Not All Seniors Face the Same Pandemic Risk | Opinion

As we head into the holiday season with COVID-19 cases rising, we're all making tough choices. Many families are wondering if it's okay to see grandparents—and many grandparents are hoping to safely see their grandkids.

Since the beginning of the pandemic, health authorities have warned that people age 65 and older are among those at highest risk for severe disease, and should thus limit interactions with others as much as possible.

There is good reason for these warnings. Statistically, the odds of hospitalization and death from the coronavirus rise with age.

But unfortunately, many of us have taken this message to an extreme—and concluded that everyone over 65 should remain in total isolation. But that's simply not true. For some seniors, social isolation is doing more harm than good.

To make the best decisions, we all must recognize that different people face different levels of risk.

There is no question that COVID-19 is dangerous and extremely contagious. But a healthy 67-year-old isn't in the same danger as an 87-year-old with a pulmonary disease. The risk of grave illness from the coronavirus doesn't suddenly shoot up when you hit retirement age, but rather increases steadily as you age. Compared with 18-to-29-year-olds, those between 65 and 74 are five times more likely to be hospitalized due to COVID-19, those between 75 and 84 are eight times more likely and those 85 and older are 13 times more likely, according to the Centers for Disease Control and Prevention.

Other factors make a difference too. Men are at higher risk than women, and a range of underlying conditions, including cancer, heart disease and obesity, also increase the level of peril.

As seniors make their health decisions, they need to weigh the risk of catching the virus against other hazards. In particular, social isolation during the pandemic has contributed to a substantial rise in mental health problems, substance abuse and suicidal thoughts.

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EMS medics prepare an IV tube for a senior with Covid-19 symptoms on August 14, 2020 in Houston, Texas. John Moore/Getty

An August survey by the Kaiser Family Foundation found that one in four seniors now report anxiety or depression, compared to one in ten back in 2018. A study published by the JAMA Network found that those over the age of 60 are drinking more often today than they were a year ago.

We knew that loneliness was bad for health well before this year, of course. Former U.S. surgeon general Vivek Murthy declared a "loneliness epidemic" in 2017. A 2018 study by scientists at the Johannes Gutenberg University Medical Center found that social isolation and loneliness are risk factors for heart disease. Loneliness can also cause stress, which can damage the blood vessels and the heart. Conversely, social interactions help stave off cognitive decline and dementia.

Seniors are already more susceptible to loneliness, partly because of declining health and the loss of friends and partners. With the social isolation imposed by COVID-19, the problem has become more acute.

The bottom line is that one-size-fits-all advice for everyone over 65 doesn't make sense. Whether an older person can join a holiday meal depends on their age, health and community prevalence of the virus. It also depends on the cautionary measures that families employ to minimize risk.

Those getting together should consider being tested for the coronavirus and quarantining for about two weeks beforehand. They should travel via private vehicle. They should meet outdoors if possible, or at the very least, in a well-ventilated space. They should wear masks when not eating and keep the celebration to under two hours if possible. Rather than having 12 people sitting together at a table, break up into smaller groups of two or three. It's even safe to greet family with a warm hug, provided the hugs are brief and everyone is masked.

We've learned an enormous amount about the virus in the last year, including that these and other preventative measures can be effective in reducing risk, especially when used in concert.

It's easier to issue blanket advice than consider people one by one. But what's best for the average isn't necessarily what's best for an individual. For some seniors, particularly those with underlying health conditions, virtual participation may be the safest option. For others, seeing loved ones safely in person may be the healthiest choice.

The holidays this year will require more planning and thoughtful execution than last year. But for many families, the ability to connect—whether in person or virtually—will make the extra effort well worth it.

John Whyte, MD, MPH, is Chief Medical Officer of WebMD.

The views expressed in this article are the writer's own.