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Underlying Conditions Most Dangerous for COVID-19?

AARP’s recent article “Three Most Dangerous Underlying Conditions for COVID-19” reports that it is well-established that risk increases with age. The CDC lists nearly two dozen health conditions that could put you at higher risk of becoming seriously ill or dying of COVID-19. AARP did some research with doctors, who said three conditions worried them the most: diabetes, high blood pressure/underlying heart disease and obesity.

This corresponds with the results of one of the largest studies so far on COVID-19 mortality, published in the journal Clinical Infectious Diseases in December 2020. It looked at data from nearly 67,000 hospitalized coronavirus patients and found that these health conditions are associated with a higher risk of death:

  • Obesity,
  • Diabetes (with complications such as organ damage), and
  • High blood pressure (with complications, such as heart damage or kidney disease).

Each is an inflammatory disease that is prevalent among American adults, and experts say they are closely linked.

Obesity is a risk factor for diabetes and high blood pressure, and diabetes can contribute to high blood pressure. Moreover, diabetes and high blood pressure both can trigger kidney disease and lung disease—two other conditions that make COVID-19 riskier, says the CDC.

Some of the other dangerous conditions mentioned by the physicians include dementia, chronic kidney disease and chronic obstructive pulmonary disease (COPD). Immunocompromised patients, those who smoke and those with organ transplants also are a concern.

Lets’ look at those three health conditions that are associated with a higher risk of death:

High-risk condition: Obesity. Obese people diagnosed with COVID-19 are more than twice as likely to be hospitalized and about 50% more apt to die compared to patients who are a healthy weight. If you test positive for the coronavirus, ask your doctor if you are a good candidate for monoclonal antibodies. It is a life-saving treatment that can reduce hospitalizations among high-risk patients by as much as 70%.

Obesity is frequently associated with other health problems, but doctors note how hard COVID-19 impacts even those obese patients who have no other underlying conditions.

Obesity can make it difficult for a person’s lungs to expand, impairing breathing and oxygenation. Obesity is also believed to increase your risk of blood clots.

High-risk condition: High blood pressure. Researchers reviewed 22 studies from eight countries in 2020 and found that high blood pressure was present in 42% of hospitalized COVID-19 patients. That makes it the most prevalent health condition by a big margin. Even more surprising is the fact that those patients had twice the risk of death compared with patients without high blood pressure, said Vikramaditya Samala Venkata, M.D., one of the study’s authors and a hospital medicine physician at Cheshire Medical Center in Keene, N.H.

However, the Clinical Infectious Diseases study on COVID-19 mortality found that hypertension on its own raised the death rate only for those under age 40. For those age 40+, mortality risk increased only if their high blood pressure had caused a complication, such as heart damage or chronic kidney disease.

Experts think that the coronavirus damages the cells that line blood vessels, causing clots and making it more difficult for them to carry oxygen. Therefore, it is important to keep your blood pressure under control. Studies show that patients with unregulated high blood pressure are at greater risk from COVID-19 compared with patients who take medication to control it.

High-risk condition: Diabetes. Research of the medical records of 61 million people in England published in The Lancet Diabetes & Endocrinology found that the risk of dying from COVID-19 was almost three times higher for people with Type 1 diabetes and almost twice as high for people with Type 2 diabetes, compared with those with neither. High blood sugar weakens the immune systems, which makes it harder for the body to fight off infections. Diabetes puts you at risk for both cardiovascular complications and infectious complications. Both of those are common with COVID.

So, watch your blood sugar levels because patients with well-controlled diabetes have a COVID-19 death rate of about 1%, according to a study published in Cell Metabolism. What about those with poorly controlled disease? Their rate is closer to 11%.

Reference: AARP (Feb. 3, 2021) “Three Most Dangerous Underlying Conditions for COVID-19”

Some Veteran Caregivers Eligible for COVID-19 Vaccine through VA

The move is the result of a coalition of veterans groups that lobbied for the caregivers to be sent to the top of the vaccine list, arguing that they deserved to be included in the first wave of medical professionals being protected against the deadly illness, says Military Times’ recent article entitled “Tens of thousands of veteran caregivers now eligible for the coronavirus vaccine through VA.”

Dr. Richard Stone, executive in charge of the VA, released a memo stating that those registered with the department’s Program of Comprehensive Assistance for Family Caregivers can be given the vaccine “in a coordinated manner with the veterans for whom they provide care.”

More than 6,700 VA patients have died from COVID complications in the last 10 months. Stone’s memo states that decisions will be made “in balance with site-specific resources, needs, vaccine availability, hesitancy to accept the vaccine and status of the pandemic locally.”

In an interview with Military Times, Stone commented that he is shifting many of those vaccination decisions to local officials to give coverage to more individuals.

“We need to leave it up to people at the bedsides, to make sure they are making the best decisions for veterans,” he said. “When someone brings a veteran in to give them the vaccine, they can easily identify what the other needs are.”

Roughly 20,000 veterans are registered in the caregiver program at the Department of Veterans Affairs. This program provides monthly stipends and other support to individuals providing regular medical assistance to infirm veterans.

The data shows that the majority of this group are family members of post-9/11 veterans. The caregiver assistance program was expanded last fall to veterans who served before May 1975.

And recently, a coalition of veteran groups, including The Independence Fund, Military Order of the Purple Heart and the Non-Commissioned Officers Association sent a letter to Federal Emergency Management Agency officials asking them to authorize the VA to administer the caregiver vaccines, under its role as the lead coordinator of federal response to the pandemic.

Dr. Stone said as of January 13, VA officials had administered the first dose of the two-part vaccine to more than 332,000 department health care employees and veterans at high-risk of contracting coronavirus. Another 45,000 individuals have already received their second dose. The vaccine has been sent to nearly 200 department facilities. However, officials have warned that it could be months before they can administer the more than 7 million vaccines they expect to be requested by veterans and staff.

Reference: Military Times (Jan. 14, 2021) “Tens of thousands of veteran caregivers now eligible for the coronavirus vaccine through VA”

What are the Issues with COVID Vaccinations Sign-ups for Seniors?

With states across the U.S. providing the COVID-19 vaccine to people 65 and older, seniors are trying to determine how to make an appointment to receive their shots. Many government agencies ask people to make appointments online. However, website errors, overwhelmed phone lines and a collection of changing rules are frustrating seniors who are frequently less tech-savvy, may live farther from vaccination sites and are less likely to have Internet access—especially minority populations and the poor.

ABC News’ recent article entitled “Online sign-ups complicate vaccine rollout for older people” reports that almost 9.5 million seniors (16.5% of Americans 65 and older) lack internet access, according to U.S. Census Bureau data. Moreover, the access is worse for minority seniors, with more than 25% of Black people, about 21% of Hispanic people and over 28% of Native Americans age 65 and older have no way to get online. Compare that with 15.5% of white seniors.

In the San Francisco Bay Area, Dr. Rebecca Parish has been saddened by the bureaucratic red tape and continued calls for help from seniors. An 83-year-old patient called her in tears, unable to navigate the online appointment system at her local drugstore. After several of these types of calls, Dr. Parish took action. She contacted Contra Costa County and acquired 500 doses to vaccinate people at a middle school in Lafayette, California. She’s also working with nonprofits to identify seniors who don’t live in nursing homes and risk falling through the cracks. All her appointments have been taken, but she’ll begin adding more when more doses are available.

Many health officials have been trying to find other solutions to ease the confusion and help senior citizens sign up, as the Trump administration asked states to make the nation’s 57.6 million seniors eligible for the COVID-19 vaccine.

Some spots have discovered that simple ideas can work. For example, in Morgantown, West Virginia, county health officials used a large road construction sign to list the phone number for seniors to call to make an appointment. Some are looking at working with community groups or setting up mobile clinics for more remote populations.

Some medical systems, like UCHealth in Colorado, are trying to partner with community groups to get vaccines to underserved populations, like seniors. Local doctors are volunteering at a clinic hosted by a church that brings in the vaccine and helps build trust between health care workers and residents.

For now, UCHealth schedules appointments online, but a COVID-19 hotline is in the works because of the volume of calls from seniors. Howwever, even a Colorado health provider setting up vaccine clinics for underserved communities, Salud Family Health Centers, said their phone lines aren’t equipped to handle the number of calls they’re getting and encouraged people to go online.

Reference: ABC News (Jan. 15, 2021) “Online sign-ups complicate vaccine rollout for older people”

Is the Pandemic Motivating People to Do Estate Planning?

A survey from Policygenius, an online insurance marketplace, found that most people (60.4%) didn’t have a will, but that may be about to change. Nearly 40% of survey respondents (39.7%) said they feel it’s more important to get a will because of the pandemic.

PR Newswire’s recent article entitled “Policygenius survey finds Americans with misconceptions about estate planning” reports that many respondents also held misconceptions about the estate planning process, which may a reason they avoid it.

The survey found that more than one in five respondents (22.8%) who think getting a will is too expensive overestimated the cost by hundreds or even thousands of dollars.

A total of 48.2% incorrectly thought that their possessions would automatically pass to their spouse, if they died without a will. That may suggest that people may not be creating wills because they think they don’t need them.

There were 24.1% respondents who said that they don’t have a will because they haven’t had time to put one together, and more than half of those respondents (62%) were parents.

The survey also found that respondents prioritized family, with more than a third of them (35.9%) saying that having a child is the most important life event for someone, if they want to create a will. About two-thirds (65.5%) said that making the process of inheritance as easy as possible is one of their top three important issues, when getting a will.

Just 39.3% knew that if someone passes away without a will, a court will determine who gets their assets.

The Policygenius survey is based on responses from a nationally representative sample of 2,689 Americans ages 25 and over. It was conducted by SurveyMonkey from July 16 through July 17, 2020.

Ask an experienced estate planning attorney about a will and a comprehensive estate plan.

Reference: PR Newswire (Dec. 2, 2020) “Policygenius survey finds Americans with misconceptions about estate planning”

What Should I Know, If I Need to Take an Elderly Person to the Doctor?

First, know and understand the rules in the pandemic.

AARP’s August 17 article entitled “4 Things to Know When Taking a Loved One to the Doctor During COVID-19” provides four other things to consider as you plan doctors’ appointments.

Is there an urgent need for the appointment? A caregiver of a senior may be tempted to schedule some appointments. However, doctors are trying to return to normal, and even with precautions in place, they may not want to see your senior for a non-urgent visit. Right now, most doctors don’t advise patients to come into their office for routine follow-ups. See if the visit can be postponed or ask the medical office about a virtual visit on Zoom.

Do you know the office’s visitor policy? If the doctor asks you to bring your loved one to the doctor’s office, look at its visitor policy before you go. With COVID-19, most offices have very strict policies and may only permit scheduled patients in the office. Some will make exceptions for a senior’s caregiver if needed, but they may request that once the patient is checked in, the caregiver wait in the car.

What are the facility’s precautions against COVID-19? In most health care facilities, as well as in imaging centers, doctors’ offices, hospitals with outpatient services, ERs and labs, there’s intense facility cleaning and sanitizing, universal masking, physical distancing and hand sanitizing. Patients are typically met at the door with a thermometer and a COVID-19 questionnaire. Other precautions include removing magazines to protect against the risk of virus transmission and requiring all staff to wear surgical masks.

What preparation is needed for an in-person appointment? Both the caregiver and patient should wear masks and get there punctually. When you make the appointment and it is prep for a scheduled surgery or procedure, ask if the patient needs a COVID-19 test.

You should also bring a list of medications with dosages and frequencies (and the number of refills left.). It is also helpful to have on hand a medical history that includes symptoms, dates and durations. This can be valuable in completing the COVID-19 questionnaire and to get more from the appointment. You should also have a list of questions for the doctor.

When you leave the appointment, be certain: (i) all of the patient’s questions have been answered; (ii) review the instructions for home care provided in the treatment plan; and (iii) schedule the next appointment, if a follow-up is needed.

Reference: AARP (Aug. 17, 2020) “4 Things to Know When Taking a Loved One to the Doctor During COVID-19”

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