Caregiver guidelines during the COVID-19 pandemic

Medical Minutes

Older adults are at elevated risk for complications from COVID-19 and are dying at higher rates than younger patients. In light of these concerns, researchers at Indiana University School of Medicine and colleagues have just issued guidelines and best practices for healthcare providers and family caregivers who are providing care for older adults during the COVID-19 pandemic. Their recommendations are published in the Journal of Geriatric Emergency Medicine.

“Our senior patients need additional measures of care and protection, and COVID-19 only exacerbates those needs,” said scientist Dr. Kathleen Unroe, who is one of the authors on the paper. “Family care providers need to be aware of the hazards COVID-19 presents to their loved ones and understand how to mitigate them.”

Dr. Unroe and her colleagues write that there is a need to prioritize testing for older adults even after increased screening capacity is available, due to their increased risk of complications from the disease. They advise health systems to make testing available in settings other than the emergency department whenever possible and to use options such as telecare in the screening process.

Older adults may be experiencing significant isolation already, and social distancing may worsen complications from seclusion, Dr. Unroe and her team note in the paper. Reduced time with caregivers may also place older adults at risk, due to missed opportunities to catch cognitive or general health decline and unrecognized falls.

While fever and respiratory symptoms have been widely recognized as key symptoms associated with COVID-19, these symptoms often present differently in older adults. Fever, for example, may be blunted or absent entirely during infection for older adults. Respiratory symptoms may either be masked or exacerbated by co-occurring diseases, such as COPD, that can further worsen outcomes. Dr. Unroe and team point to the Infectious Disease Society of America’s modified definition of fever for older adults as a helpful alternative. The definition is a single oral temperature over 100°F or two oral repeated temperatures over 99°F or an increase in temperature of 2°F over the baseline temperature.

What is the median incubation period for COVID-19?

A new study calculates that the median incubation period for COVID-19 is just over five days and that 97.5% of people who develop symptoms will do so within 11.5 days of infection. The incubation period refers to the time between exposure to the virus and the appearance of the first symptoms. Researchers examined 181 confirmed cases with identifiable exposure and symptom onset windows to estimate the incubation period of COVID-19. They conclude that “the current period of active monitoring recommended by the U.S. Centers for Disease Control and Prevention (14 days) is well supported by the evidence.”

Testing for the novel coronavirus had a halting start in the United States, mostly due to an initial test from the Centers for Disease Control and Prevention (CDC) that contained a problematic reagent leading to faulty readings. Since then, more accurate assays have been deployed, and testing has become more widely available. Yet, large-scale testing remains woefully behind, particularly in some areas of the country.

New testing modalities are sorely needed, including ultra-sensitive assays that capture very low levels of viral proteins and enable rapid point-of-care testing. Tests are now being developed that can detect biomarkers that herald the onset of an aberrant immune response, which has been linked to the development of critical complications. A great deal of research is now looking into antibody-based testing that identifies individuals who have recovered from infections with the new coronavirus and have developed immunity to the pathogen.

Experts in the field say the current pandemic offers a striking example of how mapping the architecture of a virus and understanding its basic biology can inform the development of new treatments. Scientists already have a good idea about the structure of the virus and the part they need to go after in order to block its mischief. SARS-CoV-2 is shaped like a ball with spike proteins that form its crown-like halo. The spike protein is what the virus uses to invade human cells. To make its way inside cells, the virus attaches to the ACE2 receptor, which is found on epithelial tissue, such as the lining of the airways and lungs and in the tongue and mouth. The viral spike protein could be disabled either with a vaccine or therapeutic antibodies.

Repurposing existing drugs may offer the easiest, most pragmatic route to rapid identification of antiviral treatments against COVID-19. Two favorites right now are the Ebola drug remdesivir and the antimalarial drug chloroquine, both of which have shown some promise. At centers around the world, various drugs are being combined and results are awaiting. In Seattle, a vaccine is already in testing in human volunteers and some researchers are hoping that a vaccine product could be available within the next 12 to 18 months. However, many vaccine researchers report that it may take a much longer time than that to have a commercially available vaccine for the general public.

Staying active helps boost the immune system

Being in isolation without access to gyms and sports clubs should not mean you stop exercising. A new study from researchers at the University of Bath in England suggests now more than ever it is important to get out and walk. The analysis, published in the international journal Exercise Immunology Review, considers the effect of exercise on our immune function. The research team found that in the short term exercise can help the immune system find and deal with pathogens and, in the long term, regular exercise slows down changes that happen to the immune system with aging, therefore reducing the risk of infections. The data suggest that infections are more likely to be linked to inadequate diet, psychological stress, insufficient sleep, travel and importantly, pathogen exposure at social gathering.

“In the context of coronavirus and the conditions we find ourselves in today, the most important consideration is reducing your exposure from other people who may be carrying the virus. But people should not overlook the importance of staying fit, active and healthy during this period. Provided it is carried out in isolation, away from others then regular daily exercise will help better maintain the way the immune system works, not suppress it,” said study author Dr. James Turner from the Department for Health at the University of Bath, England.

Regular moderate intensity aerobic exercise, such as walking, running or cycling is recommended, with the aim of achieving 150 minutes per week. At this current time in particular, the researchers underline the importance of maintaining good personal hygiene when exercising, including thoroughly washing hands following exercise. To give the body its best chance at fighting off infections, they suggest in addition to doing regular exercise, people need to pay attention to the amount of sleep they get and maintain a healthy diet.

John Schieszer is an award-winning national journalist and radio and podcast broadcaster of The Medical Minute. He can be reached at

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John Schieszer is an award-winning national journalist and radio and podcast broadcaster of The Medical Minute.

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