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Article by Jordan Rosenfeld

With COVID-19, the novel coronavirus, spreading across the world, experts say physicians need to act quickly to protect chronically ill and elderly patients from this potentially deadly virus.

“The majority of deaths related to COVID-19 have occurred in people over the age of 50, and the death rate is higher among individuals with certain pre-existing conditions such as cardiovascular disease, diabetes and cancer,” said Aimee Ferraro, a senior core faculty at Walden University in the Masters of Public Health Program, and a former applied epidemiologist fellow at the Centers for Disease Control.

A recent Chinese study determined that patients with COVID-19 who had at least one underlying condition had a 79% greater chance of requiring intensive care or a respirator or both, or of dying. Patients in the study had conditions including cardiovascular diseases, diabetes, hepatitis B, chronic obstructive pulmonary disease, chronic kidney diseases, and cancer.

As hospital systems brace for larger numbers of patients to enter their care, concerned that they will not have enough life-saving respirators or even beds, Ferraro said physicians should do everything they can to help patients stay out of hospitals and emergency rooms and prepare for extended periods of isolation.

What happens to the body

Understanding how COVID-19 works can help physicians be proactive in protecting their most vulnerable patients.

This virus is different from other viruses because “it has evolved a mechanism to avoid our regular immune system. It has little spikes that help it fasten onto the cells so it can climb in,” according to Mark Engleman, the director of clinical consulting for Cyrex Laboratories, a clinical immunology Lab in Phoenix, Arizona.

This virus also prefers lung tissue, he said, which is what leads many of the sickest patients to contract pneumonia that can lead to acute respiratory distress syndrome (ARDS) and even death.

It is actually the body’s own inflammatory response to the virus, which initiates a release of products from white blood cells to signaling molecules into the bloodstream, that creates the fluid that builds up in the lungs, Engleman said. Healthy patients can typically recover on their own, but chronically ill patients may decline rapidly.

What makes COVID-19 so much deadlier than the flu for these patients is that they’re already working at an immune deficit, or may have systems or organs that aren’t functioning properly, be it the respiratory system in COPD or the endocrine system in diabetes, Engleman said.

“Once the case gets entrenched, people get septic with infection all over the body and the end result is organ failure, not just of the lungs but the kidneys, liver, blood cells and so forth,” Engelman explained.

Even those who recover may have lingering effects such as reduced lung function, shortness of breath and lung scarring.

The importance of social distance

There is currently no vaccine available, Ferraro pointed out, and the data changes almost daily about how it spreads and how deadly it is. Being asymptomatic is not a guarantee, either, that a person is not contagious. Researchers have found that 10 percent of people in China who contracted the virus were infected by someone who had the virus but was not yet symptomatic.

This is why social distancing—staying home as often as possible, or staying six feet apart from others when out in public—is so key to flattening the curve of the spread of the disease, Ferraro said. But this could also lead patients to feel isolated, or disrupt their access to care for other conditions.

Ferraro hopes physicians will also consider appointing a nurse or medical assistant to make phone calls and texts to reach out to their vulnerable patients in advance to check on them and provide them with recommendations to stay safe.

“Reach out to patients and see that their needs are taken care of over the phone or by teleconference,” she said.

Physicians can also help patients plan for extended isolation by filling prescription medications for longer than usual, Ferraro said. This can include oxygen tanks for COPD patients. The COPD Foundation recommends patients contact suppliers to arrange for extra oxygen delivery.

Common sense precautions

In addition to social distancing, Engleman suggests physicians reinforce the basics of self-care with their patients to protect immunity:

  • Take medications properly and consistently
  • Get adequate sleep
  • Stay hydrated
  • Have someone else shop for you
  • Wear a mask and/or nitrile gloves if you must be out in public
  • Keep mucus membranes hydrated with saline nasal spray
  • Wash hands with soap and water for 20-30 seconds, or use hand sanitizer when soap is not available (wash hands after three sanitizer uses).
  • Eat well. A healthy gut is also shown to support immunity
  • Quit smoking, to improve lung function
  • Limit or stop drinking, as alcohol can lower immunity

Additionally, Engleman urges physicians to remind their patients to be wise about the information they read and the treatments they take, saying, “There are no magic cures on the Internet. No medicine that they’ve tried to use on this works yet.”

Healthcare providers should look to the Centers for Disease Control Coronavirus page for the latest data, recommendations, and best practices of care, Engleman urged.

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