Impacts of COVID-19 on older people, persons with disabilities, and immuno-compromised persons

Backgrounder

Introduction

COVID-19 is a serious pandemic that needs urgent attention to check its advance and impact on people’s health, lifestyles, and economic status. Consequently, it is important to reach all sectors of society to raise awareness about this pandemic.

Specific measures to prevent infection and transmission have been designed. These include wearing face masks, keeping rooms well-ventilated, keeping good hygiene, physical distancing, avoiding crowds and close contact, and, when transmission is serious, lockdowns. Such measures may impact social activities and result in temporary loss of social freedoms, which may in turn have impacts on mental and physical health, social isolation and loneliness.

Raising awareness of COVID-19 includes emphasizing the collective sense of responsibility that is needed to successfully implement these measures, and strengthening the understanding that such measures must be taken not only to save oneself but everyone in the community from COVID-19.

Unfortunately, certain groups in society are most at risk of severe illness and may be left out of these efforts. This includes older people, persons with disabilities, and those living with diseases that compromise their immune systems, including people living with HIV and AIDS, or PLHAs, as well as people with diabetes or who are receiving certain types of treatment for cancer.

This backgrounder addresses the impact of COVID-19 on older people, on persons with disabilities, and on those with chronic medical conditions that compromise their immune system.

Impact of COVID-19 among disadvantaged groups

According to an assessment by the Ministry of Health in eastern Zambia, the majority of the hospitalizations and mortalities recorded during the COVID-19 pandemic are among the following groups of people:

• older people
• people who have not been vaccinated.
• people living with HIV
• people who already have debilitating conditions and chronic diseases such as hypertension, diabetes, and advanced AIDS

What are some key facts?

• COVID-19 is a highly infectious airborne disease caused by the new coronavirus (SARS-CoV-2).
• It spreads from person-to person, primarily through sneezing and coughing.
• COVID-19 is dangerous. If diagnosis and medical attention area delayed, it can result in severe illness and even death.
• The most common symptoms of COVID-19 are fever, coughing, sore throat, difficulty breathing, and sometimes flu-like symptoms such as a running nose, sneezing, and general body weakness. Other symptoms include fatigue, headache, and loss of taste and/or smell. It’s important to note that a certain percentage of people who are infected with COVID-19 may not have any symptoms at all, but can still infect others.
• COVID-19 does not discriminate and can infect the physically fit, people with disabilities, and immune-compromised persons. It also does not discriminate based on age, race, or nationality.
• Protect yourself and those around you. Keep a physical distance of at least 1 metre from others, even if they don’t appear to be sick. Avoid crowds and close contact. This reduces the potential for transmission and infection.
• Wear masks properly. Your mask should cover your nose, mouth, and chin. It is a relatively effective barrier to breathing in droplets from infected people, especially in crowded, indoor settings. If you are infected, face masks will equally prevent droplets from sneezing or coughing from infecting other people.
• Everyone is at risk of contracting COVID-19. However, those who are at higher risk of severe illness include older persons and people with underlying health conditions such as lung problems, heart diseases, kidney failure, or weak immune systems.
• Safe and effective vaccines are available that provide strong protection against serious illness, hospitalization, and death from COVID-19. People should follow local guidance on vaccination and get vaccinated as soon as it’s their turn.

Impact of COVID-19 on older people and the immuno-compromised

Older people:

In many parts of Zambia, a majority of people live in rural clusters or villages. These are the bases from which people venture out to urban areas to find employment. After retirement, they come back to their original communities or villages. However, older people in Zambia face big challenges, which result in COVID-19 having a negative impact on them.

Challenges related to COVID-19 include the following:

• Older people are often mistakenly considered to be unproductive members of society. As a result, many are often regarded as liabilities and are sometimes neglected and merely tolerated.
• Because of this, many older people do not have access to appropriate care. Their health is often not managed because of poor diet and poor hygiene. Consequently, they are often starved, weak, and sick. This makes them vulnerable to COVID-19 and other life-threatening infections. Anecdotal information suggests that this situation is not limited to Zambia, but may apply to other southern African countries and elsewhere in Africa. It stems not from deliberate neglect of older people, but from the fact that younger, more educated people migrate from rural to urban areas.
• Older people also succumb to COVID-19 infection, hospitalization, and death more readily and at a higher rate than the young due to their frailty and vulnerability.
• Older people in some countries in Southern Africa, Zambia included, are often poor and have no means of travelling to the nearest health facility to access treatment for any kind of sickness, including COVID-19, and including vaccination against COVID-19.
• In addition, many older people do not have radio receivers, cellphones, or alternative ways of accessing accurate information. As a result, their access to good quality information from reliable sources may be compromised. Consequently, many may be inadequately informed about what is happening around them, including COVID-19. Much of the information they receive may be false, and this may result in them reacting negatively to efforts to manage COVID-19.

Ways to lessen the negative impact of COVID-19 on older people

• Produce regular radio programs that provide simple information about COVID-19—what it is, how it spreads, what measures a person can take to protect him/herself, and how to access health services related to COVID-19 and managing underlying diseases, especially HIV and AIDS and others, in the local area.
• Home-based care programs that encourage younger relatives to care for and respect the older generation.
• Regular visits by health practitioners to remote areas to ensure that older people receive both correct information and appropriate health care.
• Encourage older people to engage in activities that improve their health and well-being, e.g., taking regular walks or performing simple physical activity around the home.
• Encourage older people to get vaccinated against COVID-19.

Immuno-compromised persons

In Zambia, people living with HIV and AIDS account for the majority of individuals with compromised immunity. Many are on lifelong anti-retroviral treatment and must always be wary of their health. If they miss their medication for any length of time, their viral load can increase and they may become weak. Such people have a high risk of severe disease with COVID-19 and must be extra careful.

Other groups at risk include people with diabetes and people with hypertension and other chronic health challenges. Also, people with cancer may be especially vulnerable to serious illness from COVID-19 because of their compromised immune systems and because of the effects of some types of cancer treatment. COVID-19 could be having a big toll on these classes of people.

The methods of lessening the negative impact of COVID-19 on immune-compromised groups include the same strategies as proposed above for the elderly. In addition, health providers should take advantage of regular visits to health centres to replenish medications and provide accurate information on COVID-19. This can improve people’s compliance with any measures designed to avoid infection, and lessen the spread of COVID-19.

Key definitions

COVID-19: A highly infectious disease caused by the new coronavirus (SARS-COV-2).

Face masks: Piece of cloth or other recommended material worn over the nose, mouth, and chin to prevent inhaling and spreading infectious agents, in this case, the COVID-19 virus.

False information: Information that is not true, also called misinformation. It is often created and spread by malicious sources in order to mislead people.

Home-based care programs: Programs that involve health providers encouraging people with the same health challenge to form groups and encourage and support each other.

Immuno-compromised: State of health where natural immunity to infections is weak and sometimes completely destroyed. This is a serious situation for people with HIV and AIDS and others.

Lockdown: A period of time during which people may be required to stay indoors in order to reduce person-to-person transmission of the COVID-19 virus.

PLHAs: People living with HIV and AIDS. These are people infected with HIV or who have developed AIDS. Many of them take lifelong anti-retroviral medication and lead lifestyles that are designed to control the levels of the HIV virus in their bodies and thereby extend their lives. This involves, for example, minimizing or abstaining from alcohol and multiple sexual partnerships.