We urgently need to gather good information about what works to reduce transmission and severity of symptoms for older people.
For symptom management, we are especially interested in anything that can be beneficial (even to a small degree) outside hospital settings.
This is because most people, of all ages, will lack access to hospitals. This is a challenge, as much of the peer-reviewed literature simply states that you should get the person to hospital as soon as possible. Without directly applying Cochrane levels of evidence, we do need quick information that we can broadly trust. If you have any opportunity, please discuss with specialists in severe respiratory conditions, etc. Also, if you are in a country which is already badly hit, please try to reach out to front-line health workers, to see what their experience shows (I know these people have no time, but do try).
For transmission, there may be some tailored advice for older people. For example, can they ask a younger adult to collect their meds and health goods for them? This is because pharmacies will be a major point of infection. But we need to make it clear that older people should not avoid going to pharmacies, if nobody else can do it for them. Thoughts about this example and other possible messages are very welcome.
For both transmission and symptom management, we will need tailored messages relating to nursing homes and other residential facilities. I circulated an example from HelpAge and some guidelines from China earlier today. Please let me know if you have better guidelines or can add points to what was circulated. For example, should we suggest to care homes that they develop emergency plans to recruit local volunteers (once these have got over covid19 and so are no longer either infectious or at risk)? Should we be pushing local government agencies to conduct a fast and robust survey of unregistered care homes (of which there are many)?
Equally, I think we need to address how households with older members will manage cases of covid19. One difficult issue is, when older people live with younger people, if a household member falls ill, how do families strike a balance between isolation within the household and meeting care needs. A key consideration here is that people at very old ages are far more likely to get severe symptoms and die. Also, older people may die for other reasons -if they have other care needs but are infected and family members isolate them. As such, a very broad recommendation might be:
Isolate younger family members (less likely to need care with covid symptoms or for other things), to reduce risk of infecting oldest household members. This assumes that these younger people do not have special vulnerability to covid for other reasons.
Do not isolate oldest family members (more need for care, risk of harm for younger family members if get covid are much lower).
Many families will start to face this dilemma, but is it ethical or appropriate for us to at least set out the pros and cons of different strategies? Again, thoughts and comments very welcome.
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