Statement – Older people are at highest risk from COVID-19, but all must act to prevent community spread

Dr Hans Henri P. Kluge, WHO Regional Director for Europe

Copenhagen, 2 April 2020

Thank you for joining us.

Since I last spoke one week ago, the number of laboratory confirmed cases reported across the Region has doubled to 464,859 cases. Europe together with North America is now the epi-centre of the pandemic.

Many countries, particularly in the Western part of the Region are now seeing widespread community transmission. Italy- with over 105,792 reported cases and Spain with 94,417 cases have now surpassed China. France and Germany also have a considerable number of reported cases at 67,366 and 52,128 respectively, with other countries close behind.

Clearly there are huge differences between countries, the burden of COVID-19 on societies and economies and the measures being implemented across the European Region. There is a huge amount of data on COVID-19, but nowhere that Member States can find out what health systems are actually doing and whether it’s working. Here at the WHO Regional Office for Europe we are stepping up to capture what is happening; to support countries to organize their thinking and planning; to share the information and evidence with policy makers through the COVID-19 Health Systems Response Monitor. This is a new platform which WHO/Europe has developed and will run with the support of the European Union and the European Observatory on Health Systems and Policies, and will be updated regularly to inform and support policy decisions at various stages of the pandemic. It will be launched today on our website accompanied by a press release at 12:00 midday CEST.

The majority of those who are infected with COVID-19 have a self-limiting infection and do recover. However, we know that a minority go on to suffer more severe disease, with 10% of cases requiring intensive care unit admission. Sadly, some patients will pass away: so far 30,098 persons are reported to have died with COVID-19 in the European Region, with 90% of the deaths occurring in the mainly affected countries of Italy, Spain and France.

Older adults are at a significantly increased risk of severe disease following infection from COVID-19. This is a very important observation for the European Region: of the top 30 countries with the largest percentage of older people, all but one (Japan) are our Member States in Europe. The countries most affected by the pandemic are among them.

We know that over 95% of these deaths occurred in those older than 60 years. More than 50% of all deaths were people aged 80 years or older. We also know from reports that 8 out of 10 deaths are occurring in individuals with at least one underlying co-morbidity, in particular those with cardiovascular diseases/hypertension and diabetes, but also with a range of other chronic underlying conditions.

Today I have three key messages for your regarding COVID-19, and the need to protect, care and support older populations.

First, we should emphasize that while older people are at highest risk from Covid-19, all of us, at all ages, need to act in solidarity to prevent the further community spread of the virus

Some of the reasons older people are greatly impacted by COVID-19 include the physiological changes associated with ageing, decreased immune function and multimorbidity which expose older adults to be more susceptible to the infection itself and make them more likely to suffer severely from COVID-19 disease and more serious complications.

But age is not the only risk for severe disease. The very notion that “COVID-19 only affects older people” is factually wrong. As a colleague of mine recently said, “Young people are not invincible”. 10% to 15% of people under 50 have moderate to severe infection.  Severe cases of the disease have been seen in people in their teens or twenties, with many requiring intensive care and some unfortunately passing away.

On a positive note, there are reports of people over the age of 100 who were admitted to hospital for COVID-19 and have now since made a complete recovery. It is becoming clearer that the healthier you were before the pandemic plays a crucial role. People who age healthily are less at risk.

For those in self-quarantine or working from a home office, it is important to maintain healthy lifestyle with good nutrition, physical activity and staying away from tobacco and alcohol.

The focus to contain the pandemic may result in the disruption of routine health services, interruption of the medicine supply, confining of patients and deleting social and public services which impact people suffering from chronic conditions of heart and lung, diabetes or with immune systems that are weak including from cancer treatment.

That is why I am urging governments and health authorities to mitigate the effects of service disruption that may harm people with underlying chronic disease, increasing morbidity, disability. Policies for healthy ageing have to stay high on our policy agenda.

The figures make a clear case - protecting yourself and those in your family and community from getting infected is relevant for every single age group. It is not only an act of solidarity with others, in particular with those most likely to be severely affected, but also vital for your own health and safety.

So my first message – this relates to older people, but also all age groups.

My second point is on the importance of supporting all health and social care workers equally and giving special attention to those who provide nursing and social care services for older people: leaving no one behind.

WHO continues to stress the importance of protecting health care workers. 10% of the COVID-19 patients are healthcare workers in our Region. They must be supported with the training and resources they require, including adequate personal protective equipment. This is equally important for those providing health and social care to older people living in their communities or in long term care facilities. These are our colleagues who care for those who are among the most vulnerable: people with frailty and those living with dementia.

Let us not forget that already prior to the COVID-19 pandemic, many health and social care workers who provide long-term care have been working in challenging conditions, with few resources, whether working in the community or in nursing home facilities.
I am also encouraged here to learn of efforts made in Ireland and Belgium on this front:

For example, in Ireland, a national ‘call’ for retired health care staff (doctors, nurses) to return to work was made. The “Be on call for Ireland” initiative was launched by Prime Minister Varadkar and they received 24,000 applications in three days. Incredible solidarity.

In Belgium, through the Flemish Older Persons Council (Vlaams Ouderenraad), despite the increased workload, nurses are still taking the time to arrange communication between residents and their relatives through phones and social media apps to foster contacts and stay connected to reassure everyone.

My second message - protect the health and social care workers.

Thirdly, supporting and protecting older people living alone in the community is everyone’s business

I am reminding governments and authorities that all communities must be supported to deliver interventions to ensure older people have what they need. This support includes safe access to nutritious food, basic supplies, money and medicine to support physical health and access to social and mental health support and information to maintaining emotional well-being. All older people should be treated with respect and dignity during these times.  Remember, we leave no one behind.

Many authorities in Europe now urge older people to stay at home for an extended period of time in self-isolation (otherwise called “shielding”), in particular those who are immunocompromised or have chronic conditions. For them, we need to secure updated care plans, defined pathways for accessing services, surveillance of their compliance with prescribed medicines, supplies and equipment; transportation and support for self-management, access to rehabilitation and palliative care, as needed. Overall, it is crucial to ensure we stay connected.

A message for our younger viewers, if keeping your grandparents safe means you can’t visit them in person, talk to them, talk to them every single day so that they don’t feel alone. “Physical distancing is not social isolation”. Make sure your grandparents understand the information put out endlessly on media and that they stay and feel informed – equipped with the right information and engaged.

The Spanish Red Cross, which has more than 200,000 volunteers in more than 1,400 towns has launched an information campaign aimed at 400,000 people identified at risk including older people and those with chronic diseases. Over in Ireland, local-level sporting clubs, community groups and others are telephoning local older people regularly, collecting their shopping and dropping them at the doorstep. These daily check-ins have been an invaluable support to thousands across the country.

If you feel your community needs support, now is the time to step up.

I urge you all to take bold action, create societies and caring environments that foster healthy ageing: something all of us deserve in peace time and war time.

We will emerge from this pandemic, having paid a high price, battered and bruised, but more resilient and ready in the future.

Thank you for your attention.