John Muscedere

March 20, 2020 AS THE PRIME MINISTER addressed the nation, from his quarantined residence in Ottawa, he echoed what public health officials have been saying: Listen to your health care providers, practise social distancing and get prepared. The World Health Organization (WHO) has officially declared the novel coronavirus (COVID-19) a global pandemic, and public health officials, together with credible media sources, have shared important information and data regarding who may be more likely to contract the virus from the current ‘hot spots’ – China, South Korea, Iran and Italy. Media reports rightly reassure us that most individuals will not become seriously ill with the virus. However, the 15 to 20 per cent who may become ill enough to require hospitalization will seriously impact and possibly overwhelm our hospitals and intensive care unit (ICU) system which is already at—or over—capacity. Our failure to address the long-known crisis in elder care across the country has made us unprepared for an additional demand on hospital services on the level of COVID-19. Too many of Canada’s frail seniors are currently living in hospitals, awaiting placement in long-term care facilities or waiting for an alternative level of care elsewhere. This is why health authorities are striving now to implement policies that will slow the progression of the virus and “flatten the curve” of demand—so there is no sudden spike, but instead a slower increase in the number of those infected that would be more manageable. Canada’s older adults, particularly those with underlying health issues, those with chronic health conditions and those living with frailty, are already at increased risk for severe, adverse health outcomes from even minor illnesses and injury. They will be the hardest hit by the COIVD-19 virus. Currently around 16 per cent of the Canadian population is over the age of 65. The most vulnerable of these older adults are those living with frailty, which includes one in every four older adults over the age of 65. For those over age 80, the frailty rate jumps to 50 per cent. We need to make sure we recognize the vulnerability of seniors living with frailty. They are the main reason the current containment efforts for this virus are so important. This also means making sure that measures to prevent the spread of COVID-19 don’t negatively affect our seniors. Public health authorities have advised Canadians to engage in “social distancing”—staying away from crowded public spaces and avoiding unnecessary close contact with others. But it is important to remember that social isolation is also dangerous to the health and well-being of older adults. Loneliness is associated with potentially life-shortening health issues, such as higher blood pressure, heart disease, obesity and depression. Now is the time to check in on older, possibly frail or socially isolated neighbours, family and friends—but take precautions. This means washing your hands, making sure you’ve had your flu vaccination and avoiding in-person visits if you have been in contact with someone with an illness or have signs of illness yourself. Now is also the time to help your older loved ones prepare for the long-term consequences of a COVID-19 outbreak, which may mean helping them stock up on provisions, medicines and other essentials. We should also speak up when we hear, “Oh well, it’s only old people who are dying.” Ageism has no place in Canada and our seniors are not expendable but rather valuable members of our communities. It’s times like this, a viral COVID-19 pandemic, that we are reminded of how interdependent we are as individuals. It is up to everyone to stay informed and work together as a community to mitigate the spread of the virus, which includes taking care of our vulnerable older Canadians. Dr. John Muscedere is an the Scientific Director of the Canadian Frailty Network, an intensivist in the Intensive Care Unit at Kingston Health Sciences Centre – KGH Site, and a Professor of Critical Care Medicine at Queen’s University. The Canadian Frailty Network works to improve care for older adults living with frailty and to support their families and caregivers by increasing recognition and assessment of frailty, increasing research based evidence for decision making, advancing evidence-based changes to care, educating the next generation of care providers and by engaging with older adults and caregivers.