Next Avenue: Coronavirus: Separating facts from hype— and what’s the risk for older people?

With any sort of public health crisis, it’s critical to separate the facts from any hype and find out what you need to know. So, we asked Dr. Robert Kim-Farley, a professor of epidemiology and public health at the University of California Los Angeles and former director of the Division of Communicable Disease Control and Prevention at the Los Angeles County Department of Public Health, about the real risk of this virus — especially for older people.

Next Avenue: How are older adults more vulnerable to this disease? It seems like many of the reported deaths have been in older people.

Dr. Robert Kim-Farley: Yes, you are correct. In its more severe form, the disease definitely seems to be affecting older persons. In fact, eighty percent of the deaths that have been recorded are those over the age of sixty. Also, seventy-five percent of the deaths have been with persons who have had pre-existing health conditions, especially like cardiovascular disease and diabetes, which also tend to be in the elderly as well.

Is this similar to the way an older person might respond to a bad case of influenza or is this worse?

This has a bit of a unique aspect in that, typically, older persons, as well as very young persons, are most affected by influenza. With this coronavirus, it appears mainly to be a problem in the elderly and those with pre-existing conditions.

The Chinese Center for Disease Control had an age breakdown of the first 45,000 cases — only slightly over 400 cases were in children, [age] 0 to 9; there were no deaths in that age group. So, it appears that the disease is very mild in children, perhaps even asymptomatic. So, that is a unique feature.

It may be too soon to even answer this, but, generally, would treatment protocols be different for older adults?

In a sense, we’re still (looking for) what is going to be the best treatment protocol, because compared to influenza — where we have things like Tamiflu and other medications — we don’t yet have anything that we are certain is going to work.

The Biomedical Advanced Research and Development Authority, which is part of the U.S. Department of Health and Human Services, is partnering with some U.S. pharmaceutical companies and with the Belgium-based Rega Institute for Medical Research, to screen for some potential drugs that might work; primarily those from the anti-viral type of drugs that we already have in our armament for things like HIV or hepatitis C.

Last week, the Chinese National Medical Products Administration did approve an antiviral drug, favilavir, for use against Covid-19. It was used previously against influenza, and it may be somewhat effective. But I think the jury’s out yet, until they have done more extensive trials to see whether this might be useful for treatment.

What precautions should older people take, especially if they live in crowded cities like New York or Los Angeles?

The first thing is to look at facts, not rumors. If you’re in big cities like L.A. and New York City, they have very robust health care systems and public health systems. So, if there is a case that is detected, they are going to be rapidly isolated so they are not a source of infection for others. And the close contacts around those cases will be quarantined for the incubation period of the disease — about 14 days.

There are good systems in place to detect and act on this. One thing people can do, just in general, as we do for influenza season, and any season for that matter, is cover coughs and sneezes. Wash hands frequently with soap and water. If you don’t have soap available, use an alcohol sanitizer with at least 60% alcohol. Avoid persons who are ill.

This is a disease that looks like it is spread primarily by respiratory droplets in a cough or sneeze. But it’s not like measles in the sense that they will loft over the air long distances. This type of droplet spread is usually within about 6 feet of contact or in contact with a surface or something that’s been contaminated.

Given the recent news, should people cancel their travel plans if they are going abroad or on a cruise?

I would not take a cruise ship to China at this stage, but personally, I would not be curtailing my travel plans. Everybody has to weigh risks and benefits of anything they do, including being on a cruise ship that might be going into Italy or Japan.

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Is it possible that somebody could be incubating the disease and come on board and then come down with the symptoms when they’re on board? It’s possible, but not likely, as compared with taking a cruise that was going to stop in China, which has pretty much been curtailed anyway.

The CDC has said everybody should be preparing, but testing is still somewhat limited. If you’re sick, how can you know if it’s the flu or you may have been exposed to the coronavirus?

One of the things that is complicating preventive measures is that it is flu season. Realize that in the United States alone, 36,000 people on average die of influenza every year. So, we have to put this coronavirus in the light of some of the existing true risks that we do have for communicable diseases.

I think we can go one of three ways in terms of future scenarios with coronavirus.

One way is like with the SARS outbreak that happened in 2002 to 2003, where the genie was put back in the bottle and was contained and curtailed and it stopped. I think we’re a little bit beyond that since we [reached] 80,000 cases of coronavirus, compared to 8,000 cases of SARS.

The most recent data out of China shows that in areas outside of Hubei province, there’s actually a marked decrease in the number of cases being recorded. And even in Hubei province, the declines are beginning to happen in terms of data counts. So, that’s encouraging.

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The second scenario is what I’m calling fits and starts, like the idea that if you had a box of matches and just started striking them and throwing them around in the forest, some of those are going to catch fire. That’s what we see to a limited extent in Korea and Italy. But, again, these are developed countries, they have robust health care systems. I have a good confidence that they will be able to get a handle on this and snuff it out. The more worrisome issue is when this virus gets introduced into a highly populous, developing country, let’s say like in Lagos, Nigeria, where you do not have a robust health care or public health system. I think you will see a relatively large, potentially explosive outbreak in countries like that.

What could be a third scenario is that you start having enough of these [outbreaks] in enough places that the disease does take a foothold globally. And you end up with it being like influenza — kind of always with us, with some seasonality associated with it. And we learn to live with it. At the same time, we start to develop vaccines, which will take a while to look at safety, efficacy and then even come up to scale, but we will have a vaccine that truly takes hold. That would be the way that we ultimately curtail it.

So, it’s not going to be like the movie “Contagion” where everybody’s walking around in hazmat suits?

Again, the fatality rate is still low. We are talking about, on average, 2%. SARS was about 9.5%, MERS — Middle Eastern Respiratory Syndrome — was about thirty-four and a half percent. Actually, the fatality rate outside of Hubei province is much lower. Their health care systems are still capable of handling the surges that are occurring.

There are probably a lot of cases that are not going to be detected. If people have mild symptoms, for example, they’re not even seeking health care. So, those rates are probably even lower.

Is there anything in particular that family caregivers should be aware of or tell their loved ones?

Probably the biggest thing is influenza. Make sure that their loved ones are vaccinated. Most nursing homes have physicians on call and usually have good robust systems of vaccination and have antiviral medication available should there be an (influenza) outbreak in the nursing home itself.

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If there was ever a case of coronavirus (in a nursing home), I think … what would happen is that those patients would be isolated from the other patients and those who had close contact with the patient would be also kept in quarantine. The good side of things is that they are probably not the ones that are going out to movies and shopping malls.

I’ve noticed many more people wearing surgical masks going about their daily business. Does wearing a mask do anything to protect you?

That basically is an ineffective measure. If you’re sick and coughing, wearing a surgical mask to protect others is a good idea. But if you’re healthy, then basically the surgical mask probably gives you a false sense of security. There are air holes around the sides and only in a health care facility where they’re using the N95 respirator mask do you have some potential for protection.

Any other advice for older adults or family caregivers?

Public health departments around the country, and the federal government, are really on the lookout for this and are doing very rapid testing and making sure that if there’s someone who is infected, they’re quickly isolated and their contacts quarantined. I wouldn’t say never, but currently, the risk in the United States is very low. There are a lot of rumors going around and the situation may be overhyped somewhat by certain media.

It’s really important to keep a level head about it. I liked what the director general of the WHO [World Health Organization] said: we need facts not fear, we need science, not rumors, we need solidarity, not stigma.

You can also find updates and more information on the CDC’s coronavirus webpage. For travel-related questions, visit the U.S. Department of State website, and check with your airline, cruise operator or tour company.

New York-based journalist Liz Seegert has spent more than 30 years reporting and writing about health and general news topics for print, digital and broadcast media. Her primary beats currently include aging, boomers, social determinants of health and health policy. She is topic editor on aging for the Association of Health Care Journalists. Her work has appeared in numerous media outlets, including Consumer Reports, AARP.com, Medical Economics, the Los Angeles Times and The Hartford Courant.

This article is reprinted by permission from NextAvenue.org, © 2020 Twin Cities Public Television, Inc. All rights reserved.