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who's most at risk for covid-19? it's probably not you

public health advice doesn't help those who face domestic abuse, can't leave jobs or those in remote communities.

by diana duong

mar 13 2020

5 minute read

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the elderly, the working class, those with underlying heart and lung diseases, those without a safe and stable home are just some of the most at-risk groups for covid-19. getty images

for the vast majority of covid-19 patients, symptoms are extremely mild. early reports from china found the mortality rate sits around 2 to 3 per cent .

but there’s one stand-out age group that is at high risk: anyone aged 80 or older, especially those with pre-existing heart and lung issues. earlier reports from covid-19 patients in china found that the mortality rate among people aged 80 or older was 21.9 per cent .

those over the age of 80 with diabetes or who have a history of smoking are also at a much higher risk of intensive care.

“i would worry about those over 80 even outside of covid-19,” says dr. michael gardam, humber river hospital’s chief of staff. “if you get a serious infection, it requires your body to respond to that infection. your heart rate goes up and your breathing may be impacted. if you don’t have a lot of reserve because of smoking or you have underlying lung diseases or angina, then any stress like that is going to get you into trouble. the infection puts a lot of stress on your system and if your system is on the edge in the first place, then this stress can push you over.”

while the data is not available yet, gardam says it’s reasonable to assume that people who are generally at an increased risk for infection, like those with compromised immune systems, could get more sick than a healthy person.

there is no specific treatment for covid-19, so currently, patients with severe symptoms are receiving supportive care. this means oxygen or a ventilator if they need help breathing.

“if you’re sick, honestly, isolate yourself,” says gardham. “if there’s a birthday party for an 80-year-old grandparent on the weekend and everybody’s going to come, i don’t want somebody who’s ill to show up at that birthday party. a mild cold in a 30-year-old could be deadly in an 80-year-old.”

public health advice not possible for the abused, working class

while everyone can feel out of control in unpredictable times, it’s important to remember those who don’t have the power or privilege to follow standard public health advice. for example, people who have to take public transit are more exposed than those who commute in a car. some may not have the luxury of taking time off of work or may be unable to afford a week’s worth of supplies in case they need to self-isolate .

“most public health officials have some kind of idealized notion of a middle-class condo or house. but peoples’ living situations vary,” says blake poland, an associate professor at the dalla lana school of public health at the university of toronto and co-director of the who collaborating centre in health promotion.

poland says not everyone has a stable or safe home. for example, asking people who are being abused to stay home could mean exposing them to further domestic violence.

for those who are able to self-isolate , they need to figure out who will bring them food, medication, take care of their children, or walk their dog. and to be able to call in favours like this takes either a certain level of resources and network, or capacity to pay for someone to help — something that not everyone is in a position to do.

“even though public health might be issuing fairly standardized guidelines on what to do, the fact is we live in a very unequal society from issues of class and race to gender and ableism, and we’re not all impacted the same. we all live this in very different ways and not everyone is equally equipped to respond,” says poland. “it lowers the bar for everyone, and of course, it’s much more miserable at the bottom.”

among those at the bottom are people who live in overcrowded conditions and those who have decreased access to healthcare, either because they are uninsured or live in a remote community. they will be at risk and have less chance of getting tested, says dr. anna banerji, director of global and indigenous health in the faculty of medicine at the university of toronto.

indigenous communities, where some people may live in substandard houses with mold can become “breeding grounds” for transmission.

banerji, who worked on policy and quarantine during the 2003 sars outbreak , says this novel coronavirus is much more transmissible and is spreading much faster because some people may have symptoms so mild they don’t know they have covid-19.

“it’s easier to control a disease when you can identify who’s sick and who’s not sick — [which was the case] with sars,” says banerji. “when you’re more likely to have healthy people who can transmit [the virus], it’s harder to identify and control.”

we can protect the most vulnerable

the best way to slow down this virus is to not spread it to others. this works both ways. if you’re sick, stay away from others, and if you’re worried about catching the virus, also stay away from others and avoid large crowds .

what you can do, though — as long as you are healthy — is get outside.

gardam, whose main clinical area is tuberculosis, says he has no problem with his active tuberculosis (which is spread through microscopic droplets released into the air by coughing, speaking, and sneezing) patients walking outside. he can’t, however, allow them to get on the bus, subway, or be in an enclosed space with other people.

“there’s no reason you can’t walk around outside, just don’t be in groups of people. you’re not catching it from the air, you’re catching it from people right in front of you. airborne things don’t spread outside, the air is infinite, for all intents and purposes,” says gardam.

while children are the outlier group and seem to not be affected by covid-19, children with extremely mild symptoms can still spread it to older adults.

“we see it with influenza all the time. when you have young children at home, they make you much sicker than when you don’t have young children at home. you get infected all the time when kids are around, presumably, that is happening with this. kids are not getting that sick with this, but they might be passing it on to adults,” says gardam.

“if i were immune-compromised or i were over the age of 80, i would be avoiding people for the next while until this is clearly on its way out.”

diana duong is a writer and editor at healthing. follow her on twitter @dianaduo.

dduong@postmedia.com

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who's most at risk for covid-19? it's probably not you

public health advice doesn't help those who face domestic abuse, can't leave jobs or those in remote communities.

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