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As the COVID-19 pandemic continues unfolding around the globe, people who are at higher risk for severe disease need to take special care.
COVID-19 appears to cause mild to moderate symptoms in most people who are infected. And some people seem to have no apparent effects from the virus.
But the older you are, the greater your risk for hospitalization, admission to an intensive care unit, being placed on a ventilator, and death, according to new guidance from the Centers for Disease Control and Prevention.
For instance, people in their 50s are at higher risk than those in their 40s, and those in their 60s and 70s are at greater risk than those in their 50s, the CDC says. People 85 and older are at the greatest risk. (In the U.S., about 8 in 10 deaths from COVID-19 are in people age 65 and older.)
“We know immune systems change with age, making it harder for you to fight off diseases and infection, even if you’re otherwise fairly healthy,” says Michael Hochman, M.D., director of the Gehr Family Center for Health Systems Science and Innovation at Keck Medicine of USC in Los Angeles.
At any age, certain health conditions can also increase the likelihood of severe COVID-19, and multiple issues hike the risk further, according to the CDC’s new guidance. These include chronic kidney disease, chronic obstructive pulmonary disease, a weakened immune system due to an organ transplant, obesity (a body mass index of 30 or above), serious heart conditions, sickle cell disease, and type 2 diabetes. Children who have had heart disease since birth; have neurologic, genetic, or metabolic conditions; or are medically complex are also at higher risk.
A number of other conditions might hike the risk of poor outcomes from COVID-19, the CDC says. These include moderate to severe asthma, a compromised immune system from issues such as HIV or the use of medications like corticosteroids, dementia, high blood pressure, liver disease, pregnancy, and being a current or former smoker.
“When you have an underlying chronic condition, it can make it harder for your body to fend off and recover from infection,” Hochman says.
Given these factors, experts say that it’s imperative that anyone at higher risk for COVID-19 take specific precautions, even if there are no obvious outbreaks in their area.
“We just don’t know right now how many people in a given community have or have not been exposed to the virus,” says Sean Morrison, M.D., chair of the Brookdale Department of Geriatrics and Palliative Medicine at the Mount Sinai Health System in New York City. That’s why it’s best to err on the side of caution at this point, he says. Consider these steps if you or someone you love is at higher risk for COVID-19.
Stay Home As Much As Possible
If you’re high-risk, the CDC recommends that you stay away from crowds, especially in poorly ventilated spaces with little air circulation, which makes it easier for the virus to spread.
It’s wise to limit all outings—even those to the grocery store. A better bet is to order what you need online, or have a friend or family member run your errands for you.
For optional activities, consider your personal risk level and the likely risk of any event before deciding whether to attend. Small, shorter, outdoor gatherings (or those in well-ventilated spaces) where people can stay at least 6 feet apart, wear face coverings, come from the same area, and don’t share anything (such as food or objects) are still somewhat risky but preferable to larger indoor events.
Avoid higher-risk gatherings, the CDC says—midsized events where people can stay 6 feet apart but come from different communities or counties, and large gatherings where it’s hard to separate from others by at least 6 feet and people come from different areas. Put off any activity if you or anyone who will be attending has been in contact with someone with COVID-19 in the prior 14 days or has had any symptoms of the illness.
If you do go out, have a face covering, tissues, and a hand sanitizer that is at least 60 percent alcohol for any outings. Avoid people who aren’t wearing face coverings, the CDC advises. Also, avoid contact with “high touch” surfaces, such as elevator buttons, door handles, and handrails. Use a tissue or your sleeve instead, then wash your hands as soon as possible.
Limit Your Visitors
For now, try to limit access to your house to only the people who live with you because even people without symptoms may unknowingly spread the virus.
Don’t allow anyone who seems sick or who knows they’ve been exposed to the coronavirus to visit. And if you do have guests, “make it a rule that the first thing anyone does when they walk in your house is wash their hands,” says Morrison at Mount Sinai Health System.
If possible, maintain a distance of at least 6 feet away from them. Morrison also recommends that you clean and disinfect anything guests may have touched, including tables, doorknobs, light switches, faucets, and even toilets, after they leave.
Sticking close to home and cutting back on guests for a long period of time can be challenging, so it’s important to find alternate ways to stay active and interact with others. “Social contact is important to maintaining overall well-being,” says Ronan Factora, M.D., a specialist in internal medicine and geriatrics at the Cleveland Clinic.
FaceTime or Skype with friends or family who live elsewhere, set up a virtual book or game club with neighbors, or consider enrolling in an online course to keep your mind occupied.
And move around: It’s fine, for example, to go for a walk outdoors and stop and say a quick hello to neighbors as long as they aren’t sick. But try to keep a safe distance, don’t shake hands, don’t touch your face, and wash your hands as soon as you go back inside.
Be Scrupulous About Hand Hygiene
“No matter how much you clean, you can’t disinfect everything—nothing is sterile unless you’re in the operating room,” Factora says. And all it takes is touching a hand, if contaminated, just once to your eyes, nose, or mouth for the virus to gain access to your body.
Generally, washing with soap and water is best, for at least 20 seconds. (Hand sanitizer with at least 60 percent alcohol will do if soap is unavailable.)
The most thorough method: Wet your hands, put soap in the palm of one hand, rub both palms together, then rub the back of each hand with the palm of the other hand, interlocking fingers, says Igor Koralnik, M.D., chief of neuro-infectious diseases and global neurology at Northwestern Medicine in Chicago.
Follow by rubbing each thumb in a circular fashion before rubbing the tips of your fingers against the palm of your other hand. This will allow you to clean under your rings and nails.
Rinse and dry hands, and turn off the faucet using a paper towel, to avoid touching the handle.
The CDC recommends washing hands before eating; after using the bathroom, blowing your nose, coughing, or sneezing; after touching a pet or its food; and after touching the garbage or its handle. You should also wash your hands whenever you’ve returned home and after anyone has visited your home, Morrison says.
Take Care of Your Chronic Condition
If you have a chronic condition, such as type 2 diabetes or high blood pressure, continue taking care of yourself as your doctor advises. For instance, the American Heart Association recommends that people with heart issues, especially uncontrolled high blood pressure, limit or avoid over-the-counter decongestants and pain relievers such as ibuprofen (Advil and generic) and naproxen (Aleve and generic) because they can increase blood pressure levels.
And if you’ve been prescribed an ACE inhibitor or an angiotensin receptor blocker (ARB) for high blood pressure or heart failure, don’t stop taking it, says the AHA, the American College of Cardiology, and the Heart Failure Society of America. Some research has suggested that these medications could, in theory, raise the risks of severe effects from COVID-19. But a new review of more than 60 studies, published in the journal Mayo Clinic Proceedings, says there is no evidence that’s the case.
Check with your doctor if you have concerns or questions about how to handle your chronic condition.
Have a ‘Sick’ Plan
Put together an up-to-date list of emergency contacts for family, friends, neighbors, and healthcare providers—people you can reach out to if you or someone in your family falls ill.
It’s a good idea to also identify a few people who can check in on you by phone or email daily if you live alone.
In addition, keep at least a 30-day supply of your regular prescription medications on hand, Morrison says.
Many private health insurance companies are now allowing people to get early prescription refills, and the Centers for Medicare & Medicaid Services is permitting Medicare Part D and Medicare Advantage plans to relax their rules that prohibit refilling a prescription “too soon.”
Make sure you also have drugstore items you’ll need if you get sick, such as a pain reliever like acetaminophen and a thermometer. As for other supplies, you don’t need to buy out the toilet paper aisle at Costco, but it is good to have enough household staples and groceries on hand.
Get Medical Care the Safest Way
Get in touch with your doctor if you have nonurgent health concerns. He or she can advise you on whether you should be seen in person or via telehealth, and on what to do about delayed screenings, vaccines, and elective procedures.
For symptoms that may signal COVID-19, such as a fever, a cough, or shortness of breath, the CDC recommends calling your doctor right away. (Don’t simply show up; your doctor may have a specific protocol in place for anyone who may have COVID-19.)
If your symptoms are mild, stay home, rest, and drink plenty of fluids. For aches and fever, Hochman suggests acetaminophen, which is less likely to cause stomach bleeding in older adults than some other over-the-counter pain relievers. If you live with others, stay in a specific separate room and use a separate bathroom, if possible, and if you have to interact with others (including your pets) wear a face mask.
Any time you or a family member is experiencing what may be a health emergency, such as difficulty breathing or persistent chest pain, call your local emergency number immediately.
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