September 27, 2020
Live well club

CORONAVIRUS – A Call to Arms for Older People

Information on this page is of a general nature only. For information specific to your needs, please check with your local, state, national or facility guidelines (links below) or ask a trusted health professional.

Authors: Australian GPs, Dr Kat McLean, MBChB FRACGP FRNZCGP and Dr Wendy Burton, MBBS FRACGP (Hon) and with acknowledgement of the amazing hive mind that is GPDU


Don’t Be Scared. Be Prepared.

It is March 17, 2020, and, unless you don’t watch TV, listen to the radio or talk about current affairs, you will know that we are rather worried about the spread of a condition by the name of Covid-19. One of the blessings of age is that we’ve seen a number of things come and go and we know that this too shall pass. Quite a number of doctors around the world are on high alert however as this infection, which may be mild in most, has a nasty sting in its tail. We need your wisdom, your intelligence, your experience, your expertise, your compassion. We also need your attention. You are part of our solution, please help us all to get through this.

  • Panic is rising and there are numerous suggestions that are simply wrong or lacking in practical detail

  • We have some tips we hope will help

  • It is very important that we take action now so that we can flatten the curve and keep us all safer

  • Whatever you have heard about this being “just like a cold or flu” is simply wrong. If you want proof, look at what happened in China and what is happening in Europe. No one builds a hospital in 10 days, slams the foot on the brakes of their economy or shuts down bars, restaurants, hairdressers and locks down their people without a very good reason


Top Tips

  • The risks of severe complications such as viral pneumonia increase as you become older

  • The risks are highest in those over 80, but the risks are climbing significantly from 60

  • Other compounding risk factors include:

    • those who have heart problems

    • those who have diabetes

    • those who have lung troubles e.g. asthma, emphysema, chronic bronchitis, bronchiectasis, cystic fibrosis

    • those who have high blood pressure

    • those who have cancer

    • smokers (quit now)

We are also concerned about those whose immune systems are low, including because of medication that they take, pregnancy and our First Nations people.


Healthy Spacing

  • Is another way of saying social distancing and is what the photo above shows — we need to keep a healthy space between us and the people around us while this infection is about

  • Is an act of respect and love for those nearby

  • To the best of your ability, you MUST enact it NOW

  • No hand-shakes, hugs, fist pumps, high 5’s or kisses, just for now

  • It will help keep us all safer by reducing the spreading of germs, be they cold, flu or Covid-19

  • If you don’t already know, now is the time to learn how to use your phone, tablet or computer for video calls

Stay in your bubble. Don’t pop another’s bubble.

We all need to be prepared for significant disruption to the way we do things.

  • This is already happening

  • Set times for the elderly or disabled to do grocery shopping are now available in Australia. Take advantage of them

  • If you are not already, get set up for online shopping, where available

  • Buddy up with family, friends or neighbours

  • Help one another, can you collect something (be aware that limits currently apply) if you are heading to the shops?

  • Check-in on each other regularly (by phone, video call or across the backyard), consider having a set time

  • Visits to nursing homes have been restricted as we try to reduce the spread of this infection into vulnerable populations

Our advice is to stay at home but if you do venture out

  • Avoid public transport during peak hours

  • Avoid crowded spaces/peak hours anywhere

  • Wash your hands or use hand sanitiser regularly

  • Avoid the hand dryers – go for paper towels instead

The little ones

i.e. grandchildren and great-grandchildren

  • Sorry, I know this is hard and the preschoolers/early primary school children will not understand but you need to stay away from them

  • Kids are very effective germ transfer units and the cuddles you usually enjoy are now a high risk

  • Drop off and pick up at childcare or school, helping out in the school holidays or when they get sick is not safe for you

  • It’s not enough to say you’ll stop if they get sick. It is possible to be infectious before symptoms develop, that is what makes this outbreak much harder to control than SARS or MERS

To understand why we believe healthy spacing (aka social distancing) matters, you need to understand how Covid-19 is spread. We believe it is a spread mostly by droplet, but there is also limited aerosol spread, and the closer you are the more likely it will hit you

Droplet

  • This is the snotty, grotty stuff; the mucus and the gobs of goo you blow out or that goes flying when you sneeze or cough

  • You can catch some of this by covering your mouth when you cough e.g. with your elbow or a tissue, clothing or mask

  • If this lands on your face or hands and you touch your face, it is very easy for the virus to transfer through your mucus membranes (eyes, inside the nose and mouth) and into your body

  • Skin is a much better barrier to infection and we can wash the germs off or use hand sanitiser to kill the germs

  • We can wipe down the benches, taps, door handles, hand-held devices etc where it lands

Aerosol

  • This is the fine spray that you release when you cough, sneeze or blow hard e.g. when having breathing tests, having nebulised medicine

  • You can catch some of this spray by covering your mouth when you cough e.g. with your elbow or a tissue, clothing or mask

  • Once this spray is in the air, where we believe it can linger for hours, you can breathe it in. You cannot wipe it off

  • It can also land on surfaces, such as benches, taps, door handles, hand-held devices etc where it can be wiped off

Hence our advice to stay home if sick; where possible, keep 1.5-2m from each other; cover your mouth when you cough/sneeze; wash your hands and clean surfaces regularly

For a cool visual to help us understand the difference healthy spacing (aka social distancing) can make, click here

Now, I’m sure you know this, but would you please pass it on to those who don’t?

  • If you are sick, stay home and keep your germs to yourselves

  • Wash your hands

  • Cover your mouth when you cough

  • Keep your hands below your shoulders and, unless your hands are clean, don’t touch your mouth, eyes or nose

  • Clean regularly (at least twice a day if someone in the household is sick) including hand-held devices

  • Masks are for sick people, those caring for sick people or health care workers

  • Quit smoking

If you have 8 minutes and you want to see Dr Wendy Burton say this (and a few other things) out loud, click here

More common sense stuff:

  • How would you manage if you had to stay in quarantine or isolation for 2 weeks or more? Do you have supplies? Someone who can shop for you? Home delivery options?

  • Limit visitors

  • If you don’t know how to do it, get set up for Face Time, Skype or Zoom or one of any number of ways to be “face to face” without actually being in a room with others

  • To the best of your ability, you must not have contact with people who are in quarantine or isolation

  • Caregivers, including family members, coming in? If they are at all unwell, they can’t be there with you. Simple as that. If needs be, politely ask them to leave, then wash your hands (take the WHO #SafeHands challenge) and clean any surfaces they may have touched

Common sense stuff continued:

  • Cancel all family gatherings from now on until further notice

  • Cancel all concerts, bridge club, gym classes, visits to busy shopping centres from now until further notice. As Australia goes into lockdown, you will not be able to do most of these things anyway

  • If you live in the community – who are your neighbours? Do you have their contact details?  Let’s look out for one another

  • Well-meaning neighbours may want to come over for cuppa, but you need to politely say no.  Alternatives: chat across the fence? A cuppa outside (keeping a safe space!)? Can you organise a phone call instead?

  • At home – do you have a hobby that has fallen by the wayside?  It may be time to pick it back up

  • Do you like to cook? To sew? To knit? To paint? Do puzzles? Woodwork? Crosswords? Sudoku?

  • Books may come back in fashion — goodness knows, the internet is going to slow down under the load of everyone at home trying to watch stuff at once!

    • Can someone pick up books from the library for you? Brisbane City Council libraries have closed as of 22nd of March 2020, but their online services continue

    • Grab some bargains on Gumtree or at a garage sale?

    • Did you keep a box or ten when you moved house? Dust them off, we may have need of them

  • Audiobooks are a great invention but download now (the internet will slow as more people are in lockdown) and earphones in if you are the only one who wants to listen to that book

  • Music—have you seen the Italians, on their balconies, singing? That’s the spirit! Keep 2m apart, but keep singing, set up a virtual band or choir

  • It’s important, always, to eat well, which is more fruit and vegetables and less highly processed foods, but you know that. Time to make sure you act on what you know, every little bit helps

  • Smoking of any kind? STOP NOW

Even more common sense stuff (how is that even possible!)

  • Alcohol – avoid the temptation to have a drink or three to manage

  • Immunisations – influenza, ASAP (we are expecting to have Australian public stocks in mid-late April) pneumococcal (one shot after age 65 for most folk, extra dose for a long list of chronic conditions)

  • Care plans and health assessments – do you have a copy? Is it up to date? Do you have a My Health Record? Has a Shared Health Summary been uploaded and is it up to date? (check with your GP)

  • Prescriptions – we don’t know if shortages will increase, but it is certainly possible. We suggest having a month’s supply on hand. Limits now apply in Australia

  • Ask your pharmacist if they can home deliver your medications

  • The Australian government has provided funding from Medicare for telephone or video consultations with doctors. Everyone over 70 is eligible, ask your GP if they are providing this service. Please avoid busy waiting rooms

  • The exception to avoiding waiting rooms include having your flu vaccine (there is a specific, stronger version for over 65’s which is not available at the chemist) and Prolia injections for osteoporosis. These need to be given when due but we are working on ways to do this more safely for you

  • Movement matters and it is never too late to start—a little bit of boogie, jive (ok, these lot have been practising!) or disco (oh, there are some golden oldie moves there!), so c’mon, put on some music and move, even if it just doing a jiggle in your chair

  • Chair exercises: knees up and down, pretend to stomp on grapes to make wine. Stretch your arms back and forward as if you are holding a bag of pasta or rice, alternating. Do these to music, make up some better moves!

Someone has to say this out loud:

  • make sure your advance care directive/statement of choices are up to date and on hand

  • do you have an enduring power of attorney/guardianship in place? Are these documents at hand?

  • speak to your family about your wishes in case they need to make difficult decisions for you

  • Does your will need updating?

In a nursing home

  • We hate to say this, but is it possible to stay in your room for meals?

  • Can you close your bedroom door?

  • Perhaps it’s time to put a sign on your door, requesting people knock and wait for you to answer?

  • Deter people ‘just popping in for a chat/cuppa’ but do encourage them to phone/Zoom/meet outside/go for a walk (just not side by side at present)

  • Nursing homes will be vigilant with sick staff, so if you are worried someone is unwell, please speak up.  Let someone know.  It is not OK for unwell caregivers to be at work

  • We suggest washing hands or using alcohol gel when moving from one area to another, before eating and hand-washing (as usual, but more attention to doing it properly) after going to the toilet, if we’ve been in contact with contaminated surfaces. Every time. That’s a lot of soap or hand sanitiser!

  • Open doors and windows, if possible/practical

  • NO sharing of food and drinks

  • NO communal meals, for now, including no shared platters of fruit, biscuits, cake

  • Hand-washing properly takes 20 seconds. Get creative with some favourite songs or some new words to old tunes and time them for 20 seconds. That’s how long we all need to be washing our hands for!

  • Surfaces will need to be wiped regularly if you are sick — at least twice a day: door handles, handrails, benches, light and power switches, toilets, sinks, taps, computers, especially if they have touch screens, keyboards, tablets, your phone

  • Hand-held devices can harbour lots of germs. If you are using these devices, clean them regularly – we use some alcohol spray, wipes or gel on a tissue and give it a quick wipe (don’t get it wet). Click here for advice from Apple

  • Sick people (especially sick carers) need to stay home or if they get sick while at work, they need to go home. Yes, this will be disruptive as Australia heads into winter and our cold and flu season, but COVID-19 can be very mild, especially in kids (who you need to avoid for now) and we are serious about flattening that curve!

For all of us

  • Reconsider indoor gatherings for birthday parties or any gatherings at present, particularly large ones

  • Ask what your community is doing

  • Make suggestions

  • Get involved

  • Help (many hands, light work and all that)

  • Be mindful of what you say and what others, especially little ones or anxious ones, hear

  • Check your local health recommendations (we have links for Australian as well as some international resources below)

Mental health considerations

  • Anxiety is also highly contagious (Australia, I’m looking at you and the great toilet paper shortage, which is now international!) so try and ensure others don’t catch this from you

  • Don’t be scared. Be prepared

  • Head to Health has some great online mental health resources

  • There are lots of great free apps or websites you can access

  • Contact your GP if you need additional support

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