COVID-19: Who amongst us is most in danger?

The latest coronavirus SARS-CoV-2, which causes the disease COVID-19, is spreading rapidly from individual to individual, causing respiratory illness in 1000’s of individuals around the globe. Now, within the US, there’s a world pandemic, COVID-19, and life as we understand it has come to a grinding halt. Major league sports teams have suspended or delayed the beginning of their seasons, live shows and major entertainment events have been canceled, schools are closing across the country, bars and restaurants are closing, and travel from Europe is suspended for 30 days. The Centers for Disease Control and Prevention (CDC) and the federal government recommend that folks avoid gatherings of greater than ten people and limit unnecessary travel. The mayor of San Francisco became the primary to issue a citywide “shelter in place” order for all residents of six Bay Area counties, asking all residents to remain home and limit contact with others for 3 weeks. These extraordinary efforts, which encourage “social distancing,” are an try and “flatten the curve,” mitigate the results this extremely contagious disease can have on the health care system and forestall the possibly deadly impact it could have on the highest-risk populations.

Because SARS-CoV-2 is a newly identified virus, humans haven’t any pre-existing immunity and subsequently everyone seems to be susceptible. According to the World Health Organization (WHO, 2020a), most individuals (roughly 80%) recuperate from the disease without requiring special treatment. However, roughly one in six individuals who contract Covid-19 will change into seriously in poor health and develop respiratory difficulties (WHO, 2020). Who are these people who find themselves at higher risk of developing serious illness from Covid-19?

Who is most in danger?

There are specific segments of our population which are most prone to severe acute respiratory infection (SARI) secondary to Covid-19. Belong to them:

• – over 60 years of age
  • As we age, our immune system’s ability to fight infections declines (Azar, 2018), making us more at risk of infections.
    • Fewer immune cells lead to an extended response to foreign microorganisms.
    • Fewer white blood cells can delay healing.
  • Other aspects that make older adults more at risk of infection include malnutrition, comorbidities (i.e., diabetes, chronic obstructive pulmonary disease), reduced mucus barrier, and weakened cough reflex (Azar, 2018).
• People from:
  • – equivalent to coronary heart disease, heart failure and hypertension
    • Although the precise effects of the Covid-19 virus on the cardiovascular system are usually not fully understood, there are reports of acute cardiac damage, arrhythmias, hypotension and tachycardia. Based on experience with influenza and other acute viral infections, short-term effects on the cardiac system may include (Beck, 2020):
      • Increased risk of acute coronary syndromes related to a severe inflammatory response to infection.
      • Depression of the center muscle resulting in heart failure.
      • Underestimated risk of arrhythmias related to acute inflammation.
  • – chronic obstructive pulmonary disease (COPD), asthma, pulmonary fibrosis and cystic fibrosis
    • People with chronic lung disease suffer from restricted airflow attributable to quite a lot of conditions, including inflammation, narrowed or obstructed airways, alveolar abnormalities, and other structural problems.
    • Viral diseases exacerbate lung disease and could cause respiratory failure, acute respiratory distress syndrome (ARDS), sepsis and septic shock.
  • The risk of infection in individuals with diabetes is increased attributable to several aspects (Weintrob, 2020):
    • Hyperglycemia, or poor blood glucose control, weakens the immune system.
    • Vascular insufficiency may impede the local inflammatory response and absorption of antibiotics.
• – people receiving chemotherapy and other treatments for cancer, treatments for autoimmune diseases (i.e. rheumatoid arthritis, lupus, multiple sclerosis and inflammatory bowel disease), patients with human immunodeficiency virus (HIV) and patients after organ or bone marrow transplantation
  • As described above, a weakened immune system reduces a person’s ability to fight infection and heal.
• At the time of writing, there is proscribed evidence on the danger and transmission of the virus while pregnant and breastfeeding. Please seek advice from the CDC Interim Considerations for Infection Prevention and Control of Coronavirus Disease 2019 (COVID-19) in Inpatient Maternity Facilities.

A report released on February 20, 2020 by the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19) provided the crude mortality rate (CFR) for every of those high-risk groups based on 55,924 laboratory-confirmed cases of COVID-19 (WHO , 2020b).

Based on current information, CDC outlined several essential steps that each one high-risk people should take to scale back their risk of contracting Covid-19, in addition to actions to take in the event that they change into in poor health (CDC, 2020a). The recent deaths at Life Care Center in Washington State are a tragic reminder that long-term care facilities, expert nursing facilities and nursing homes must comply with detailed CDC recommendations to forestall the spread of Covid-19 equivalent to limiting visitors except in end-of-life situations, restricting access to all volunteers and non-essential medical personnel, canceling group activities and communal meals, and actively screening residents for fever and respiratory symptoms (CDC, 2020b).

A note regarding healthcare staff

Doctors working on the front lines of the fight against this disease are putting their very own well-being aside to take care of Covid-19 patients and are undoubtedly putting themselves at increased risk of contracting the virus. As we’ve got witnessed in other countries, the pandemic has placed and can proceed to put an undue burden on our healthcare system. Long working hours and stressful environments can take a toll on practitioners, weakening their immune systems, making them more at risk of serious illness. Lack of appropriate personal protective equipment (PPE), equivalent to N95 masks, gowns, and gloves, or inadequate adherence to infection prevention and control practices may additionally contribute to exposing providers to increased risk. Health care administrators should ensure adequate staffing, availability of appropriate infection prevention resources, and strengthen education and training on the importance of following infection control guidelines.

We all have a responsibility to forestall the spread of this infection, no matter our personal risk. More resources about COVID-19 might be present in our Nurse Practitioner Resources Tools for frontline clinicians and medical researchers.

Azar, A. (2018). Immune function in older people. . Downloaded from https://www.uptodate.com/contents/immune-function-in-older-adults

Beck, L. (2020). Coronavirus disease 2019 (COVID-19) is a stark reminder of the danger of infectious agents. . Downloaded from https://www.acc.org/latest-in-cardiology/articles/2020/03/01/08/42/feature-coronavirus-disease-2019-covid-19-provides-potent-reminder-of-the- risk of infectious agents

Centers for Disease Control and Prevention (2020a). Coronavirus disease 2019 (COVID-19): If you might be at increased risk. Downloaded from https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/high-risk-complications.html

Centers for Disease Control and Prevention (2020b). Temporary additional guidance on infection prevention and control for patients with suspected or confirmed Covid-19 infection in care homes. Downloaded from https://www.cdc.gov/coronavirus/2019-ncov/healthcare-facilities/prevent-spread-in-long-term-care-facilities.html

Centers for Disease Control and Prevention (2020c). Severe outcomes amongst coronavirus disease 2019 (COVID-19) patients – United States, February 12 – March 16, 2020 Source: https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e2.htm?s_cid=mm6912e2_w

Weintrob, A. C. (2020). Susceptibility to infections in individuals with diabetes. Downloaded from https://www.uptodate.com/contents/susceptibility-to-infections-in-persons-with-diabetes-mellitus

World Health Organization (2020a). What is COVID-19: What are the symptoms of COVID-19? Downloaded from https://www.who.int/news-room/qa-detail/qa-coronaviruses

World Health Organization (2020b). Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19). Downloaded from https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf