- Researchers say the aging process may make people over the age of 60 more vulnerable to COVID-19.
- Part of the reason may be because the immune system might overreact in older adults when battling the disease.
- Experts say this information can be used to develop more specific treatments for older adults with COVID-19.
It’s been known since COVID-19 burst into public consciousness that older adults are more vulnerable to the disease.
But it wasn’t known just how much more until recently.
A study published earlier this month reported that the novel coronavirus is about 100 times more deadly to people over age 60 than for people under age 40.
It was widely assumed that underlying conditions to which older people are already prone played a part.
Now, researchers say older immune systems just aren’t keeping pace with a virus that’s still a mystery in many ways.
“As we age, the production of immunological components such as T cells and B cells, in addition to the overall effectiveness of the immune system, decreases to some extent,” said Dr. Thomas Pitts, a neurologist with Hudson Medical Group in New York who has conducted clinical trials on possible COVID-19 treatments.
“I’m not sure we underestimate these effects,” Pitts told Healthline. “Rather, I think the issue is that we do not fully understand the entirety of the implications of these immunological changes and the effects they have across the broad spectrum of pathogens the immune system surveils and ultimately attempts to neutralize, all while trying not to injure its own organs in the process.”
How an older immune system reacts
Dr. Makeda Robinson, an infectious diseases fellow at Stanford University in California, told Healthline that researchers are beginning to see differences in cell quantity and how they react to triggers around age 50.
She said cells then begin aging in a process called “inflamm-aging,” during which cells become locked in a state of inflammation.
“These two aging processes may prevent older adults from controlling the virus initially, and then to an overly aggressive inflammatory response later on,” Robinson said.
Even if the “viral load” begins to decline, the immune system continues to secrete inflammatory proteins called cytokines and chemokines, leading to a “cytokine storm.”
“In older adults who have a greater proportion of cells arrested in an inflammatory state, this process can become more robust, like a runaway train, which can’t be stopped with viral targeted therapies as it’s the host response that’s mostly to blame,” Robinson said.
“This is, in part, what new evidence showing that steroid treatment is beneficial in critically ill patients, may be preventing,” she added.
The immune system is one of the most complex areas of medicine and needs further study, said Dr. William Lang, the medical director of WorldClinic and a former White House doctor.
“In considering the effects of SARS-CoV-2 on the human body, a major area of concern is why we see higher severity and fatality rate with age, even if these rates are adjusted for the presence of other illnesses,” Lang said.
“No one has all the right answers,” he added, “but we do know the body does exhibit more chronic low-grade inflammation as we get older.”
Lang said it’s “too soon” to know if COVID-19 is rougher on older immune systems than other viruses because it targets so many cell types.
“It’s not clear if SARS-CoV-2 is especially tough on the older immune system, or is it more of an indirect effect that is affecting multiple cell types and causing them to send out all kinds of message proteins and the immune system is essentially being overwhelmed indirectly,” Lang told Healthline.
Using the information
As researchers unravel how COVID-19 affects different demographics, they can use that knowledge to strategize different attacks based on a person’s situation.
“It is already affecting development plans for vaccines, as major phase 3 trials are making definitive efforts to include individuals older than 65 in their studies, as their generation of antibody and cellular immune responses will likely be mitigated compared to those who are much younger,” Dr. Daniel Sterman, the director of pulmonary medicine, critical care, and sleep medicine at NYU Langone Health, told Healthline.
“It is possible that there may need to be specific vaccines for the elderly, as with the influenza vaccine, and/or recommendations for more frequent boost vaccinations,” Sterman said.
Older people tend not to respond as well to vaccination, according to Dr. William Li, an author and president of the Angiogenesis Foundation.
“And yet, they are most vulnerable to COVID-19, so the elderly will be prioritized to receive the vaccine,” Li told Healthline. “More research is needed to find out if the elderly will respond to [a] COVID-19 vaccine. So, clinical trials for the vaccine are enrolling all age groups to see what are the response rates, based on age.”
But there’s hope for anyone whose immune system may not be up to par, said Dr. Scott Kaiser, a geriatrician at Saint John’s Health Center Foundation in Santa Monica, California.
“The basic tips for maintaining a strong immune system generally align with recommendations for a healthy lifestyle: adequate sleep, well-balanced nutrition, exercise, stress management, avoiding cigarettes and excessive alcohol consumption,” Kaiser told Healthline.
“Add to this some key ingredients known to promote health and well-being, such as maintaining relationships, meaningful social connections, having a strong sense of purpose, and even having some creative outlets and exposure to the arts,” he added.
“While the science can be a bit murky around specific things anyone can do to help strengthen their immune system— and things can vary widely from person to person — there are several habits associated with robust and healthy lines of defense,” Kaiser said.
“The good news is many of these suggestions may sound familiar, perhaps something your grandmother recommended,” he added.
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