[Craic] Why COVID-19 Disproportionately Affects the Elderly

[Arthur Blomme]

I pasted the whole article because of the problems Dr. Mercola is having 
with censorship on the Internet.


  Why COVID-19 Disproportionately Affects the Elderly


      Story at-a-glance

  * While the mortality rate for COVID-19 varies around the world, one
    trend is clear: The infection disproportionately affects the
    elderly, with those over the age of 75 making up the bulk of the deaths
  * Adults over 65 years of age represent 80% of hospitalizations and
    have a 23-fold greater risk of death than those under 65
  * In addition to age, underlying health conditions are primary risk
    factors that raise your risk of death from COVID-19
  * More than 80% of deaths have occurred in nursing homes, assisted
    living facilities and live-in rehab centers. More than 90% of such
    residents have at least one chronic disease and more than 70% have
    two conditions
  * Additional factors that make the elderly more susceptible to dying
    is an aging immune system, excessive calorie intake and epigenetic
    changes that occur with age, specifically the dysregulation of the
    epigenome and changes in glycosylation

While the mortality rate for COVID-19^1 varies around the world (in 
large part due to variations in testing), one trend is clear: The 
infection disproportionately affects the elderly, with those over the 
age of 75 making up the bulk of the deaths.


    COVID-19 Outcomes Tied to Age

Looking at provisional data^2 from the U.S. Centers for Disease Control 
and Prevention, you can see a clear and dramatic increase in deaths for 
each older age group.

For young people, especially children, the risk of death is negligible. 
(Even so, more elderly die from pneumonia that is unrelated to COVID-19. 
The statistics separate out COVID-19 cases, pneumonia only, and 
pneumonia with concurrent COVID-19 infection.^3 )

The exact same age-dependent trend is seen in other countries, four 
examples of which are included in the OurWorldInData.org’s graph 
below.^4 As noted in a May 29, 2020, review^5 in the journal Aging, 
“Adults over 65 years of age represent 80% of hospitalizations and have 
a 23-fold greater risk of death than those under 65.”

coronavirus case fatality by age

Below is a graph created by the Minnesota Department of Health, 
published by Twin Cities Pioneer Press^6 June 1, 2020, showing the same 
kind of age-dependent mortality curve.

minnesota covid 19 deaths by age group


    Underlying Conditions Are a Primary Risk Factor

In addition to age, underlying health conditions (so-called 
comorbidities) are a primary risk factor that raises your risk of death 
from COVID-19. Not surprisingly, the elderly tend to have more 
underlying conditions. Very few people who have no underlying health 
conditions at all end up dying from this infection.

Below is an Our World in Data graph showing the breakdown of 
comorbidities found in Chinese patients, as of February 11, 2020.^7

coronavirus early stage

Another graph from the Minnesota Department of Health, (again, published 
by Twin Cities Pioneer Press^8 ) reveals a different picture of 
prevailing comorbidities, yet the trend itself is clear: A vast majority 
of those who die have underlying conditions that make them more 
susceptible to severe infection and death.

pre existing conditions fatal coronavirus

In the case of Minnesota, 97% of COVID-19-related deaths have occurred 
in those “already fighting serious illness before they were infected.“^9 
The average age of those who have died is 82. Meanwhile, the medial age 
of Minnesotans with known COVID-19 infection is 42.

Just like in other areas, more than 80% of deaths occurred in nursing 
homes 
<https://articles.mercola.com/sites/articles/archive/2020/05/07/nursing-homes-covid-19-risks.aspx>, 
assisted living facilities and live-in rehab centers, and there are 
logical reasons for this. More than 90% of residents of these centers 
have at least one chronic disease and more than 70% have two conditions, 
which in turn can weaken their immune systems.^10 They also live in 
close quarters and share staff, which facilitates the spread of pathogens.

Italy and certain states in the U.S. — most notably New York, which has 
the highest COVID-19 death rate in the world — made the grave error of 
sending COVID-19 infected patients into nursing homes.

In light of what we currently know about the transmission, this was one 
of the most catastrophic and negligent government decisions that likely 
caused far more deaths than the lockdown prevented.

Rather than calling for the total lockdown of healthy and low-risk 
populations, why did health and government officials not simply call for 
the protection and isolation of the elderly?

Nursing home residents and workers account for about one-third of all 
COVID-19 deaths in the U.S., and up to 20% of hospitalized COVID-19 
patients actually caught it in the hospital while being treated for 
another ailment.

According to a May 15, 2020, report by the University of Michigan,^11 
nursing home residents and workers account for about one-third of all 
COVID-19 deaths in the U.S. Another report^12 in The Guardian has 
pointed out that up to 20% of hospitalized COVID-19 patients actually 
caught it in the hospital while being treated for another ailment.

If 20% of people catch the disease at the hospital and 33% of deaths 
happen in nursing homes, just how much of the entire disease burden is a 
result of the health care system alone?

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    Biological Differences Help Explain Age-Related Morbidity

According to the outstanding May 29, 2020, review by David Sinclair on 
the molecular biology of COVID-19^13 mentioned earlier, “Comorbidities 
such as cardiovascular disease, diabetes and obesity increase the 
chances of fatal disease, but they alone do not explain why age is an 
independent risk factor.”

If that’s so, then what else might account for the radical discrepancy 
in mortality? In his excellent review, Sinclair discusses the “molecular 
differences between young, middle-aged and older people that may explain 
why COVID-19 is a mild illness in some but life-threatening in others.” 
If you have any interest in this topic I would strongly recommend 
reading this paper.

Importantly, Sinclair points out that inhibiting the virus is not enough 
in and of itself. One must also restore the patient’s ability to fight 
the infection and upregulate their immune responses to avoid an 
overreaction. This is done by many strategies I have previously 
discussed such as exercise, time-restricted eating and NAD+ optimization 
<https://articles.mercola.com/sites/articles/archive/2019/10/20/regenerative-medicine-benefits.aspx>.


    The Aging Immune System

Topping the list of additional factors that make the elderly more 
susceptible to dying is an aging immune system — both the innate and 
adaptive arms. As noted by Sinclair:^14

    /“For the immune system to effectively suppress then eliminate
    SARS-CoV-2, it must perform four main tasks: 1) recognize, 2) alert,
    3) destroy and 4) clear. Each of these mechanisms are known to be
    dysfunctional and increasingly heterogeneous in older people.” /

During aging, your immune system undergoes a gradual decline in function 
known as immunosenescence, which inhibits your body’s ability to 
recognize, alert and clear pathogens. Aging also increases systemic 
inflammation, known as inflammaging, thanks to an overactive yet 
ineffective alert system. According to Sinclair:

    “/An abundance of recent data describing the pathology and molecular
    changes in COVID-19 patients points to both immunosenescence and
    inflammaging as major drivers of the high mortality rates in older
    patients./

    /The inability of [alveolar macrophages] AMs in older individuals to
    recognize viral particles and convert to a pro-inflammatory state
    likely accelerates COVID-19 in its early stages, whereas in its
    advanced stages, AMs are likely to be responsible for the excessive
    lung damage.”/

Sinclair also addresses the impact an aging innate immune system has on 
vaccination efficacy, noting that:

    /“In the aged, immune responses to vaccination are also often weak
    or defective whereas autoimmunity increases. Therefore, in designing
    vaccines against SARS-CoV-2, it will be important to consider that
    older people may not respond as well to vaccines as young people.”/


    Vascular Inflammation Is a Risk Factor

While we have all heard of the cytokine storm, what is even more 
predictive of death is an increase in the fibrin degradation product 
D-dimer that is released from blood clots in the microvasculature and is 
highly predictive of disseminated intravascular coagulation (DIC). The 
elderly have naturally higher levels of D-dimer, which appears to be a 
“key indicator for the severity of late-stage COVID-19,” the Sinclair 
states.^15

In the elderly, elevated levels are thought to be due to higher basal 
levels of vascular inflammation associated with cardiovascular disease, 
and this, the authors say, “could predispose patients to severe 
COVID-19.” Similarly, the elderly tend to have higher levels of NLRP3 
inflammasomes, which appear to be a key culprit involved in cytokine 
storms. According to Sinclair:

    /“In older individuals, NLRP3 may be poised for hyperactivation by
    SARS-CoV-2 antigens. NLRP3 activity is under the direct control of
    sirtuin 2 (SIRT2), a member of the NAD+-dependent sirtuin family of
    deacetylases. /

    /During aging, NAD+ levels decline, reducing the activity of the
    sirtuins. Old mice … have decreased glucose tolerance and increased
    insulin resistance. This decline, exacerbated by COVID-19, might
    promote hyperactivation of NLRP3 and the trigger [for] cytokine
    storms in COVID-19 patients.”/


    Higher NAD+ Level May Be Protective

Importantly, he points out that maintaining optimal NAD+ levels may 
therefore alleviate COVID-19 symptoms. This theory is further supported 
by recent data showing “SARS-CoV-2 proteins … deplete NAD+,” and the 
fact that NAD+ precursors are known to inhibit inflammation.

Helpful strategies to achieve that include taking NAD precursors such as 
nontimed-release niacin, lowering your sugar intake (as excess blood 
glucose lowers NAD+), cyclical nutritional ketosis, and/or taking 
glycine or collagen 
<https://articles.mercola.com/sites/articles/archive/2019/02/04/what-is-nadph-and-nox.aspx>. 



    Other Factors at Play

Other factors that predispose the elderly to severe infection and death 
include epigenetic changes that occur with age, specifically:

  * The dysregulation of the epigenome
  * Excessive calorie intake
  * Changes in glycosylation (the enzymatic process by which glycans, a
    type of carbohydrate, are covalently attached to proteins or fats on
    the cell surface or in the bloodstream)

Sinclair points out that metformin, a glucose-lowering drug that 
inhibits the mTOR pathway, “has been suggested as a possible drug to 
combat severe SARS-CoV-2 infection in older people.”

Metformin also has antiviral effects and helps improve mitochondrial 
metabolism, decrease inflammatory cytokines, decrease cellular 
senescence and protect against genomic instability, Sinclair notes.

The following illustrations from his review^16 summarize the biological 
mechanisms that determine your COVID-19 susceptibility and subsequent 
risk of death.

covid-19 susceptibility

covid-19 fatality risk


    Vitamin D Is a Simple Strategy That Can Save Lives

The elderly also tend to have low vitamin D levels, and vitamin D 
deficiency is another trend that several researchers have now identified 
as an underlying factor that significantly impacts COVID-19 severity and 
mortality. I discuss this in “Vitamin D Is Directly Correlated to 
COVID-19 Outcome 
<https://articles.mercola.com/sites/articles/archive/2020/05/08/vitamin-d-level-correlated-to-covid19-outcomes.aspx>.”

The following graph is from a May 18, 2020, letter^17 to the Federal 
Chancellor of Germany, Angela Merkel, from retired biochemist Bernd 
Glauner and Lorenz Borsche, in which they highlight studies^18 showing a 
clear correlation between COVID-19 mortality and vitamin D levels.

correlation covid 19 death rate

It’s important to note that experts are already warning SARS-CoV-2 may 
reemerge in the fall when temperatures and humidity levels drop, thereby 
increasing the virus’ transmissibility.

To improve your immune function and lower your risk of viral infections, 
you’ll want to raise your vitamin D to a level between 60 nanograms per 
milliliter (ng/mL) and 80 ng/mL by fall. In Europe, the measurements 
you’re looking for are 150 nanomoles per liter (nmol/L) and 200 nmol/L. 
Optimizing your vitamin D is particularly important if you are older or 
have darker skin.

One of the easiest and most cost-effective ways of measuring your 
vitamin D level is to participate in the GrassrootsHealth’s 
<https://www.grassrootshealth.net/> personalized nutrition project, 
which includes a vitamin D testing kit 
<https://shop.mercola.com/product/1090/vitamin-d-test-kit-for-consumer-sponsored-research>, 
either alone or in combination with the omega-3 test 
<https://shop.mercola.com/product/2124/vitamin-d-omega-3-test-kit-for-consumer-sponsored-research>. 
This is done in the convenience of your home.

To make sure your vitamin D level and immune system function are 
optimized, follow these three steps:

*1. Measure your vitamin D level — *Once you know what your blood level 
is, you can assess the dose needed to maintain or improve your level. 
The easiest way to raise your level is by getting regular, safe sun 
exposure, but if you’re very dark-skinned, you may need to spend about 
1.5 hours a day in the sun to have any noticeable effect.

Those with very light skin may only need 15 minutes a day, which is far 
easier to achieve. Still, they too will typically struggle to maintain 
ideal levels during the winter. So, depending on your situation, you may 
need to use an oral vitamin D3 supplement. The next question then 
becomes, how much do you need?

*2. Assess your individualized vitamin D dosage — *To do that, you can 
either use the chart below, or use GrassrootsHealth’s Vitamin 
D*calculator <https://www.grassrootshealth.net/project/dcalculator/>. To 
convert ng/mL into the European measurement (nmol/L), simply multiply 
the ng/mL measurement by 2.5. To calculate how much vitamin D you may be 
getting from regular sun exposure in addition to your supplemental 
intake, consider using the DMinder app.^19

Vitamin D - Serum Level

*3. Retest in three to six months — *Lastly, you’ll need to remeasure 
your vitamin D level in three to six months, to evaluate how your sun 
exposure and/or supplement dose is working for you.

Not only will optimizing your vitamin D be an important strategy for you 
and your family, but it would be really helpful to start thinking about 
your community as well. I am in the process of writing an even more 
comprehensive and detailed report on vitamin D in the prevention of 
COVID-19 and I hope to enlist ALL of you to talk to your friends and 
family and get them on board to get their vitamin levels optimized.

If you can, speak to pastors in churches with large congregations of 
people of color and help them start a program getting people on vitamin 
D, and if you have a family member or know anyone who is in an assisted 
living facility, meet with the director of the program and encourage 
them to get everyone tested or at least start them on vitamin D.

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