds — at church, sporting events, or bingo night, as well as shopping at peak times — could be a good idea.
Alles said senior facilities should post signs asking any visitors or staff with symptoms to divulge that before entering. Like LeadingAge, he recommends separating people with and without virus symptoms during an outbreak and assigning different staff members to each group. Facilities should then also cancel group activities and refuse new admissions.