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Why did Covid-19 hit seniors so hard?

It took six Weeks, several long, frustrating phone calls, and a consultation with Apple Care before Laurie Jacobs got her 89-year-old father up and running on FaceTime. Jacobs, a trained geriatrician and now chair of the medical department at Hackensack University Medical Center in New Jersey, was concerned about how her parents coped with the pandemic. They live in a long-term care community, but felt isolated and lonely. On the phone, Jacobs couldn’t tell how her mother, who had a cognitive decline, felt or whether she was walking comfortably. “Communication from a distance is very difficult,” she says. “You don̵

7;t always get the whole picture with an older adult on the phone.”

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And like so many other quarantined Americans, their parents ran out of things to do. “They seemed bored and a little depressed by the lack of stimulation, so more interaction was very important to them,” Jacobs said.

The Covid 19 pandemic is a doubly complicated situation for the elderly: not only are they at higher risk of developing the disease, they are also more likely to develop serious infections and die from them, but they are also fighting most likely with and suffer from the consequences of prevention strategies such as social distancing. For people with dementia, Alzheimer’s disease or severely restricted mobility, socially distancing guidelines can be impractical and almost impossible to follow, which makes prevention and treatment even more complicated.

Seniors, especially those over the age of 80, are severely affected by the virus. This is due in part to the fact that they often suffer from comorbidities such as diabetes and high blood pressure, which increases the likelihood that they will be hospitalized. Doctors are not sure why these conditions exacerbate the effects of the virus, but both conditions are associated with increased expression of the ACE2 receptor, a protein on human cells to which the coronavirus binds to begin replication.

Many older adults also have a chronic, highly inflammatory disease called “inflammatory”, in which the body cannot control the release of cytokines, small proteins that are supposed to modulate the body’s immune response. This dysregulation could put seniors at high risk for “cytokine storms”, a condition reported in severe Covid-19 cases where a patient’s immune system gets out of control and damages healthy organs.

Seniors are also more susceptible to immunosensitivity, a slow deterioration in the immune system that is a normal part of aging. When people are young, the immune system has a large reservoir of T and B cells that are ready to fight infections. These are called “naive cells”, ie they have not yet encountered any bacteria, viruses or other pathogens. When these naive cells encounter infection, some of them learn to recognize this pathogen and are ready to fight it off when the body is exposed to it again. “As we age, we lose this reservoir of T and B cells,” said Wayne McCormick, director of the Department of Gerontology and Geriatrics at the University of Washington. “It is difficult for us to develop new ones, although some people seem to retain this ability better than others.” This means that the person’s body may show a less robust immune system response than in younger years.

Immunosensitivity also means that diseases occur differently in the elderly, which can make it difficult for your doctor or caretaker to identify a Covid-19 infection. For example, while many Covid-19 cases involve fever, symptoms in the elderly can include confusion, delirium, drowsiness, or loss of appetite. This may be because the virus has reached important organs such as the brain, kidneys, or the digestive system. “As you get older, the virus can penetrate without being so resilient and some really bad things happen,” said William Greenough, clinical director of the ventilator rehabilitation unit at Johns Hopkins Bayview Medical Center. “Especially in the elderly, we find that the blood vessels in the brain and kidneys are blocked.”

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