The AstraZeneca vaccine and over-65s: we may not have all the data yet, but limiting access could be counterproductive

Kylie Quinn, RMIT University

Last week, a German vaccine advisory committee recommended the AstraZeneca vaccine only be used in 18-64-year-olds, citing a lack of data on the efficacy of the vaccine in people over 65.

Subsequently, the European regulator, the European Medicines Agency, conditionally approved the vaccine for anyone over 18.

What can we make of this? Should we be giving this vaccine to older people or not?

While we don’t yet have all the data we’d like, we don’t have reason to believe this vaccine won’t be at least somewhat effective in older adults. To exclude them from receiving it wouldn’t necessarily be the right approach.

The recommendation

STIKO, a German vaccine advisory committee that reports to the country’s government, was responsible for the draft recommendation which caused the stir. It released a similar final recommendation at the weekend.

While the German government may elect to follow STIKO’s advice or the European Medicines Agency’s guidelines, the latter’s approval carries significant weight. Equivalent to the Therapeutic Goods Administration (TGA) in Australia, this body decides which vaccines may legally be supplied in Europe.

The AstraZeneca vaccine has already received approvals, not singling out older age groups, from multiple international regulators, including those in the United Kingdom, India and Mexico.

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Why did STIKO make this recommendation?

STIKO’s advice is based on the fact it didn’t have enough data to definitively say whether the vaccine will work in older people — not because it won’t.

According to the data we have so far from AstraZeneca’s phase 3 trials, only two out of 660 people in the trial aged over 65 got sick with COVID-19. Two sick people isn’t enough for a strong statistical analysis.

AstraZeneca initially enrolled younger people in its trials, with older people enrolled only later. So data on older people in the original trials and another trial in the United States are still on the way.

AstraZeneca’s early trials didn’t include as many older people as younger people.
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What do we know about the vaccine?

We have very good safety data for the AstraZeneca vaccine in older people. Older people actually have significantly lower levels of early side effects after vaccination. This makes sense, as older people’s immune systems don’t tend to react as strongly to vaccines, which would reduce many of these early side effects.

But the vaccine has been shown to induce strong immune responses in older people, which are likely to provide a degree of protection. The European Medicine Agency’s press release on their decision refers to a reasonable likelihood of protection based on this data.

So, just looking at immune responses, it’s reasonable to anticipate the AstraZeneca vaccine will be of some benefit, at least, to older people.

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What do we know from other vaccines?

Often, vaccines aren’t as effective in older people as compared to younger people, because their immune responses can be less robust. For example, in 2010-2011 in the US, the flu vaccine was 60% effective in the general population, but only 38% effective in people over 65.

There’s more information on efficacy in older people for other COVID-19 vaccines. Notably, the Pfizer vaccine maintained efficacy of 93.7% for people over 55, compared to 95% overall. Accordingly, it would be reasonable to prioritise the Pfizer vaccine for older people.

But we’re beginning to see that vaccine supply and distribution can be unpredictable, with supply issues for Pfizer and AstraZeneca starting to affect vaccine rollout.

Importantly, all COVID-19 vaccines assessed so far, including the AstraZeneca vaccine, provide a high level of protection against severe disease and death across variants of the SARS-CoV-2 virus.

Older people are more susceptible to the coronavirus.
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Limiting access limits options for older people

The question that advisory committees and regulators are weighing up is, should the AstraZeneca vaccine, or any vaccine, be recommended for older people if we know:

• the vaccine has low risk of side effects

• the vaccine has a fair but unconfirmed likelihood of providing some benefit

• COVID-19 has a higher likelihood of severe disease and death in the demographic.

This is tricky to navigate and advice may differ across different vaccines and countries. For example, China is delaying vaccine rollout to older people while it waits for more data.

But conditional approval is a reasonable path to take. It allows for some uncertainty and maintains contact with the manufacturer. It also recognises that the likely benefit of giving older people any available vaccine could outweigh the hypothetical risk that it might not work in the midst of a crushing pandemic.

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In any case, approvals from regulators, such as the European Medicines Agency and the TGA, have the most impact — defining who the vaccine can be supplied to in a country.

If regulatory guidelines are kept open to all age groups above 18, it will facilitate access to vaccines for many people who could benefit from them. The next steps are distributing these vaccines, and educating and updating the public with the latest information as it comes to hand.

Crucially, we should support older people in vaccine decisions with two things; good information and easy access to an array of safe, protective vaccines.

Kylie Quinn, Vice-Chancellor’s Research Fellow, School of Health and Biomedical Sciences, RMIT University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

The Pfizer vaccine may not be the best choice for frail people, but it’s too early to make firm conclusions

Nathan Bartlett, University of Newcastle

Reports of about 30 deaths among elderly nursing home residents who received the Pfizer vaccine have made international headlines.

With Australia’s Therapeutic Goods Administration (TGA) expected to approve the vaccine imminently and the roll out set to begin next month, this development might seem like cause for concern around the safety of the vaccine.

But there are a few reasons it shouldn’t be.

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What we know

We haven’t seen this issue reported in any other countries which are rolling out the Pfizer vaccine.

Norway has reported about 45,000 people around the country have been vaccinated against COVID-19 so far. Their vaccine program has mostly focused on residents in nursing homes.

In other countries, there may be more of a focus on frontline health-care workers in the first instance. So if there is any association between deaths in the elderly and this vaccine, it may not be apparent as yet.

It also depends on surveillance. Norway may have an especially rapid surveillance and reporting system in place, efficiently tracking everyone who has been vaccinated and quickly reporting any adverse outcomes.

We would expect surveillance reporting from other countries with an active vaccination program soon, increasing data critical to building a more accurate picture of vaccine safety across different populations.

Norway’s reports will sensitise other countries to monitoring vaccine recipients closely, particularly those in nursing homes who are older and vulnerable. We may see further reports on this coming through in coming weeks from other countries.

But we also may not. We have limited information regarding these cases in Norway. The people reported to have died were elderly and very frail. Many had significant underlying health conditions common in the very old, and may have been nearing the end of their lives independent of the vaccine.

Though they are under investigation, it’s important to note the deaths have not been linked conclusively to complications from the vaccine. Meanwhile, Australian experts have called for calm.

Vaccines and the elderly

In the recent history of vaccines, we haven’t seen any trends showing deaths in elderly people following vaccination. For example, there’s no evidence the annual influenza vaccine has been associated with deaths in older people — or people of any age.

It’s important to note though, that in making a comparison with the flu shot or another vaccine and the Pfizer vaccine for COVID-19, we’re comparing apples and oranges.

The Pfizer vaccine is based on mRNA technology, which is completely new in a human vaccine. This technology introduces part of the genetic material of the SARS-CoV-2 virus in the form of messenger RNA (mRNA). This instructs your cells to make part of the virus which stimulates an immune response that inhibits infection and protects against disease.

All vaccines are designed to generate an immune response — albeit in different ways — to prepare our bodies to fight the virus if and when we encounter it.

With any vaccine, different people will experience side effects differently.
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Creating an immune response leads to inflammation in the body. Some people will experience no side effects from a vaccine, but the inflammation can manifest in different ways in different people and between different vaccines. This may mean a reaction at the site of the injection, or fatigue, or feeling unwell.

The deaths in Norway were reportedly associated with fever, nausea and diarrhoea, which, while at the severe end of the spectrum of vaccine side effects, would be tolerable for the vast majority of people.

How different people will respond to the mRNA is what we’re starting to understand now. It’s possible this vaccine will have more serious effects in older, vulnerable people where the initial inflammatory response could be overwhelming.

But it’s still too early to draw any conclusions.

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Side effects show a vaccine is generating an immune response

Vaccines need to generate an immune response in order to work, and side effects are a byproduct of our bodies mounting an immune response.

While the deaths are sad, they shouldn’t be cause for alarm. This actually tells us the vaccine is stimulating an immune response. For most people that response will be entirely tolerable and lead to development of immune memory that protects you from severe COVID-19.

The big challenge for any vaccine is generating enough of an immune response so you’re protected from the disease in question, but not too much that you experience serious adverse effects. Where this line in the sand exists will vary across different people, but the oldest and frailest vaccine recipients are likely to be most at risk of severe, potentially life-threatening reactions.

So for those who may be more susceptible, we may want to be a little more cautious. In approving the Pfizer vaccine, the TGA may consider advising against this particular vaccine for people who are very elderly and frail, particularly those who have other conditions and are potentially nearing the end of their lives.

Ideally, the vaccine should be considered on a case-by-case basis for this group, carefully weighing up the risks and benefits in each situation, based on the best available data.

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Nathan Bartlett, Associate Professor, School of Biomedical Sciences and Pharmacy, University of Newcastle

This article is republished from The Conversation under a Creative Commons license. Read the original article.

COVID-19 vaccines could go to children first to protect the elderly

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Julian Savulescu, University of Oxford and Margie Danchin, Murdoch Children’s Research Institute

Several COVID-19 vaccines are in late-stage clinical trials. So discussion is turning to who should receive these vaccines first, should they be approved for use. Today, we discuss two options. One is to prioritise the elderly. This article looks at the benefits of vaccinating children first.

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The World Health Organisation is discussing how best to allocate and prioritise COVID-19 vaccines when they arrive.

It is focusing on the immediate crisis. To reduce deaths quickly when there are extremely limited vaccine doses available, vaccinating older, more vulnerable people is expected to be the best option, even if the vaccine is relatively poor at protecting them. That is because the elderly are so much more likely to die from the disease.

But as we produce more vaccines, the goal will be returning to normality where we can freely mix without increased risk. If vaccines are not very effective in older adults, we will need many more people to be vaccinated, including children. One possible strategy is to prioritise children.

Why children first?

The risks and benefits of particular COVID-19 vaccination strategies depend on information we don’t yet have. For example, we don’t yet know whether vaccines work or are safe for specific population groups, such as the young or the old.

But it is worth thinking about the ethics of different strategies in advance. In a pandemic, time can save lives.

A COVID-19 vaccine may be less effective in the elderly because their immune systems decline naturally with age, making them perhaps less able to trigger an efficient, protective immune response after vaccination.

We see this with the flu vaccine, which only reduces influenza-like illnesses by around one-third in the over-65s and deaths by around half.

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If there are similar results for a COVID-19 vaccine, to return to normality, we may need to also prevent community transmission through vaccinating young people, who generally mount a stronger immune response. This would in turn protect older, more vulnerable people because the virus would be less likely to reach them.

Yes, this is controversial. Children cannot autonomously consent to being vaccinated. Adults, who make these decisions on their behalf, are also likely to benefit from a reduced risk of contracting the virus within their own household, making the decision a possible conflict of interest.

When would this be OK?

We do sometimes make altruistic decisions on behalf of children. Children can be life-saving bone marrow donors for siblings, for example, despite the risks.

We can also apply the idea that we can restrict liberty where there is a risk of harm to others. For instance, if a child is infected with COVID-19, they need to be isolated and quarantined just like adults.

However, vaccination differs from both examples in one key respect. With vaccination, there is unlikely to be a single identified person the child will help, or whom they are uniquely placed to help. Instead, the potential benefits are collective, to the wider public.

If a child lived with a sibling who had an underlying condition that makes them particularly vulnerable to COVID-19, or lived with their grandparents, vaccination might be an easier choice.

If a child lived with grandparents, vaccination might be an easier choice.
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Three factors could help us decide

When weighing up whether children should be vaccinated ahead of adults, we can ask:

1. How severe is the threat to public health?

So far, more than a million people have died from COVID-19. There’s also the risk of overwhelming health systems and the additional collateral damage in terms of economic, social, educational and risk of excess non-COVID-19 deaths as a result (for example through suicide, or delayed access to health care). COVID-19 affects everyone in society, including children.

2. Are there alternatives?

If vaccination works well enough in vulnerable people, or there are other strategies to achieve the same effect, such as general adult vaccination, we should use those instead.

3. Is the response proportional to the threat?

As we vaccinate the vulnerable, and the general adult population, even if it is not fully effective, we will reduce the severity of the crisis. We should assess at that stage whether the remaining problem warrants vaccinating children.

Assuming we meet these conditions, we argue prioritising childrens’ vaccination, on a voluntary basis at least, is the right strategy.

How about mandatory vaccinations?

Mandatory vaccination can be justified if voluntary strategies do not achieve herd immunity, or do not achieve it fast enough to protect the vulnerable.

To gauge whether mandatory vaccination is worth it, we might also need to consider how lethal and infectious a virus is.

For instance, smallpox had a death rate of up to 30% (although contagion requires fairly prolonged contact). It was eradicated by 1979 through vaccination, which was mandatory in many countries. With COVID-19, 0.1-0.35% of infections are fatal.

By definition, mandatory vaccination involves some form of coercion. This can include withholding financial benefits or access to early childhood education (No Jab, No Pay or No Jab, No Play in Australia); preventing children from entering school (USA, with specific rules varying by state) to fines (Italy). France even has legal provision for imprisonment for parents who refuse certain vaccines.

Mandatory vaccination (of some kind) could be justified in groups who are at increased personal risk from COVID-19 — such as health-care workers, the elderly, men, or people with other health conditions — if incentives such as increased freedoms, or even payment are not sufficient. For these groups, the vaccine is win-win: it both protects others and the person vaccinated.

And mandatory vaccinations for children?

The situation is more tricky with children. Unless they have underlying health conditions or have a rare but serious inflammatory condition after infection, children are less likely to have severe COVID-19 or die from it.

So the risk of the vaccine itself (as yet unknown) weighs more heavily.

On the other hand, children benefit from grandparent relationships, and other freedoms afforded by a pandemic-free society.

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Mandatory vaccination might be justified in children if the following criteria are met:

• the vaccine is proven to be very safe for children (including in the long term, as yet unknown), and safer than the effects of the disease

• children are significant spreaders of infection (which does not appear to be the case for COVID-19, at least for pre-teens)

• there are other non-COVID benefits to children, such as return to normal social and educational life (school), and access to normal health-care services which they otherwise could not have

• measures are reasonable and proportionate, for instance, by limiting child care benefits (rather, for instance, than sending parents to prison).

We are certainly not close to meeting these criteria for mandatory vaccination of children against COVID-19 yet, especially as we don’t know how effective and safe candidate vaccines are in different populations.

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Julian Savulescu, Visiting Professor in Biomedical Ethics, Murdoch Children’s Research Institute; Distinguished Visiting Professor in Law, University of Melbourne; Uehiro Chair in Practical Ethics, University of Oxford and Margie Danchin, Associate Professor, University of Melbourne, Murdoch Children’s Research Institute

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Why we should prioritise older people when we get a COVID vaccine

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Kylie Quinn, RMIT University

Several COVID-19 vaccines are in late-stage clinical trials. So discussion is turning to who should receive these vaccines first, should they be approved for use. Today, we discuss two options. One is to prioritise children. This article looks at the benefits of vaccinating older people first.

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While we wait for further results from phase 3 trials, it’s clear that supply of any potential COVID vaccine would initially be limited.

Local authorities will need to prioritise distribution to specific groups, at least at first. So how might they make these decisions?

The general consensus is people with very high risk of exposure to COVID, such as workers in front line health-care and quarantine facilities, should be first.

Less clear is the question of who should be next. This group could include people with work, demographic or health characteristics that put them at high risk of either exposure or serious disease.

Following a National Cabinet meeting on Friday, the federal government indicated the elderly and vulnerable would be a priority group.

Here’s why prioritising older people to receive the earliest COVID vaccines is a good idea.

First, a bit of background

Vaccines work in several different ways, providing benefits to the individual and the community.

An obvious individual benefit is that vaccines can prevent infection in the person who is vaccinated. But vaccines can also reduce the amount of virus a person makes if they do end up becoming infected. This can reduce severe disease and reduce their likelihood of transmitting the virus to others.

All this leads to benefits for the community. If vaccine uptake is high enough and transmission is reduced, our collective (or herd) immunity can be used like a fire break. It blocks pathways of virus transmission and protects vulnerable people from infection, even when those people are not vaccinated.

Here’s what happens when you don’t vaccinate compared to when you do, if we were to have a vaccine that was 66% effective. The figures who turn red catch COVID-19.
Author provided

Severe disease due to COVID is a critical health issue, with the potential to put significant stress on health-care systems and resources. But if vaccine supply is limited, do we:

• directly reduce severe disease by giving the vaccine to those most at risk, such as older people

• indirectly reduce severe disease by vaccinating the people most likely to get sick and transmit the virus, such as certain groups of younger people

• use a mix of both strategies?

The question is, how can a limited supply of vaccine have the most impact?

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Vaccines and the elderly

As we get older, our immune cells can become more difficult to activate, in response to the natural ageing process or other factors like chronic inflammation. As a result, vaccines often don’t protect older people as well as younger people.

Importantly, a phase 1 study with a BioNTech/Pfizer COVID vaccine candidate showed the size of the immune response was lower in older people, which may suggest reduced protection.

Because of this, the public might think prioritising vaccines for older people is a bad idea. Why give a vaccine to people who it won’t work as well in? But we should explore older people as a priority group for several reasons.

First, older people are bearing the brunt of severe disease from COVID. In Australia, nearly half of severe cases requiring intensive care, and more than 90% of deaths, have been people over 65.

Second, a potential vaccine may not protect as well in older people, but it should protect to a degree. As an example, the flu vaccine provides 60-70% protection in the general community, dropping to 30-40% protection in people over 65 — but even at that rate it’s still protecting a substantial number of older people.

Third, where a potential vaccine doesn’t prevent infection, it could still reduce severe disease. For example, in one study, the flu vaccine reduced the rate of severe disease in vaccinated people by 23% regardless of age group.

A modest improvement in cases or severe disease in older people could have a big impact on the overall burden of disease and death.

In particular, aged-care facilities should be considered a top priority. This environment is high risk, combining people at very high risk of severe disease and high-density accommodation. Vaccinating aged-care staff could prevent the virus getting in and vaccinating residents could minimise the consequences if it did.

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Finally, some vaccines may work well in older people. For example, the Shingrix vaccine stunned the research community in 2015 by demonstrating over 90% protection against shingles in older people — a vast improvement on the previous Zostavax vaccine which provided only 50% protection.

While initial supply will be limited, we may end up with access to multiple COVID vaccines, which could allow us to prioritise potent vaccines for older people.

Big decisions take a village

In any scenario, tackling complex questions around vaccine distribution will require specialist knowledge from across many disciplines.

We need to understand how the virus spreads in a given population, how the vaccine works in different groups within that population, who might be hesitant about the vaccine, how we can deliver the vaccine to a wide variety of people and many other factors.

Older people are more likely to become severely unwell if they contract coronavirus.
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Importantly, we’re still learning about this virus. It behaves differently in different communities, due to different environments, demographics, biology and behaviours. Strategies may differ in different regions and must adapt with our evolving understanding of the virus. There won’t be a “one size fits all” approach.

It’s also vital to keep in mind that a vaccine won’t be a silver bullet. Vaccines are not 100% protective and will take time to roll out. Public health measures such as rigorous testing, hand-washing, mask-wearing and a level of social distancing will remain important for some time.

There will be challenging and contentious decisions for initial access to COVID vaccines, but ultimately vaccine supply will become less restricted. It’s important to remember we all collectively benefit by shepherding certain groups to the front of the vaccine queue.

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Kylie Quinn, Vice-Chancellor’s Research Fellow, School of Health and Biomedical Sciences, RMIT University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

For older people and those with chronic health conditions, staying active at home is extra important – here’s how

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Rachel Climie, Baker Heart and Diabetes Institute and Erin Howden, Baker Heart and Diabetes Institute

Fitbit recently released data showing a global decrease in physical activity levels among users of its activity trackers compared to the same time last year.

As we navigate the coronavirus pandemic, this is not altogether surprising. We’re getting less of the “incidental exercise” we normally get from going about our day-to-day activities, and many of our routine exercise options have been curtailed.

While we don’t know for sure how long our lifestyles will be affected in this way, we do know periods of reduced physical activity can affect our health.

Older people and those with chronic conditions are particularly at risk.

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Cardiorespiratory fitness

To understand why the consequences of inactivity could be worse for some people, it’s first important to understand the concept of cardiorespiratory fitness.

Cardiorespiratory fitness provides an indication of our overall health. It tells us how effectively different systems in our body are working together, for example how the lungs and heart transport oxygen to the muscles during activity.

The amount of physical activity we do influences our cardiorespiratory fitness, along with our age. Cardiorespiratory fitness generally peaks in our 20s and then steadily declines as we get older. If we’re inactive, our cardiorespiratory fitness will decline more quickly.

As we get older, our cardiorespiratory fitness declines.
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One study looked at five young healthy men who were confined to bed rest for three weeks. On average, their cardiorespiratory fitness decreased 27% over this relatively short period.

These same men were tested 30 years later. Notably, three decades of normal ageing had less effect on cardiorespiratory fitness (11% reduction) than three weeks of bed rest.

This study demonstrates even relatively short periods of inactivity can rapidly age the cardiorespiratory system.

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But the news isn’t all bad. Resuming physical activity after periods of inactivity can restore cardiorespiratory fitness, while being physically active can slow the decline in cardiorespiratory fitness associated with normal ageing.

Staying active at home

Generally, we know older adults and people with chronic health conditions (such as heart disease or type 2 diabetes) have lower cardiorespiratory fitness compared to younger active adults.

This can heighten the risk of health issues like another heart disease event or stroke, and admission to hospital.

While many older people and those with chronic health conditions have been encouraged to stay home during the COVID-19 pandemic, it’s still possible for this group to remain physically active. Here are some tips:

1. set a regular time to exercise each day, such as when you wake up or before having lunch, so it becomes routine

2. aim to accumulate 30 minutes of exercise on most if not all days. This doesn’t have to all be done at once but could be spread across the day (for example, in three ten-minute sessions)

3. use your phone to track your activity. See how many steps you do in a “typical” day during social distancing, then try to increase that number by 100 steps per day. You should aim for at least 5,000 steps a day

4. take any opportunity to get in some activity throughout the day. Take the stairs if you can, or walk around the house while talking on the phone

5. try to minimise prolonged periods of sedentary time by getting up and moving at least every 30 minutes, for example during the TV ad breaks

6. incorporate additional activity into your day through housework and gardening.

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A sample home exercise program

First, put on appropriate footwear (runners) to minimise any potential knee, ankle or foot injuries. Also ensure you have a water bottle close by to stay hydrated.

It may be useful to have a chair or bench nearby in case you run into any balance issues during the exercises.

• Start with five minutes of gentle warm up such as a leisurely walk around the back garden or walking up and down the hallway or stairs

• then pick up the pace a little for another ten minutes of cardio – such as brisk walking, or skipping or marching on the spot if space is limited. You should work at an intensity that makes you huff and puff, but at which you could still hold a short conversation with someone next to you

The Conversation, CC BY-ND

• next, complete a circuit program. This means doing one set of six to eight exercises (such as squats, push ups, step ups, bicep curls or calf raises) and then repeating the circuit three times

  • these exercises can be done mainly using your own body weight, or for some exercises you can use dumbbells or substitutes such as bottles of water or cans of soup
  • start with as many repetitions as you can manage and work up to 10-15 repetitions of each exercise
  • perform each exercise at a controlled tempo (for example, take two seconds to squat down and two seconds to stand up again)

• finish with five minutes of gentle cool down similar to your warm up.

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If you have diabetes, check your blood sugar levels before, during and after you exercise, and avoid injecting insulin into exercising limbs.

If you have a heart condition, it’s important to warm up and cool down properly and take adequate rests (about 45 seconds) after you complete the total repetitions for each exercise.

For people with cancer, consider your current health status before you start exercising, as cancers and associated treatments may affect your ability to perform some activities.

Rachel Climie, Exercise Physiologist and Research Fellow, Baker Heart and Diabetes Institute and Erin Howden, Group Leader, Baker Heart and Diabetes Institute

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Why are older people more at risk of coronavirus?

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Hassan Vally, La Trobe University

As we learn more about COVID-19, it’s increasingly clear that your risk of severe illness and death increases with age.

Children under nine years of age seem to be largely unaffected, either with no or mild symptoms. None have died as a result of the infection.

People over the age of 80 years and those with chronic diseases are the most vulnerable. For those over 80, approximately 15% of those infected will die.

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The death rate starts to increase for those over 50 years of age. Those under 50 years who are infected have a death rate of 0.2-0.4%, while for those 50-59 years it’s 1.3%.

For those 60-69 years it’s 3.6%, for 70 to 79 year olds it’s 8.0% and for those over 80 years of age it is 14.8%.

A similar picture is emerging when looking at the increased risk of severe illness and death of those with underlying conditions.

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The death rate for those with no underlying chronic conditions is approximately 1%.

For those with cardiovascular (heart) disease the death rate is 10.5%, for diabetes it’s 7.3%. Chronic respiratory disease (such as asthma and chronic obstructive pulmonary disease) has a 6.3% death rate, for hypertension (high blood presure) it’s 6.0% and cancer is 5.6%.

Why are older people at greater risk?

The likelihood of having chronic conditions increases markedly as you age. Four in five Australians aged 65 years and over have at least one chronic condition.

But the presence of chronic conditions only partially explains the high death rate in older people.

As we age, our immune system weakens. This makes us more vulnerable to infections of all types. And any sort of challenge to the body can do more damage.

When the immune system gears up in older people, there is also a higher likelihood of a phenomenon called a cytokine storm. This is where the immune system overreacts and produces too many of the chemicals to fight an infection.

So you get a severe inflammatory reaction which has the potential to cause significant damage in the body, including organ failure.

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What about specific chronic diseases?

The biggest risk factor for dying of coronavirus is cardiovascular (heart) disease, with a death rate of 10.5%. But we don’t yet know why.

This doesn’t mean that infection necessarily causes a heart attack, just that people with underlying heart problems are more likely to become seriously ill and die from complications of coronavirus.

The increased risk of severe disease for those with diabetes, such as actor Tom Hanks, may be easier to understand. Diabetes depresses immune function and makes it harder to fight off viral infections.

Elevated glucose (blood sugar) levels in people with diabetes may also provide a more ideal environment for viruses to thrive.

The increased risk of severe disease from COVID-19 in people with chronic respiratory illness such as asthma and lung disease (known as chronic obstructive pulmonary disease, or COPD) is perhaps the clearest, especially if your illness is not well controlled.

Respiratory conditions – such as uncontrolled asthma, which causes causes inflammation of the airways – are likely to be exacerbated by infection with COVID-19, which also targets the airways.

How can you reduce your risk?

If you fall into a vulnerable group, or have close contact with someone who does, be vigilant with hygiene. The government reccomends:

• sanitising your hands wherever possible, including entering and leaving buildings

• using “tap and pay” to make purchases rather than handling money

• travelling at quiet times and trying to avoid crowds

• asking public transport workers and taxi drivers to open vehicle windows where possible

• regularly cleaning and disinfecting surfaces that are touched a lot.

You may even want to limit your public transport use and non-essential travel to reduce your chance of coming into contact with the virus.

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It’s also reasonable to ask family or friends not to visit you when they’re ill.

Even if you’re young and healthy and not feeling particularly at risk of coronavirus, remember you play an important role in stopping the spread of the virus to those more vulnerable.

What can governments do?

Some government are implementing additional measures to reduce the risk of older people becoming infected.

In the United Kingdom, the government has indicated that in the coming weeks people aged over 70 could be asked to self-isolate, or reduce their social contact, for up to four months.

The UK government has also asked that no one visits aged care facilities unnecessarily, and that people visiting elderly relatives for essential reasons keep their distance.

Some countries are asking families to restrict visits to aged care facilities.
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In the United States, president Donald Trump has urged older Americans to stay home for the next 15 days.

In Australia, the government has recommended limiting visits to residential care facilities and is likely to announce new measures tomorrow.

For now, asking older people in the community to take precautionary measures appears to be sensible advice, rather than imposing rules around self-isolation which come with logistical and social consequences.

Hassan Vally, Associate Professor, La Trobe University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Older Australians and Eating Disorders

Blast Kills 21 outside Church in Alexandria, Egypt

Bomb explodes as Christians leave New Year’s Eve Mass.

LOS ANGELES, January 3 (CDN) — At least 21 people were killed and scores were wounded on Saturday (Jan. 1) when a bomb outside a church in Alexandria, Egypt exploded as congregants were leaving a New Year’s Eve Mass celebration.

The explosion ripped through the crowd shortly after midnight, killing instantly most of those who died, and leaving the entrance-way to the Church of the Two Saints, a Coptic Orthodox congregation, covered with blood and severed body parts.

The blast overturned at least one car, set several others on fire and shattered windows throughout the block on which the church is located.

Egyptian authorities reportedly said 20 of the victims have been identified. At least 90 other people were injured in the blast, 10 seriously. Among the injured were eight Muslims. Many of the injured received treatment at St. Mark’s Hospital.

Burial services for some of the victims started Sunday (Jan. 2) in Alexandria, located in northern Egypt on the Mediterranean Sea.

Witnesses reportedly said a driver parked a car at the entrance of the church and then ran away seconds before it exploded. Government officials have claimed they found remnants of the bomb, filled with nails and other make-shift shrapnel, at the site; they suspect an unidentified suicide bomber, rather than a car bombing.

No one has claimed responsibility for the bombing, but the attack comes two months after an Islamic group known as the Islamic State of Iraq (ISI) issued a threat stating that, “All Christian centers, organizations and institutions, leaders and followers are legitimate targets for the muhajedeen [Muslim fighters] wherever they can reach them.”

Claiming they would open “rivers of blood” upon Christians, the group specifically threatened Egyptian Christians based an unsubstantiated rumor that two Coptic women, both wives of Orthodox clergy, were being held against their will after converting to Islam. The statement came after ISI claimed responsibility for an attack on a Baghdad church during mass in which 58 people were killed.

The Egyptian government continues to suspect foreign elements mounted the Alexandria attack, but an unconfirmed report by The Associated Press, citing anonymous government sources, said an Egyptian Islamic group is being investigated.

Bishop Mouneer Anis, head of the Episcopal Diocese of Egypt, said in a written statement that he thinks the attack was linked to the Iraqi threats. He added that his church has taken greater security measures at its downtown Cairo location.

“We pray with all the people of Egypt, Christians and Muslims, [that they] would unite against this new wave of religious fanaticism and terrorism,” he said.

For weeks before the ISI issued its threat, Alexandria was the site of massive protests against the Orthodox Church and its spiritual leader, Pope Shenouda III. Immediately after Friday prayers, Muslims would stream out into the streets surrounding mosques, chant slogans against the church and demand the “return” of the two women. Before that, as early as June, clerics from at least one central Alexandria mosque could be heard broadcasting anti-Christian vitriol from minaret loudspeakers during prayers, instructing Muslims to separate themselves entirely from their Christian countrymen.

The Alexandria bombing comes almost a year after a shooting in Nag Hammadi, Egypt left six Christians and one Muslim security guard dead. In the Jan. 6, 2010 attack, a group of men drove by St. John’s Church, 455 kilometers (282 miles) south of Cairo, and sprayed with gunfire a crowd leaving a Coptic Christmas Eve service.

Three men were eventually charged with the shootings, but the case has yet to be resolved.

Egypt wasn’t the only place in the Middle East plagued with anti-Christian violence over the holiday season.

The day before bombers struck the Alexandria church, an elderly Christian couple in Baghdad was killed when terrorists placed a bomb outside of their home, rang the doorbell and walked away, according to media and human rights reports. The bombing happened at the same time other Christian-owned homes and neighborhoods throughout Baghdad were being attacked.

Estimates of the number of people wounded in the attacks in Iraq range from nine to more than 13.

Report from Compass Direct News

Recent Incidents of Persecution

Punjab, India, December 1 (CDN) — Hindu extremists on Nov. 14 beat a Christian in Moti Nagar, Ludhiana, threatening to harm him and his family if they attended Sunday worship. A source told Compass that a Hindu identified only as Munna had argued with a Christian identified only as Bindeshwar, insulting him for being a Christian, and beat him on Nov. 7. Munna then returned with a mob of about 50 Hindu extremists on Nov. 14. Armed with clubs and swords, they dragged Bindeshwar out of his house and severely beat him, claiming that Christians had offered money to Munna to convert. Local Christian leaders reported the matter to the police at Focal Point police station. Officers arrested three Hindu extremists, but under pressure from local Bharatiya Janata Party leaders released them without registering a First Information Report. Police brokered an agreement between the parties on Nov. 18 and vowed they would not allow further attacks on Christians.

Tripura – Hindu extremists attacked a prayer conference on Nov. 6 in Burburi, threatening Christians if they opened their mouths. A local evangelist known only as Hmunsiamliana told Compass that area Christian leaders organized a prayer conference on Nov. 5-7, but extremists ordered the participants not to open their mouth or make any sound. Christian leaders reported the threat to police, and the participants proceeded to pray aloud. On the nights of Nov. 6 and 7, a huge mob of Hindu extremists pelted the Christians with stones, but the participants continued praying. The meeting ended on the evening of Nov. 7 under police protection.

Chhattisgarh – Hindu extremists from the Vishwa Hindu Parishad (VHP or World Hindu Council) disrupted a Christian youth gathering in Raipur on Nov. 6 and accused organizers of forcible conversion. The Evangelical Fellowship of India reported that Vision India had organized the Central India Youth Festival with about 900 in attendance when the extremists stormed in at about 4:30 p.m. and began questioning leaders. The Christian and VHP leaders then held a meeting in the presence of police, with the Christian leaders explaining that it was a normal youth meeting with no forceful conversion taking place. Nevertheless, officers and VHP leaders proceeded to observe the gathering and proceedings, and the Christians were made to submit a list of participants. In this tense atmosphere, the meeting concluded at 10 p.m. under heavy police protection.

Madhya Pradesh – On Oct. 31 in Neemuch, Hindu extremists from the Bajrang Dal barged into a worship meeting shouting Hindu slogans and accused those present of forceful conversion. The Evangelical Fellowship of India (EFI) reported that about 40 extremists rushed into the church building at about 10 a.m. shouting “Jai Shri Ram [Hail Lord Ram].” The Rev. K. Abraham, who was leading the service, pleaded with them to come back later, but the invaders remained and continued shouting. After the service ended, the extremists rushed Abraham and accused the church of paying money to people to convert, as published in newspaper Pupils Samachar. The Christians said the newspaper published the false news because Abraham, principal of United Alpha English School, refused to advertise in it, according to EFI. The extremists grabbed a woman in the congregation who had a bindi (dot) on her forehead, claimed that she had been lured to Christianity and asked her why she was attending the service, according to EFI. “Where were you people when I was demon-possessed?” the woman replied, according to EFI. “You didn’t come to help me, but when I came to the church in God’s presence, these people prayed for me and helped me to get deliverance.”

Karnataka – Police on Oct. 29 detained Christians after Hindu extremists registered a false complaint of forced conversion in Kalammnagar village, Uttara Kannada. The Global Council of Indian Christians (GCIC) reported that at around 8:15 p.m. police accompanied extremists belonging to the Bajrang Dal, who along with members of the media stormed the Blessing Youth Mission Church during a worship service for senior citizens. They dragged out Ayesha Nareth, Hanumanta Unikal,Viru Basha Doddamani, Narayana Unikkal and Pastor Subash Deshrath Nalude, forced them into a police jeep and took them to the Yellapur police station. After interrogation for nearly six hours, the Christians were released without being charged.

Orissa – Hindu extremists refused to allow the burial of a 3-year-old Dalit Christian who died in Jinduguda, Malkangiri. The All India Christian Council (AICC) reported that the daughter of unidentified Christian tribal people fell ill and was taken to a nearby health center on Oct. 27. The doctor advised the parents to take the child to a nearby hospital, and the girl developed complications and died there. When the parents brought the body of the girl back to their village, according to AICC, Hindus refused to allow them to bury her with a Christian ritual. There are only 15 Christian families in the predominantly Hindu village. With the intervention of local Christian leaders, police allowed the burial of the body in a Christian cemetery.

Karnataka – On Oct. 6 in Beridigere, Davanagere, a Christian family that converted from Hinduism was assaulted because of their faith in Christ. The Global Council of Indian Christians (GCIC) reported that the attack appeared to have been orchestrated to appear as if the family provoked it. An elderly woman, Gauri Bai, went to the house of the Christian family and picked a quarrel with them. Bai started shouting and screaming for help, and suddenly about 20 Hindu extremists stormed in and began beating the Christians. They dragged Ramesh Naik out to the street, tied him to a pole, beat him and poured liquor into his mouth and onto his body. His sister, Laititha Naik, managed to escape and called her mother. Later that day, at about 8:30 p.m., the extremists pelted their house with stones, and then about 70 people broke in and began striking them with sickles, stones and clubs. Two brothers, Ramesh Naik and Santhosh Naik, managed to escape with their mother in the darkness, but the Hindu extremists took hold of their sister Lalitha and younger brother Suresh and beat them; they began bleeding and lost consciousness. The attackers continued to vandalize the house, damaging the roof and three doors with large boulders. The unconscious victims received treatment for head injuries and numerous cuts at a government hospital. Police from the Haluvagalu police station arrested 15 persons in connection with the assault.

Report from Compass Direct News

Pakistani Muslims Beat Elderly Christian Couple Unconscious

80-year-old’s bones broken after he refused prostitute that four men offered.

SARGODHA, Pakistan, October 21 (CDN) — An 80-year-old Christian in southern Punjab Province said Muslims beat him and his 75-year-old wife, breaking his arms and legs and her skull, because he refused a prostitute they had offered him.

From his hospital bed in Vehari, Emmanuel Masih told Compass by telephone that two powerful Muslim land owners in the area, brothers Muhammad Malik Jutt and Muhammad Khaliq Jutt, accompanied by two other unidentified men, brought a prostitute to his house on Oct. 8. Targeting him as a Christian on the premise that he would not have the social status to fight back legally, the men ordered him to have sex with the woman at his residence in village 489-EB, he said.

“I turned down the order of the Muslim land owners, which provoked the ire of those four Muslim men,” Masih said in a frail voice. District Headquarters Hospital (DHQ) Vehari officials confirmed that he suffered broken hip, arm and leg bones in the subsequent attack.

His wife, Inayatan Bibi, said she was cleaning the courtyard of her home when she heard the four furious men brutally striking Masih in her house.

“I tried to intervene to stop them and pleaded for mercy, and they also thrashed me with clubs and small pieces of iron rods,” she said by telephone.

The couple was initially rushed to Tehsil Headquarters Hospital Burewala in critical condition, but doctors there turned them away at the behest of the Jutt brothers, according to the couple’s attorney, Rani Berkat. Burewala hospital officials confirmed the denial of medical care.

Taken to the hospital in Vehari, Inayatan Bibi was treated for a fractured skull. The beatings had left both her and her husband unconscious.

Berkat said the Muslim assailants initially intimidated Fateh Shah police into refraining from filing charges against them. After intervention by Berkat and Albert Patras, director of human rights group Social Environment Protection, police reluctantly registered a case against the Jutt brothers and two unidentified accomplices for attempted murder and “assisting to devise a crime.” The First Information Report (FIR) number is 281/10.

Station House Officer Mirza Muhammad Jamil of the Fateh Shah police station declined to speak with Compass about the case. Berkat said Jamil told her that the suspects would be apprehended and that justice would be served.

Berkat added, however, that police appeared to be taking little action on the case, and that therefore she had filed an application in the Vehari District and Sessions Court for a judge to direct Fateh Shah police to add charges of ransacking to the FIR.

Doctors at DHQ Vehari said the couple’s lives were no longer in danger, but that they would be kept under observation.

Report from Compass Direct News