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The Coronavirus (COVID-19) Guide for Caregivers and Patients

Friday, March 27, 2020

The coronavirus (or COVID-19) has spread to almost every country in the world. At the time of writing, there have been more than 450,000 confirmed cases worldwide.


More than 22,000 people have died from the coronavirus, and over 117,000 have recovered. According to the data we have so far, around 80 percent of the cases are mild. 


The new coronavirus originated near Wuhan, China, sometime between November and December of 2019. 


The virus began spreading rapidly in Wuhan and other parts of China, leading to mass quarantines and travel restrictions within China. 


Soon, it began spreading to other countries in Asia, then Europe, with Italy becoming the second epicenter of the virus. 


By now, the virus has spread almost all over the globe. It has been declared a global pandemic by the World Health Organisation, and the United States has declared a state of national emergency.


To combat the spread of the virus, governments across the world have restricted travel or entirely closed their borders temporarily. Some cities and countries have implemented mandatory lockdowns to prevent gatherings that could facilitate the transmission of Covid-19. 


How does the coronavirus affect how you care for the elderly?


You may have heard that the elderly are at a higher risk of developing severe illness or dying from the coronavirus.


As a home caregiver, you might be wondering how it affects how you care for the elderly. Or maybe you look after your senior parents, and you’re wondering what steps to take to ensure their safety during this global pandemic.


In this article, we’ll look at what we know so far, based on the available data and research. 


We’ll discuss what the coronavirus is, who is most at risk of severe illness, and what steps you can take to ensure the safety and wellbeing of your elderly family members or home care patients. 


Coronavirus (COVID-19) resources for home caregivers


Before we get started, it is vital to note that we’re still in the relatively early stages of this pandemic. That means there are a lot of things we don’t yet know about the virus.


All the information in this article is based on what we know to be accurate at the time of writing, based on recommendations from public health officials, scientific research, and anecdotal evidence.


But we’re learning more every day as new research and data come in from scientists and healthcare professionals all around the world.


So, as a caregiver, you should periodically check for the latest updates from health officials to make sure you’re complying with their recommendations when caring for the elderly.


Here are a couple of authoritative sources when it comes to up to date information on Covid-19.


1. Centers for Disease Control and Prevention (CDC) 


The CDC is a United States federal agency under the Department of Health and Human Services, and it is one of the leading national health institutes in the country. 


The CDC’s coronavirus page is a comprehensive resource with up-to-date information. You can find the latest number of cases per state, updates on travel restrictions, and the newest information on symptoms, caring for your family, and more.


2. Johns Hopkins University Coronavirus Resource Center


Johns Hopkins University is another leading medical institution in the United States, and they have created a coronavirus resource hub to help people stay updated with the latest information during this pandemic.


On the JHU Coronavirus Resource Center page, you’ll find the real-time statistics from around the world, as well as helpful information on how to care for your family, how long the virus can live on surfaces, and more.


3. CDC coronavirus page for older adults


Older adults seem to be especially vulnerable to Covid-19. Based on the data we have so far from China, Italy, and other counties, seniors are at the highest risk of severe illness from the virus.


For that reason, The CDC has created a separate web page with resources and recommendations for older adults.


What is the coronavirus (COVID-19)?


To give you a better idea of what you’re dealing with and how it may affect your care for an older adult, let’s quickly discuss what the coronavirus is.


Coronaviruses are nothing new. They’ve been around for a long time, and chances are, you’ve already been infected by one of them before.


Coronaviruses are a family of hundreds of viruses that are responsible for the common cold, fever, and sometimes digestive issues. The new 2019 coronavirus is one of the seven members of the family that have been known to infect humans.


The latest coronavirus is officially known as SARS-Cov-2, and the disease it causes formally is known as Covid-19. 


You may recognize the name SARS from a previous outbreak in 2003 that killed almost 8000 people, which was also a part of the coronavirus family. The new 2019 version has a lower death rate, but spreads much easier, according to what we know so far.


What are the symptoms of Covid-19?


One of the challenges in dealing with Covid-19 is that it seems to vary from person to person when it comes to symptoms and severity. Some individuals may experience only mild symptoms such as fever, fatigue, and cough. In others, it could be more severe and even cause death.


Based on what we know so far, here are the most common symptoms of Covid-19. Symptoms typically appear anywhere between 2 and 14 days after exposure to the virus.


  • Fever
  • Cough
  • Shortness of breath


There are other symptoms of Covid-19, which may indicate more severe illness.


If you or your elderly family member/home care patient develop any of these symptoms, seek medical attention immediately. 


  • Chest pain or chest pressure
  • Trouble breathing
  • Sudden confusion
  • Sudden inability to stand up 
  • Bluish lips or face


Please note that this is not a comprehensive list of symptoms, but the most common ones at the time of writing. For an up-to-date list of symptoms, as well as ones to look out for that indicate an emergency, check the CDC Covid-19 symptoms page.


An asymptomatic spread can be risky for the elderly


One of the biggest concerns for health officials is that many people with Covid-19 can be either asymptomatic or that their symptoms may be too mild for them to seek medical attention.


A healthy young person could be infected with the virus, and they may feel completely fine or only have a minor cough. Or, they could be in the incubation period of 2-14 days before they start experiencing symptoms.


Experts believe that people without symptoms can still transmit the disease to others, people who could be at a higher risk of severe illness. 


This is one of the reasons why, as a caregiver to the elderly, you need to be extra cautious.


In the following sections, we’ll discuss the risk Covid-19 presents to the elderly, and the steps you can take to make sure you don’t mistakenly transmit the disease to an older adult. 


Who’s at a higher risk of severe illness from Covid-19?


There is a misconception among many that Covid-19 only affects the elderly. Although certain groups are indeed at higher risk of severe illness than others, the coronavirus can infect and hospitalize people from all age groups.


We've seen anecdotal stories from healthcare workers in Italy, as well as in New York, about their patients who are in their 30s and 40s requiring treatment in the ICU. 


That being said, the data we have so far does seem to suggest that the 2019 coronavirus disproportionately affects certain groups, especially the elderly, those with underlying medical conditions, or anyone with suppressed immune function (due to medications or disease). 


Here are the groups that are most vulnerable to Covid-19 based on currently available data.


1. Older adults above the age of 65


According to the CDC, 80 % of the Covid-19 related deaths in the U.S. have been in adults 65 years of age or older.


The CDC also reports that those above the age of 65 are at a higher risk of hospitalization or admission to ICU from Covid-19 when compared to the rest of the population. 


This in line with the data we currently have from other countries like China, Italy, and the UK. 


According to a WHO-China Joint Mission report published on February 28, 2020, based on 55,924 laboratory-confirmed cases, the death rate increases significantly beyond the age of 60 among those confirmed with Covid-19 in China. 


The death rate among those above 80 was 14.8 %, compared to 0.4 % in the 40-49 age group. As a point of comparison, the overall death rate among all adults with Covid-19 was 2.3 %, according to this report. 


The data from Italy shows a similar trend. Although the numbers were different than China, the death rate is significantly higher among adults above the age of 65 who were infected with Covid-19.


2. Those with diabetes


Diabetes is one of the underlying medical conditions that may increase someone’s risk of severe illness or death from the 2019 coronavirus. 


According to the same report from WHO-China Joint Mission, those with diabetes had a 7.3 % mortality rate from Covid-19, which is also significantly higher than the 2.3 % rate in the overall population. 


The American Diabetes Association (ADA) agrees. They state that people with diabetes have a higher chance of experiencing more severe symptoms from coronavirus than the general population.


But there’s a silver lining. The ADA also states that if people manage their blood sugar and diabetes well, then the risk of severe illness from Covid-19 is about the same as the rest of the population. 


3. People with cardiovascular diseases


Another risk factor for complications from Covid-19 is cardiovascular diseases. Those suffering from heart disease had a mortality rate of 10.5 %. 


For people suffering from any of the following cardiovascular diseases, it is recommended that they practice social distancing (see below) to reduce their risk of getting infected with the coronavirus. 


  • Congenital heart disease
  • Cardiomyopathy
  • Recent open-heart surgery
  • Heart valve disease
  • Heart failure that involved recent hospitalization


People with hypertension are also at a higher risk of mortality from Covid-19.


4. People with lung conditions


People with lung conditions are also among those who are at a higher risk of severe illness from Covid-19. 


According to the British Lung Foundation, if you or your elderly family member have any of the following conditions, then you/they should avoid contact with others as much as possible during the pandemic.


  • Any type of cystic fibrosis
  • Severe chronic obstructive pulmonary disease (COPD)
  • Severe asthma
  • Lung cancer and mesothelioma
  • Any interstitial lung disease


Health experts have speculated that smokers are also at a higher risk of complications because they are more likely to have weakened lungs. 


Notes about current data on Covid-19


There are a couple of things to note about the mortality rates, especially when it comes to the elderly.


Death rates with no pre-existing conditions


The death rate among those with no underlying medical conditions was 0.9%, regardless of age. 


So, the reason that the elderly have a higher risk of complications from Covid-19 could be because they are typically more likely to have underlying conditions, and that age itself is not a determining factor. 


Underreported number of cases 


Another thing to consider is that, at this point, we simply don’t have enough data to estimate the death rate from Covid-19 accurately. 


We don’t know how many actual cases of Covid-19 there are for two reasons.


In most countries, there aren’t enough tests available to test everyone for the coronavirus. So, that means that most people who get infected may go uncounted because their symptoms are too mild to seek medical attention.


As the BBC reports,  the chief scientific adviser for the UK, Sir Patrick Vallance, estimated there are about 55,000 cases in the UK. But the number of confirmed cases only stands at 2,000.


So what does that mean for the death rate? If cases are truly underreported, that could mean the actual death rates are a lot lower than what is currently reported. 


But, as of now, we have to act on based on what we know from the confirmed cases. 


As a caregiver, you need to help your patients or family members take steps to prevent infection, and increase their wellness during these stressful times. You also need to help them devise a plan of action in case they do need medical attention due to Covid-19.


That’s what we’ll focus on for the rest of the article. 


How can at-risk individuals protect themselves from the coronavirus?


If you’re providing home care for an older adult, there are steps both of you can take to protect yourselves, and each other, from getting infected with the coronavirus.


Let’s take a look at what an older adult (or any at-risk individual) can do to protect themselves.


1. Maintain good personal hygiene


The CDC recommends personal hygiene to protect against the coronavirus. 


Doctors suggest regular hand washing during the flu season to reduce the chances of getting sick, because soap or alcohol-based sanitizers typically kill the virus.


When you visit your elderly family member or patient, be sure to wipe down and disinfect surfaces they may frequently touch.


2. Practice social distancing


If an individual is at risk due to age or an underlying condition, they should avoid close contact with others as much as possible during the outbreak. 


Experts believe that the new coronavirus spreads faster than other viruses, and people who are infected can seem healthy and unknowingly pass it on to others.


An older person should maintain at least 6 feet of distance with other people and avoid crowds. This could be a difficult thing to do, especially if going to church, synagogue, or mosque, or the community center is a vital part of their social life.


But there are ways they can connect with their community virtually, as we’ll discuss below.


3. Wear a mask around other people


There are conflicting opinions among experts when it comes to the effectiveness of masks in preventing the spread of the coronavirus.


And although we don’t have research on masks and Covid-19 specifically, we do have some research around masks and other viruses to provide us some clues.


According to a 2018 model from the University of Maryland, 80 % of the general public wearing a mask could eliminate a flu outbreak. Also, in a scientific review of studies on masks and the 2003 SARS outbreak, 6 out of 7 studies show that face masks were associated with a 70 % reduction in the risk of catching SARS.


At the very least, masks prevent sick people from spreading the virus to others. It also prevents the person wearing the mask from touching his or her own face, which could help prevent infection.


4. Boost immunity


As of right now, there are no cures or vaccines for Covid-19. Experts estimate that it will be some time in  2021 at the earliest before we can develop a vaccine. 


So, for now, the best defense against the disease is a robust immune system.


Here are a few things older adults can do to strengthen their immunity.


Exercise


Anything that gets their heart pumping can be beneficial. The goal here is to boost heart and lung health. The types of exercises will depend on the individual and their physical capacity and mobility issues. 


Exercise also reduces stress, which could be good for the immune system. 


Eat a healthy diet 


A healthy diet rich in fruits and vegetables is one of the best ways to support the immune system. Leafy greens like spinach, kale, broccoli, and fruits like blueberries are loaded with beneficial antioxidants, vitamins, and minerals. 


Healthy sources of lean protein like eggs, chicken breast, fish, and quinoa are good too. 


A good night’s sleep 


Sleep is when the body restores and repairs itself. Experts recommend an average of 7-9 hours of sleep each night. Going to bed and waking up at the same time each day promotes a healthy sleep-wake cycle, hormonal balance, and better immune function.


What can caregivers do to prevent the spread of Covid-19?


As a caregiver to an older adult, you have an added responsibility. You have to keep yourself healthy, so you don’t end up spreading the virus to your at-risk or elderly family member or patient.


Here are some steps you can take to prevent infection and keep yourself virus-free.


Washing hands before entering an older adult’s home 


Make sure to thoroughly wash your own hands before you start helping your patient with household chores or activities of daily living. As we explained before, regular hand washing may kill the virus and prevent further spreading.


Ideally, you can also bring a change of fresh clothes with you that you’d wear when working with your patient or family member. 


Wear a mask


It’s not only the older or at-risk individual that should be wearing a mask when you visit them. You should be wearing one as well.


There may be times when your patient may need to take their mask off. For example, if you’re giving them medication, or helping them with their meals. During these times, it is vital that you have a mask on to prevent spreading the virus.


Remember, you can be completely asymptomatic with the virus, especially if you’re younger and in good health. But you can still pass it on to others even if you don’t have symptoms.


Wearing a mask will significantly reduce the chance that you mistakenly spread the virus to your at-risk patient or family member. 


Avoid contact with your patient if you feel sick


If you start feeling sick, you should avoid contact with your patient or home care clients. Be sure to arrange for a backup caregiver, whether it’s a family member or another home care professional who can swap hours with you. 


The most common symptoms of Covid-19 are fever, cough, and shortness of breath, in some cases. But even if you experience other cold symptoms like a sore throat or runny nose, it is best to avoid contact with the elderly to be on the safe side.


For an up-to-date list, check the CDC’s coronavirus symptoms page.


Self-isolate when not with the patient


At the time of writing, many parts of the country, including New York City, are under lockdown orders from public officials. People all over the country are practicing self-isolation and social distancing. 


As a caregiver, you have to remain extra vigilant about your contact with others. And that includes self-isolation, as much as possible, when you’re not with your patient.


Wash your hands throughout the day, and if you need to go out for supplies, or exercise, do it when there are likely to be fewer people around, like late evening. 


For up-to-date recommendations, visit New York’s official guidelines page.


Limit visitors for your patients


The more you can limit your patient’s contact with others, the better their chances of preventing infection. If your patient or senior family member insists on having visitors, limit the number of visitors to one at a time. 


When people visit, provide them masks and hand sanitizers, and have them maintain at least 6 feet of distance from your patient. After the visitor leaves, be sure to wipe down and disinfect any surface they touched.


It can be very tough for an older adult to cut communication with their community and loved ones. But there are ways they can stay connected virtually, as we’ll discuss below. 


Be there for deliveries


Now more than ever, seniors will have to rely on deliveries for their supplies. But delivery people interact with others all day long and could be more susceptible to infection from Covid-19.


So, you should be the one to meet them at the door instead of an at-risk individual. As always, be sure to wear a mask, and wipe down the package with a disinfectant after you receive the delivery.


How can the elderly mitigate feelings of loneliness?


For many people, one of the most challenging aspects of dealing with the Covid-19 outbreak is that they feel isolated from their friends and family as they practice social distancing and self-isolation.


Seniors, who are already more likely to feel isolated due to mobility issues, can be especially susceptible to loneliness during these times.


As a caregiver, you can play a vital role in helping your family member or patient remain connected.


Here are some ideas.


Facetime with family members and loved ones


Even in these difficult times, we are fortunate as a society to have access to incredible technology to help us stay informed and connected.


We have access to things like Facetime, Skype, Zoom, and other apps to communicate with loved ones through both audio and video.


Help your senior patient get set up with the necessary tech so they can schedule calls with their family members and friends. 


Depending on how tech-savvy your patient or family member is, it might take a little patience on your part in the beginning. But once they get used to it after a few calls, they should be able to do it on their own.


Prayer and meditation


Depending on one’s spiritual and religious beliefs, prayer and meditation can be powerful tools when it comes to dealing with things like loneliness and a sense of purpose.


A daily prayer or meditation practice can instill a sense of calm and acceptance at times of chaos and uncertainty in the world.


If your patient believes in a higher power, help them schedule a daily prayer. If you share their faith, it can be beneficial to both of you if you pray together. You can also use communication apps like Facetime or Skype to set up prayer groups with others in the community.


Regardless of religious beliefs, meditation can help relieve stress and promote a sense of calm and wellness. Meditation could also benefit the immune system.


Books and board games


With everyone stuck at home, now is the ideal time to catch up on some reading. 


Help your patient select books on Amazon. You could also help them order a Kindle, or get set up with an Audible (audiobooks) account on their smartphone.


Another idea along those lines is to help them discover podcasts that might be interesting. There are many free podcasts covering virtually every topic under the sun. Listening to podcasts could be a productive and fun way to spend time while in isolation.


Finally, there are board games like monopoly, chess, and others. But of course, this is only an option when you’re present with your patient or family member. 


Miscellaneous things to plan for during Covid-19


With all the steps outlined in this article, and by following the guidelines from public officials, the chances of infection can be drastically reduced.


But you should still be prepared if your older patient or family member requires medical attention due to Covid-19.


Here are some things to prepare.


Primary doctor contact information 


You should know the contact information of your primary care doctor in case of an emergency, or if your patient experiences shortness of breath due to Covid-19.


Expect the best but prepare for the worst 


The time to plan for the worst is not during an emergency. 


Go through an emergency scenario step by step. Who do you need to call? Who do you need to inform? Do you know your patient’s insurance information? Are there family members you can call for assistance? 


Have a bag of supplies ready in case your patient needs to go to the hospital.


Have a backup caregiver ready


If you fall sick and can’t provide care, have a backup caregiver ready for your senior patient.


It could be one of their family members or one of your care providing colleagues. Make sure they are up to date with the recommendations on treating an older or at-risk individual during the Covid-19 outbreak.


Share this article with your backup care provider if needed.


Final thoughts on caring for an older or at-risk individual during Covid-19


The Covid-19 pandemic has been challenging for everyone with lockdowns, job losses, and travel restrictions. Not to mention the high risk of getting infected with the coronavirus.


But seniors and at-risk individuals may be experiencing much tougher times than the rest of society.


Not only do they have to deal with the stress from isolation and financial worries, but they also have the added stress of severe illness if they get infected with Covid-19.


As a caregiver, your job is now more critical than ever. Not only can you make sure that they have all the supplies they need and that they remain safe from the virus, but you can also provide emotional support and comfort during this challenging period.


Follow the recommendations in this article to keep both yourself and your patient safe, especially when it comes to personal hygiene, social distancing, and the use of protective masks.


And for the most up-to-date and information and recommendations, be sure to check the CDC coronavirus page periodically.


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