1200 public health experts have signed an open letter
asserting that Black Lives Matter mass gatherings should be encouraged
because “white supremacy” is a bigger health threat than COVID-19.
Yes, really.
“White supremacy is a lethal public health issue that predates and contributes to COVID-19,” states the letter,
before adding, “Black people are twice as likely to be killed by police
compared to white people, but the effects of racism are far more
pervasive,” (a claim which is completely misleading given that black
people are far likelier to be involved in violent confrontations with
police).
The letter goes on to basically assert that COVID-19 isn’t a threat,
so long as people are protesting against racism, which is a bigger
threat, a completely ludicrous assertion that sounds like it came
straight from a far-left protest group, not 1200 public health experts.
“As public health advocates, we do not condemn these gatherings as
risky for COVID-19 transmission,” states the letter. “We support them as
vital to the national public health and to the threatened health
specifically of Black people in the United States.”
The letter then claims that ‘stay-at-home’ protests shouldn’t be
treated the same because they “not only oppose public health
interventions, but are also rooted in white nationalism and run contrary
to respect for Black lives.”
The health experts then go on to assert that BLM protesters shouldn’t
be arrested, shouldn’t be held in vans and that tear gas shouldn’t be
used against them due to the threat of it exacerbating symptoms of
people infected with COVID-19.
The letter also says that facemasks should be ‘celebrated’ and not
seen as an easy way for criminals and looters to hide their identity.
In the space of 10 days, leftists and even public health officials
have gone from demanding police arrest ‘stay-at-home’ protesters for the
crime of gathering outside, to demanding the abolition of police and
encouraging mass gatherings of people outside.
You’re bad and “killing granny” for participating in a
protest while remaining inside your car, but tens of thousands of people
gathering in close proximity in cities across America is good because
“racism” or something.
No, this isn’t an episode of the Twilight Zone, it’s 2020.
http://feedproxy.google.com/~r/zerohedge/feed/~3/WtWuObmIzrI/1200-public-health-experts-advocate-mass-gatherings-because-white-supremacy-bigger-threat
Saturday, June 6, 2020
Long term care facilities are where most COVID-19 deaths occur
Long-term care facilities (LTCFs) are a major driver of total COVID-19 deaths. Reported today in the Journal of the American Geriatrics Society,
Boston Medical Center (BMC) and Boston University School of Medicine
(BUSM) geriatricians Rossana Lau-Ng, Lisa Caruso and Thomas Perls
studied the past month’s case and death data reported by the
Massachusetts Department of Health’s COVID-19 daily Dashboard along with
data provided by the Kaiser Family Foundation and other countries. As
the pandemic drags on, the proportion of COVID-19 deaths in
Massachusetts that occur in LTCFs (nursing homes and group homes) has
climbed from 54 percent to 63 percent as of May 29t.
Some states have even higher proportions of COVID-19 deaths in LTCFs. According to Kaiser Family Foundation data, as of May 28, 81percent of COVID-19 deaths in Minnesota and Rhode Island had occurred in nursing homes. In Connecticut the proportion was 71 percent and in New Hampshire it was 70 percent. Another 22 states reported that 50 percent or more of their COVID-19 deaths occurred in LTCFs. Despite these lopsided figures, 11 states (Alabama, Alaska, Arizona, Arkansas, Hawaii, Michigan, Missouri, Montana, New Mexico, North and South Dakota) continue to not report the number of COVID-19 deaths occurring in LTCFs, which has contributed to a vast underestimation of the total number of COVID-19 deaths in the United States.
Other causes of under-reporting nursing home COVID-19 deaths include incomplete data collection by states and that up through mid-April, many states and the Centers for Disease Control did not accept a diagnosis of COVID-19 without substantiation by a positive test. Thus, many deaths were not reported because tests for COVID-19 were largely unavailable to nursing homes. Now, officials are going back to see if many deaths can be categorized as probable COVID-19 based upon the medical presentation and history of exposure. As of May 28, New York reported the lowest proportion of COVID-19 deaths in LTCFs at 21 percent, yet the rate is three-four times higher in other Northeastern states. “Once we get accurate counts of the COVID-19 deaths in all states, we will likely see a big increase in the total number of deaths in the United States,” says Thomas Perls, MD, professor of medicine at BUSM and a study co-author.
Other countries are reporting that the majority of their COVID-19 deaths are also occurring in LTCFs. In early May, Canada indicated that 82 percent of its deaths are in LTCFs. The World Health Organization estimates that half of all COVID-19 deaths in Europe and the Baltics happen in nursing and care homes.
However, there are other countries and regions that are bucking the trend. Hong Kong reports no LTCF COVID-19 deaths and South Korea and Singapore each report fewer than 20 such deaths. New Zealand, because it closed its borders early and with its strict quarantining policy, also reports fewer than 20 LTCF COVID-19 deaths.
So why are most LTCFs so vulnerable to COVID-19? In Massachusetts, almost 90 percent of LTCFs have had at least one COVID-19 case. Lisa Caruso MD, assistant professor of medicine at BUSM and another author indicates, “the asymptomatic spread of this virus allows it to easily sneak in to these facilities where essential staff go from nursing home to nursing home, like x-ray technicians, phlebotomists, nurses and nursing assistants who have to work more than one job to make ends meet.” Caruso, a geriatrician at BMC, goes on to say, “Checking temperatures of visitors and staff is obviously not enough. Everyone visiting or working in a LTCF needs to either be found to have immunity to the virus or to be regularly tested.”
Beyond the untenable deaths, the pandemic is exacting a terrible psychological and social toll on families, residents and staff. Author Rossana Lau-Ng, MD, instructor of medicine at BUSM remarks, “Our residents are now isolated in their rooms and families who can’t visit are terribly worried. We are doing all we can to maintain some semblance of the home-like environment that we had previously strived to achieve but that is now so very challenging.” Just as the community at-large must adapt to a new norm during this pandemic, LTCFs have emerged as the front line and must be even more vigilant for the foreseeable future.
https://www.eurekalert.org/pub_releases/2020-06/buso-ltc060420.php
Some states have even higher proportions of COVID-19 deaths in LTCFs. According to Kaiser Family Foundation data, as of May 28, 81percent of COVID-19 deaths in Minnesota and Rhode Island had occurred in nursing homes. In Connecticut the proportion was 71 percent and in New Hampshire it was 70 percent. Another 22 states reported that 50 percent or more of their COVID-19 deaths occurred in LTCFs. Despite these lopsided figures, 11 states (Alabama, Alaska, Arizona, Arkansas, Hawaii, Michigan, Missouri, Montana, New Mexico, North and South Dakota) continue to not report the number of COVID-19 deaths occurring in LTCFs, which has contributed to a vast underestimation of the total number of COVID-19 deaths in the United States.
Other causes of under-reporting nursing home COVID-19 deaths include incomplete data collection by states and that up through mid-April, many states and the Centers for Disease Control did not accept a diagnosis of COVID-19 without substantiation by a positive test. Thus, many deaths were not reported because tests for COVID-19 were largely unavailable to nursing homes. Now, officials are going back to see if many deaths can be categorized as probable COVID-19 based upon the medical presentation and history of exposure. As of May 28, New York reported the lowest proportion of COVID-19 deaths in LTCFs at 21 percent, yet the rate is three-four times higher in other Northeastern states. “Once we get accurate counts of the COVID-19 deaths in all states, we will likely see a big increase in the total number of deaths in the United States,” says Thomas Perls, MD, professor of medicine at BUSM and a study co-author.
Other countries are reporting that the majority of their COVID-19 deaths are also occurring in LTCFs. In early May, Canada indicated that 82 percent of its deaths are in LTCFs. The World Health Organization estimates that half of all COVID-19 deaths in Europe and the Baltics happen in nursing and care homes.
However, there are other countries and regions that are bucking the trend. Hong Kong reports no LTCF COVID-19 deaths and South Korea and Singapore each report fewer than 20 such deaths. New Zealand, because it closed its borders early and with its strict quarantining policy, also reports fewer than 20 LTCF COVID-19 deaths.
So why are most LTCFs so vulnerable to COVID-19? In Massachusetts, almost 90 percent of LTCFs have had at least one COVID-19 case. Lisa Caruso MD, assistant professor of medicine at BUSM and another author indicates, “the asymptomatic spread of this virus allows it to easily sneak in to these facilities where essential staff go from nursing home to nursing home, like x-ray technicians, phlebotomists, nurses and nursing assistants who have to work more than one job to make ends meet.” Caruso, a geriatrician at BMC, goes on to say, “Checking temperatures of visitors and staff is obviously not enough. Everyone visiting or working in a LTCF needs to either be found to have immunity to the virus or to be regularly tested.”
Beyond the untenable deaths, the pandemic is exacting a terrible psychological and social toll on families, residents and staff. Author Rossana Lau-Ng, MD, instructor of medicine at BUSM remarks, “Our residents are now isolated in their rooms and families who can’t visit are terribly worried. We are doing all we can to maintain some semblance of the home-like environment that we had previously strived to achieve but that is now so very challenging.” Just as the community at-large must adapt to a new norm during this pandemic, LTCFs have emerged as the front line and must be even more vigilant for the foreseeable future.
https://www.eurekalert.org/pub_releases/2020-06/buso-ltc060420.php
COVID-19 safety recommendations to reduce deaths of elders in nursing homes
Seeking to address estimates that more than a third of COVID-19
deaths nationally have occurred in nursing homes and long-term care
facilities–more than 38,000 – the American Medical Directors Association
published recommendations for reducing the spread of the pandemic virus
among residents and staff.
Among the recommendations were the creation of COVID-specific units, screenings of residents twice daily, discontinuing of drug delivery modes (e.g. nebulizers) that might spread the virus, and reviews with patients and families of do-not-intubate and do-not-hospitalize advance directives.
“The scope and speed of the COVID-19 pandemic brought continual changes in healthcare protocols as providers learned more about the disease’s transmission,” said Paula Lester, MD, FACP, CMD, a geriatrician at NYU Winthrop Hospital and the corresponding author of the consensus recommendations, which were recently published online in Journal of American Medical Directors Association (JAMDA).
“The time has come to consolidate our learnings as a field in terms of caring for at-risky elderly and implement uniform, best practices, especially as we prepare for a potential second wave of infections in the coming months, as well as for future pandemics,” adds Lester, who along with her co-authors, serves as a skilled nursing facility (SNF) certified medical director.
Recommended protocols for facility staff also include COVID testing on a serial basis–three tests one-week apart–to enable identification of newly infected staff. Also recommended is to have staff assigned to specific units to permit easier contact tracing in the event of COVID cases, and to have staff that are assigned to COVID-19 units not work elsewhere in the facility.
The report also states that the authors “do not support the mandatory admission of COVID-19 patients from hospitals to nursing homes as it may force unprepared facilities to provide care to COVID patients without the necessary resources or precautions.”
The consensus guidelines in the report – titled “Policy Recommendations Regarding Skilled Nursing Facility Management of COVID-19: Lessons From New York State” – are endorsed by the Executive Board of the New York Medical Directors Association and the Board of the Metropolitan Area Geriatrics Society. The authors noted, however, that the suggestions in the report should not take precedence over local Department of Health or Centers for Disease Control recommendations.
https://www.eurekalert.org/pub_releases/2020-06/nlh-csr060520.php
Among the recommendations were the creation of COVID-specific units, screenings of residents twice daily, discontinuing of drug delivery modes (e.g. nebulizers) that might spread the virus, and reviews with patients and families of do-not-intubate and do-not-hospitalize advance directives.
“The scope and speed of the COVID-19 pandemic brought continual changes in healthcare protocols as providers learned more about the disease’s transmission,” said Paula Lester, MD, FACP, CMD, a geriatrician at NYU Winthrop Hospital and the corresponding author of the consensus recommendations, which were recently published online in Journal of American Medical Directors Association (JAMDA).
“The time has come to consolidate our learnings as a field in terms of caring for at-risky elderly and implement uniform, best practices, especially as we prepare for a potential second wave of infections in the coming months, as well as for future pandemics,” adds Lester, who along with her co-authors, serves as a skilled nursing facility (SNF) certified medical director.
Recommended protocols for facility staff also include COVID testing on a serial basis–three tests one-week apart–to enable identification of newly infected staff. Also recommended is to have staff assigned to specific units to permit easier contact tracing in the event of COVID cases, and to have staff that are assigned to COVID-19 units not work elsewhere in the facility.
The report also states that the authors “do not support the mandatory admission of COVID-19 patients from hospitals to nursing homes as it may force unprepared facilities to provide care to COVID patients without the necessary resources or precautions.”
The consensus guidelines in the report – titled “Policy Recommendations Regarding Skilled Nursing Facility Management of COVID-19: Lessons From New York State” – are endorsed by the Executive Board of the New York Medical Directors Association and the Board of the Metropolitan Area Geriatrics Society. The authors noted, however, that the suggestions in the report should not take precedence over local Department of Health or Centers for Disease Control recommendations.
https://www.eurekalert.org/pub_releases/2020-06/nlh-csr060520.php
COVID-19, 1918 Influenza Pandemic, and Racial Disparities
Abstract
The coronavirus disease 2019 (COVID-19) pandemic is exacting a disproportionate toll on ethnic minority communities and magnifying existing disparities in health care access and treatment. To understand this crisis, physicians and public health researchers have searched history for insights, especially from a great outbreak approximately a century ago: the 1918 influenza pandemic. However, of the accounts examining the 1918 influenza pandemic and COVID-19, only a notable few discuss race. Yet, a rich, broader scholarship on race and epidemic disease as a “sampling device for social analysis” exists. This commentary examines the historical arc of the 1918 influenza pandemic, focusing on black Americans and showing the complex and sometimes surprising ways it operated, triggering particular responses both within a minority community and in wider racial, sociopolitical, and public health structures. This analysis reveals that critical structural inequities and health care gaps have historically contributed to and continue to compound disparate health outcomes among communities of color. Shifting from this context to the present, this article frames a discussion of racial health disparities through a resilience approach rather than a deficit approach and offers a blueprint for approaching the COVID-19 crisis and its afterlives through the lens of health equity.Unfortunately, this comes as no surprise to health equity researchers and historians of medicine and public health. The United States has a long history of racial and socioeconomic disparities, with the current pandemic further revealing the rifts created by historical injustice, structural racism, and interpersonal bias (11–13). Although some have touted COVID-19 as a “great equalizer” that strikes across age, sex, race/ethnicity, and geography, we contend that it has magnified the many “unequalizers” in our society (14, 15).
To understand the current crisis, physicians and public health researchers have mined history for insights (16). Most have focused on a century-old outbreak, the 1918 influenza pandemic (misleadingly called the “Spanish flu”), because COVID-19 most closely approximates it in scope and effect (17–19). Of the accounts comparing the 1918 influenza pandemic and COVID-19, only a notable few discuss race (8, 20, 21). Yet, a rich, broader scholarship on race and epidemic disease as a “sampling device for social analysis” exists (22–27). Given the excessive mortality due to COVID-19 in minority communities, reexamination of such historical antecedents is fruitful. Although this scholarship hesitates to offer predictions, this kind of analysis can provide orienting frameworks, reveal nuance, and modulate our approach to the current crisis—which has been called “unprecedented,” reflecting a lack of historical context.
We examine the historical arc of the 1918 influenza pandemic, focusing on black Americans and showing the complex, sometimes surprising ways it triggered particular responses both within a minority community and in wider racial, sociopolitical, and public health structures. Shifting to the present, we frame a discussion of racial health disparities through a resilience approach versus a deficit approach and offer a blueprint (Table) for approaching the COVID-19 crisis and its afterlives through the lens of health equity.
Table. The 1918 Influenza Pandemic, COVID-19, and Racial Disparities: Historical Context and Present and Future Opportunities*
https://www.acpjournals.org/doi/10.7326/M20-2223
 |
Delta to provide passengers with hygiene kits
Delta is to offer complimentary “care kits” to customers, as part of
the carrier’s requirement for all passengers to wear face masks.
The hygiene kits will be available at ticket counters and gates by June 5, and consist of a disposable face mask, hand sanitiser gel pouches, and an information card “detailing measures in place that are helping Delta transform the industry standard of clean”.
The airline recently introduced requirements for all passengers to wear face masks inflight, and Delta said that feedback from customers showed that “receiving a care kit weighed heavily on their decision to travel”.
The carrier added that it was “is leaning on its data-driven approach to customer experience, listening, testing and refining to make sure we’re delivering on the aspects of travel that customers say matter most”.
Delta has implemented a number of measures to ensure the safety of customers, including the sanitising of aircraft before every flight, capping capacity to ensure onboard spacing, and requiring both employees and customers to wear face masks or coverings.
Commenting on the news Bill Lentsch, chief customer experience officer, said:
“Our survey data showed a clear desire for these kits and we have a bias toward action when we see new trends emerge. As more people begin to consider travelling in the months ahead, ensuring their safety at all steps of their journey remains our top priority.”
The hygiene kits will be available at ticket counters and gates by June 5, and consist of a disposable face mask, hand sanitiser gel pouches, and an information card “detailing measures in place that are helping Delta transform the industry standard of clean”.
The airline recently introduced requirements for all passengers to wear face masks inflight, and Delta said that feedback from customers showed that “receiving a care kit weighed heavily on their decision to travel”.
The carrier added that it was “is leaning on its data-driven approach to customer experience, listening, testing and refining to make sure we’re delivering on the aspects of travel that customers say matter most”.
Delta has implemented a number of measures to ensure the safety of customers, including the sanitising of aircraft before every flight, capping capacity to ensure onboard spacing, and requiring both employees and customers to wear face masks or coverings.
Commenting on the news Bill Lentsch, chief customer experience officer, said:
“Our survey data showed a clear desire for these kits and we have a bias toward action when we see new trends emerge. As more people begin to consider travelling in the months ahead, ensuring their safety at all steps of their journey remains our top priority.”
Delta to provide passengers with hygiene kits
ArcherDX on deck for $100M IPO
ArcherDX (RCHR) has filed a preliminary prospectus for a $100M IPO.
The Boulder, CO-based biotech has developed five
research-use-only (RUO) diagnostic product lines that laboratories use
to conduct genomic analyses for cancer therapy optimization and
monitoring. It plans to file marketing applications for STRATAFIDE, a
multigene pan-solid tumor companion diagnostic, and its Personalized
Cancer Monitoring (PCM) assay with the FDA aimed at marketing both as in
vitro diagnostic tests.
2019 Financials: Revenue: $50.6M (+78%); Operating Expenses: $87.8M (+163%); Net Loss: ($41.0M) (-632%); Cash Flow Ops: ($37.5M) (-715%).
https://seekingalpha.com/news/3580952-archerdx-on-deck-for-ipoFor seniors, COVID-19 sets off a pandemic of despair
As states relax coronavirus restrictions, older adults are advised,
in most cases, to keep sheltering in place. But for some, the burden of
isolation and uncertainty is becoming hard to bear.
This “stay at home awhile longer” advice recognizes that older adults are more likely to become critically ill and die if infected with the virus. At highest risk are seniors with underlying medical conditions such as heart, lung or autoimmune diseases.
Yet after two months at home, many want to go out into the world again. It is discouraging for them to see people of other ages resume activities. They feel excluded. Still, they want to be safe.
“It’s been really lonely,” said Kathleen Koenen, 77, who moved to Atlanta in July after selling her house in South Carolina. She’s living in a 16th-floor apartment while waiting to move into a senior housing community, which has had cases of COVID-19.
“I had thought that would be a new community for me, but everyone there is isolated,” Koenen said. “Wherever we go, we’re isolated in this situation. And the longer it goes on, the harder it becomes.”
(Georgia residents age 65 and older are required to shelter in place through June 12, along with other vulnerable populations.)
Her daughter, Karestan Koenen, is a professor of psychiatric epidemiology at Harvard University’s T.H. Chan School of Public Health. During a Facebook Live event this month, she said her mother had felt in March and April that “everyone was in (this crisis) together.” But now, that sense of communality has disappeared.
Making it worse, some seniors fear that their lives may be seen as expendable in the rush to reopen the country.
“(Older adults) are wondering if their lives are going to end shortly for reasons out of their control,” said Dr. Linda Fried, dean of the Mailman School of Public Health at Columbia University, in a university publication. “They’re wondering if they’ll be able to get the care they need. And most profoundly, they’re wondering if they are going to be cast out of society. If their lives have value.”
On the positive side, resilience is common in this age group. Virtually all older adults have known adversity and loss; many have a “this too shall pass” attitude. And research confirms that they tend to be adept at regulating their reactions to stressful life events—a useful skill in this pandemic.
“If anything, I’ve seen a very strong will to live and acceptance of whatever one’s fate might be,” said Dr. Marc Agronin, a geriatric psychiatrist and vice president of behavioral health at Miami Jewish Health, a 20-acre campus with independent living, assisted living, nursing home care and other services.
Several times a week, psychologists, nurses and social workers are calling residents on the campus, doing brief mental health checks and referring anyone who needs help for follow-up attention. There’s “a lot of loneliness,” Agronin said, but many seniors are “already habituated to being alone or are doing OK with contact (only) from staff.”
Still, “if this goes on much longer,” he said, “I think we’ll start to see less engagement, more withdrawal, more isolation—a greater toll of disconnection.”
Erin Cassidy-Eagle, a clinical associate professor of psychiatry at Stanford University, shares that concern.
From mid-March to mid-April, all her conversations with older patients revolved around several questions: “How do we keep from getting COVID-19? How am I going to get my needs met? What’s going to happen to me?”
But more recently, Cassidy-Eagle said, “older adults have realized the course of being isolated is going to be much longer for them than for everyone else. And sadness, loneliness and some hopelessness have set in.”
She tells of a woman in her 70s who moved into independent living in a continuing care community because she wanted to build a strong social network. Since March, activities and group dining have been canceled. The community’s director recently announced that restrictions would remain until 2021.
“This woman had a tendency to be depressed, but she was doing OK,” Cassidy-Eagle said. “Now she’s incredibly depressed and she feels trapped.”
Especially vulnerable during this pandemic are older adults who have suffered previous trauma. Dr. Gary Kennedy, director of the division of geriatric psychiatry at Montefiore Medical Center in New York City, has seen this happen to several patients, including a Holocaust survivor in her 90s.
This woman lives with her son, who got COVID-19. Then she did as well. “It’s like going back to the terror of the (concentration) camp,” Kennedy said, “an agonizing emotional flashback.”
Jennifer Olszewski, an expert in gerontology at Drexel University, works in three nursing homes in the Philadelphia area. As is true across most of the country, no visitors are allowed and residents are mostly confined to their rooms.
“I’m seeing a lot of patients with pronounced situational depression,” she said—”decreased appetite, decreased energy, a lack of motivation and overall feelings of sadness.”
“If this goes on for months longer, I think we’ll see more people with functional decline, mental health decline and failure to thrive,” Olszewski said.
Some are simply giving up. Anne Sansevero, a geriatric care manager in New York City, has a 93-year-old client who plunged into despair after her assisted living facility went on lockdown in mid-March. Antidepressant and anti-anxiety medications have not helped.
“She’s telling her family and her health aides ‘life’s not worth living. Please help me end it,'” Sansevero said. “And she’s stopped eating and getting out of bed.”
The woman’s attentive adult children are doing all they can to comfort their mother at a distance and are feeling acute anguish.
What can be done to ease this sort of psychic pain? Kennedy of Montefiore has several suggestions.
“Don’t try to counter the person’s perception and offer false reassurance. Instead, say, yes, this is bad, no doubt about it. It’s understandable to be angry, to be sad. Then provide a sense of companionship. Tell the person, ‘I can’t change this situation but I can be with you. I’ll call tomorrow or in a few days and check in with you again.'”
“Try to explore what made life worth living before the person started feeling this way,” she said. “Remind them of ways they’ve coped with adversity in the past.”
If someone is religiously-inclined, encourage them to reach out to a pastor or a rabbi. “Tell them, I’d like to pray together or read this Bible passage and discuss it,” Kennedy said. “Comforting person-to-person interaction is a very effective form of support.”
Do not count on older adults to own up to feeling depressed. “Some people will acknowledge that, yes, they’ve been feeling sad, but others may describe physical symptoms—fatigue, difficulty sleeping, difficulty concentrating,” said Julie Lutz, a geropsychologist and postdoctoral fellow at the University of Rochester.
If someone has expressed frequent concerns about being a burden to other people or has become notably withdrawn, that’s a worrisome sign, Lutz said.
In nursing homes, ask for a referral to a psychologist or social worker, especially for a loved one who’s recovering from a COVID hospitalization.
“Almost everybody that I’m seeing has some kind of adjustment disorder because their whole worlds have been turned upside down,” said Eleanor Feldman Barbera, an elder care psychologist in New York City. “Talking to a psychologist when they first come in can help put people on a good trajectory.”
https://medicalxpress.com/news/2020-06-seniors-covid-pandemic-despair.html
This “stay at home awhile longer” advice recognizes that older adults are more likely to become critically ill and die if infected with the virus. At highest risk are seniors with underlying medical conditions such as heart, lung or autoimmune diseases.
Yet after two months at home, many want to go out into the world again. It is discouraging for them to see people of other ages resume activities. They feel excluded. Still, they want to be safe.
“It’s been really lonely,” said Kathleen Koenen, 77, who moved to Atlanta in July after selling her house in South Carolina. She’s living in a 16th-floor apartment while waiting to move into a senior housing community, which has had cases of COVID-19.
“I had thought that would be a new community for me, but everyone there is isolated,” Koenen said. “Wherever we go, we’re isolated in this situation. And the longer it goes on, the harder it becomes.”
(Georgia residents age 65 and older are required to shelter in place through June 12, along with other vulnerable populations.)
Her daughter, Karestan Koenen, is a professor of psychiatric epidemiology at Harvard University’s T.H. Chan School of Public Health. During a Facebook Live event this month, she said her mother had felt in March and April that “everyone was in (this crisis) together.” But now, that sense of communality has disappeared.
Making it worse, some seniors fear that their lives may be seen as expendable in the rush to reopen the country.
“(Older adults) are wondering if their lives are going to end shortly for reasons out of their control,” said Dr. Linda Fried, dean of the Mailman School of Public Health at Columbia University, in a university publication. “They’re wondering if they’ll be able to get the care they need. And most profoundly, they’re wondering if they are going to be cast out of society. If their lives have value.”
On the positive side, resilience is common in this age group. Virtually all older adults have known adversity and loss; many have a “this too shall pass” attitude. And research confirms that they tend to be adept at regulating their reactions to stressful life events—a useful skill in this pandemic.
“If anything, I’ve seen a very strong will to live and acceptance of whatever one’s fate might be,” said Dr. Marc Agronin, a geriatric psychiatrist and vice president of behavioral health at Miami Jewish Health, a 20-acre campus with independent living, assisted living, nursing home care and other services.
Several times a week, psychologists, nurses and social workers are calling residents on the campus, doing brief mental health checks and referring anyone who needs help for follow-up attention. There’s “a lot of loneliness,” Agronin said, but many seniors are “already habituated to being alone or are doing OK with contact (only) from staff.”
Still, “if this goes on much longer,” he said, “I think we’ll start to see less engagement, more withdrawal, more isolation—a greater toll of disconnection.”
Erin Cassidy-Eagle, a clinical associate professor of psychiatry at Stanford University, shares that concern.
From mid-March to mid-April, all her conversations with older patients revolved around several questions: “How do we keep from getting COVID-19? How am I going to get my needs met? What’s going to happen to me?”
But more recently, Cassidy-Eagle said, “older adults have realized the course of being isolated is going to be much longer for them than for everyone else. And sadness, loneliness and some hopelessness have set in.”
She tells of a woman in her 70s who moved into independent living in a continuing care community because she wanted to build a strong social network. Since March, activities and group dining have been canceled. The community’s director recently announced that restrictions would remain until 2021.
“This woman had a tendency to be depressed, but she was doing OK,” Cassidy-Eagle said. “Now she’s incredibly depressed and she feels trapped.”
Especially vulnerable during this pandemic are older adults who have suffered previous trauma. Dr. Gary Kennedy, director of the division of geriatric psychiatry at Montefiore Medical Center in New York City, has seen this happen to several patients, including a Holocaust survivor in her 90s.
This woman lives with her son, who got COVID-19. Then she did as well. “It’s like going back to the terror of the (concentration) camp,” Kennedy said, “an agonizing emotional flashback.”
Jennifer Olszewski, an expert in gerontology at Drexel University, works in three nursing homes in the Philadelphia area. As is true across most of the country, no visitors are allowed and residents are mostly confined to their rooms.
“I’m seeing a lot of patients with pronounced situational depression,” she said—”decreased appetite, decreased energy, a lack of motivation and overall feelings of sadness.”
“If this goes on for months longer, I think we’ll see more people with functional decline, mental health decline and failure to thrive,” Olszewski said.
Some are simply giving up. Anne Sansevero, a geriatric care manager in New York City, has a 93-year-old client who plunged into despair after her assisted living facility went on lockdown in mid-March. Antidepressant and anti-anxiety medications have not helped.
“She’s telling her family and her health aides ‘life’s not worth living. Please help me end it,'” Sansevero said. “And she’s stopped eating and getting out of bed.”
The woman’s attentive adult children are doing all they can to comfort their mother at a distance and are feeling acute anguish.
What can be done to ease this sort of psychic pain? Kennedy of Montefiore has several suggestions.
“Don’t try to counter the person’s perception and offer false reassurance. Instead, say, yes, this is bad, no doubt about it. It’s understandable to be angry, to be sad. Then provide a sense of companionship. Tell the person, ‘I can’t change this situation but I can be with you. I’ll call tomorrow or in a few days and check in with you again.'”
“Try to explore what made life worth living before the person started feeling this way,” she said. “Remind them of ways they’ve coped with adversity in the past.”
If someone is religiously-inclined, encourage them to reach out to a pastor or a rabbi. “Tell them, I’d like to pray together or read this Bible passage and discuss it,” Kennedy said. “Comforting person-to-person interaction is a very effective form of support.”
Do not count on older adults to own up to feeling depressed. “Some people will acknowledge that, yes, they’ve been feeling sad, but others may describe physical symptoms—fatigue, difficulty sleeping, difficulty concentrating,” said Julie Lutz, a geropsychologist and postdoctoral fellow at the University of Rochester.
If someone has expressed frequent concerns about being a burden to other people or has become notably withdrawn, that’s a worrisome sign, Lutz said.
In nursing homes, ask for a referral to a psychologist or social worker, especially for a loved one who’s recovering from a COVID hospitalization.
“Almost everybody that I’m seeing has some kind of adjustment disorder because their whole worlds have been turned upside down,” said Eleanor Feldman Barbera, an elder care psychologist in New York City. “Talking to a psychologist when they first come in can help put people on a good trajectory.”
https://medicalxpress.com/news/2020-06-seniors-covid-pandemic-despair.html
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