Doctor: Older patients still at greatest risk from virus

Posted 6/3/20

Nearly three weeks since Gov. Doug Ducey let his stay-at-home order expire, some experts worry loosened social distancing restrictions are spurring a second wave of novel coronavirus infections.

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Doctor: Older patients still at greatest risk from virus


Nearly three weeks since Gov. Doug Ducey let his stay-at-home order expire, some experts worry loosened social distancing restrictions are spurring a second wave of novel coronavirus infections.

And while experts and officials weigh concerns of a renewed outbreak, those at greatest risk of harm from the virus must continue to take care regardless.

According to a Capitol Media Services report published Wednesday in the Daily Independent, the pace of infections is on the rise, with more than 1,000 patients currently hospitalized due to COVID-19 as of Monday.

Likewise, the Biodesign Institute at Arizona State University cited a steady increase in the infection rate, with a current 7-day average of 519 new cases daily throughout the state, where that average was only 378 as recently as May 15, when the governor’s order expired, according to the report. 

If the outbreak continues to accelerate, hospitals may be better prepared this time to deal with an influx of patients, according to Christian Bime, M.D., medical director of the intensive-care unit at Banner  — University Medical Center Tucson.

The doctor said he and his staffers have been through it once and their experience will may them save lives.

“You can image that if we open up and people are getting infected, there could be a second wave. I think it’s just a logical thing to be concerned about,” Dr. Bime said. “We’re better prepared in the sense that we have dealt with patients who have the virus. So, there is that level of comfort from the providers  — the doctors, the nurses, the respiratory therapists, the pharmacists  — since we’ve kind of gone through the routine. We know how to get into the rooms and treat the patients and get out safely.”

A renewed surge could pose challenges, though, if institutions don’t have access to needed medications and supplies or if the pace of infection outruns hospital capacity, he warned.

“We will need to have enough resources  — medications, PPEs, IV infusions, enough beds  — and everything that is needed to take care of these very sick patients. Our ability to do that depends on the number of patients we suddenly get at one time,” Dr. Bime said. “When this started, the talk about flattening the curve, that was the whole principle  — trying to mitigate the surge that could overwhelm the capacity of our hospitals, that’s what we fear the most. We don’t want a situation where all the beds are taken and the patients are in hallways or in stadiums, that’s not good.”

Ideally, avoiding a new peak in infections, even if hospitals are ready for it, would be better, he said.

“I’d say generally, having been through the first wave and having some level of comfort among providers, we can treat the occasional COVID-19 patients that show up. But having another surge is not something that we want or hope for,” Dr. Bime added.

Greater risks

According to Arizona Department of Health Services officials, the disease has infected approximately 3 in every 1,000 Arizonans  — with 22,223 confirmed cases and 981 deaths reported as of yesterday. Of the more than 345,000 individuals tested so far, 5.8% have tested positive for COVID-19.

Of those who’ve tested positive, the largest demographic group is those between 20 and 44 years of age, with 9,162 positive tests comprising 41% of those infected in the state.

Those 65 and older came in second with 18.5% of confirmed cases; people 45-54 ranking third with 16.2%; those 55-64 placing third with 14.3%; and those under 20 coming in last with 9.5%.

But the proportion of the demographic age groups infected does not necessarily reflect those at greater risk for dire complications if infected.

Based on data from the Centers for Disease Control and Prevention for the week ending April 18  — which was the peak for COVID-19 deaths nationally  — the risk rises steadily from the young to the old.

Of the 15,739 deaths reported that week, fully one-third of victims were 85 or older; while more than 80% of deaths were among those over 65. Those younger than 55 comprised less than 7% of those who died.

According to CDC’s reporting, the potential reason older patients suffer worse outcomes lies in comorbidity, or the presence of other underlying health conditions or diseases in addition to the novel coronavirus.

For example, among patients believed to have died during the outbreak, only in 7% of cases was COVID-19 the only cause listed.

Among those who’ve died, on average they had 2.5 additional health conditions, which contributed to their death, according to CDC officials.

Preexisting health conditions, which can increase likelihood of severe reactions to coronavirus include:

  • Chronic lung disease;
  • Asthma;
  • Serious heart conditions;
  • Obesity (with a body mass index of 40 or higher);
  • Diabetes;
  • Chronic kidney disease;
  • Liver disease.

Anyone with a condition, which compromises the immune system is also a greater risk. Some of the compromising conditions may include cancer treatment, smoking cigarettes, bone marrow or organ transplants, immune deficiencies, poorly controlled HIV or AIDS, and prolonged use of steroids and other medications, which can weaken the immune system, according to information published at the CDC website,

Dr. Bime confirmed that CDC’s research assessment matches up with what he has seen in his emergency room.

“When you say, ‘If you’re healthy don’t worry,” well, everything is a percentage,” he said. “We know that if you are older  — this thing is hitting the elderly harder where we have a lot of comorbidity there, with the obese, diabetic, heart disease and uncontrolled hypertension  — then, obviously you’re going to get hit harder if you get COVID, too.”

As people get older, there is a greater prevalence of health complications, starting with obesity and its associated diseases, he explained.

“People who are obese are more likely to also have diabetes, uncontrolled hypertension and maybe cardiovascular disease. It winds up being a combination of sort of ‘all of the above’ and so it’s hard to tell because there’s a lot of overlap among those,” Dr. Bime said. “But if you’re young and otherwise healthy, if you’re not obese and have no high blood pressure and your labs check out generally fine, you’re less likely to die from COVID-19.”

The doctor said COVID-19’s ability to exacerbate illness for those already ill is not unique; but that what’s different and dangerous is the severity of the complications.

“The patients that get severe respiratory failure from COVID-19 tend to stay in the ICU for much longer than we would previously expect from people who get the flu, for example. But for some reason, this particular virus makes people sicker, so they stay in the ICU for much longer. That’s the unique thing about it,” Dr. Bime said.