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My 86 year old mom

The Public Health Professionals say “Older people and immunocompromised people are most at risk.” The public hears either “It’s only old people so I’m fine” or “Why doesn’t anyone care about old people?!”

We do. We care about the elderly and immunocompromised and other high risk groups especially.

From an epidemiological perspective, that it mostly affects elderly and people with co-morbidities is important to note. Not that it’s ok and we shouldn’t care, but that it’s an important factor.

People with compromised immune systems — that includes older people — are already at higher risk for nearly every disease, esp. respiratory diseases. That’s not dismissive, that’s understanding the epidemiology of disease.

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From a study of more than 72,000 cases in China

When a disease has a great impact in “young, healthy adults” like the 1918 flu strain and the 2009 flu strain (though that one was less deadly), it sends a signal that this virus is different. That’s because “young healthy adults” don’t usually die of respiratory diseases. So there’s either something different about the virulence or in how it’s transmitted if it’s targeting a young and healthy population.

It also helps healthcare systems and public health to understand where to target limited resources. Nursing homes are particularly vulnerable, so we need to work with them to address infection control. It means focusing social distancing efforts on areas were people at risk are likely to congregate matter more. It means that if we cancel K-8 schools, which in our society often means grandma cares for the kids, we’re putting the highest risk group in danger. It means understanding that our workforce is less likely to be severely impacted and could continue productively to a certain extent — provided they don’t have to stay home to take care of kids.

This last point is a huge factor in pandemic planning, based on the 1918 virus. Losing workforce means shutting down businesses. While “cancel everything” sounds like a nice plan, in practical matters, we need to remember that grocery stores still need food. Hospitals still need to function. Utility companies need to stay open. Pharmacies need their staff. It’s not just about economics, but about maintaining the essential elements of society so that those most at risk can survive.

So, saying that older people are most at risk doesn’t dismiss the seriousness of this outbreak. It means we can better utilize our resource and helps us to better determine control measures.

Dr. Rohr-Allegrini is an epidemiologist and tropical disease scientist currently working to prevent diseases through immunizations.

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