Wednesday, May 27, 2020

Why Are Elderly More Susceptible to COVID-19?

by Dr. Iva Lloyd, ND

Over 80% of deaths due to COVID-19 have been in those over the age of 70. Although there is some variability based on country, the fatality rate for those in their 40's is about 0.4% and it is just over 1% for those in the 50's.  The fatality rate jumps to about 8% for those in their 70's that contract COVID-19 and can be as high as 15% for those over 80 years of age that have the virus. Those of any age that have co-morbidities and are in institutions are the greatest risk.

As we have seen, people of all ages contract COVID-19.  Most people experience no symptoms or mild symptoms that don't require hospitalization or medical treatment. When we see the tremendous impact that COVID-19 is having on the elderly it is imperative to delve into this situation in more detail and to understand the various factors that are contributing to this situation.  We have all unfortunately heard of the issues around the management of some old-age homes, this blog focuses on other factors that contribute including age itself, co-morbidities, nutrient deficiencies, lack of movement, stress and isolation and air quality.

Understanding why the elderly are more susceptible to dying from COVID-19 is a complex problem that will require a multi-factorial approach on an ongoing basis.

Age Itself

As people age their ability to fight infections decreases.  Older people are generally not as good at reacting to microorganisms that they haven't encountered before. They have less immune chemicals to fight pathogens, such as viruses and their immune system is slower and less effective.  This gradual deterioration of the immune system is referred to as immunosenscence and there is a concern that older people who have survived COVID-19 may not have the same immune memory as younger people exposed to COVID-19 and may be at greater risk of contracting the virus again.

It is important to recognize the difference between chronological age and biological age.  Chronological age is your actual age based on date of birth.  Biological age is the accumulation of your genetics, lifestyle factors, health habits, accidents and conditions that you have encountered throughout your life.  Some people in their 70's and 80's are in better health and have more resiliency or vitality than people in their 50's that have poor lifestyle habits and chronic conditions that they are managing. When deciding if you or a loved one is at high risk, the biological age will be more accurate.

Nutrient Deficiencies

Research has shown that nutrient deficiencies are a global problem. The elderly and those that are institutionalized are more likely to be nutrient deficient.

Although nutrient deficiencies are more common with age, this is a problem as there are a number of nutrients that are required for the immune system to function properly.  Vitamin A, Vitamin C and Vitamin D, Omega 3 Fish Oil, Selenium, Zinc and Melatonin are all essential nutrients in immune function. When a person, of any age, is deficient in essential vitamins, minerals and nutrients, what we find is that the immune system is not able to efficiently handle a virus or pathogen that it encounters.

It is common for dietary habits to change with age.  If that change includes a decrease in fresh fruit and vegetables and lean protein then nutrient deficiencies will result. Immunosenescense and chronic inflammation are correlated with nutritional deficiencies.  Maintaining adequate nutritional levels throughout a person's lifetime, whether through diet or supplementation, is essential for optimal health.

Check out blog: Food and Immune Health .

Lack of Movement

Movement is required for every function in the body.  It promotes proper blood and lymphatic circulation which keeps the cells of the immune system functioning and moving.

Movement may actually help flush pathogens out of the lungs and the airways.  It also supports the role of white blood cells in fighting disease. Moderate movement is associated with immune health.  Walking 20 minutes a day, bicycling, swimming, playing golf and other gentle types of movement are best for immune health.

As COVID-19 is impacting the cell's ability to carry oxygen, it is not surprising that the elderly that are institutionalized and generally less active are more affected.  When active, be cautious about wearing a mask. Although the new trend is for people to wear masks often, they can actually be detrimental - especially if worn while exercising.  Here is some update information on the pros and cons of masks.

Check out our blog: Movement - Top 5 Things to Remember

Stress and Isolation

The connection between stress and a weakened or compromised immune system is well understood.  When a person is under a lot of stress the immune system's ability to fight off infections is reduced. For some people this time of isolation has been an opportunity to recoup and to catch up on sleep and and tasks around the home.  Some people have welcomed the opportunity to work from home and spend time with their family and loved ones.

For others, the COVID-19 pandemic has been an unyielding stressors.  For many elderly people the fact that they have not been able to socialize with their family and friends has been a tremendous physical and emotional burden. Seniors are also more likely to be institutionalized and isolated.

The impact of stress and isolation can not be overlooked.  How a society treats older adults plays a big role in their risk from diseases like COVID-19. Isolation worsens everything and the current situation is a stark reminder of the importance of reaching out to those that are alone to let them know that we are thinking of them and that we are here to help.


Irrespective of age, co-morbidities such as diabetes, hypertension, cardiovascular disease and obesity are associated with increased risk of COVID-19 affecting the health of those affected at any age, especially in the elderly.

A person's ability to handle an infection partly depends on how stressed the body is in dealing with other chronic diseases. It is also important to note that nutrient deficiencies, a sedentary lifestyle and excess stress are also correlated with increased risk of chronic diseases. It is not surprising that elderly have a greater chance of having one or more chronic disease.

Addressing any co-morbidities is an important part of health promotion and disease prevention.

Blog: Don't Wait Until You're Sick To Get Healthy
Blog: A Crash Course on Respiratory Health

Air Quality

Addressing the management of COVID-19 must include assessing air quality especially as most people that have been infected have contracted the virus while inside. COVID-19 is more likely to spread indoors with hospitals and institutions having been associated with the most infections other than family transmission while at home. Air quality in institutions, especially those with high rates of infected individuals, is important to assess and address.

There has been a tremendous focus on washing hands frequently and cleaning surfaces, but there is growing research that in order to control COVID-19 the focus must also include the role of indoor air on disease transmission and occupant health. When the indoor air is dry, human occupants are more vulnerable to viral respiratory infections. Dry air can impair respiratory immunity by drying out the nose, sinuses and throat thus lessening the ability of cilia, the hair-like projections on cells lining airways, to expel viral particles. Dry air also lessens the effectiveness of the skin, eyes and other mucous membranes that are there to protect us from infections.

Over the next few months expect to hear more about ways that companies are improving the air quality in offices, air planes are making it safer to travel by addressing the air quality in planes, hospitals are assessing air exchange and there will be numerous recommendations on how to have healthier air quality at home. I expect that there will be a competition on what type of building or plane has the best and worst air quality.

The growing focus on air quality should be a reminder of the importance of spending time outside, ideally in a park or area with trees. When outside, especially with exercising, consider not wearing a mask so that you and your lungs can take advantage of everything that nature has to offer.

It is important that we look at why elderly are more susceptible to COVID-19 from as many angles as possible. Going forward we need to be aware of the health promotion and disease prevention strategies for each of us, including the elderly.

Additional Symptoms of COVID-19

by Dr. Iva Lloyd, ND

A common question over the last month is whether or not a specific symptom could indicate COVID-19.  The focus of Public Health and the media has been on the three most common symptoms, that is tiredness, fever and cough.  Tiredness is the most common symptom with about 68% of people experiencing it, followed by 60% of people having a dry cough and 56% of people experiencing fever, especially in the early stages of COVID-19.

An interesting symptom that has received a lot of focus over the last few months is loss of smell.  There are a number of research articles that indicate that an early indicator of contracting COVID-19 appears to be anosmia, or loss of smell.  The loss of smell does not appear to be correlated with how severe the symptoms of COVID-19 will be as there are some individuals that only experience a loss of smell, whereas others have digestive and/or respiratory symptoms as well.  Some people experience an altered sense of taste which can be associated with the altered sense of smell.

There are a number of other symptoms that are commonly experienced in those that tested positive for COVID-19.  Digestive symptoms such as loss of appetite, diarrhea and nausea are common in 44% to 55% of individuals that tested positive.  Muscle and joint pain and headaches are also common in about 45% of individuals.

What Does This Mean?

Based on:
Many of the symptoms associated with COVID-19 are common symptoms that people experience all the time.  The chart to the right highlights the frequency (by percentage) that the following symptoms were experienced in 202 individuals with mild to moderate symptoms (age range from 20-89 years with a median age of 56) that tested positive for COVID-19.  The results in this study were similar to those reported in a number of other studies from around the world.

A symptom that is not on the chart, but was the focus of the study was loss of smell and/or taste. The study found that 64% of those that tested positive also reported an altered sense of smell and/or taste.

The presence of any one symptom does not necessarily mean that you are dealing with COVID-19.  For example, many people commonly experience headaches, digestive issues or muscle pain and other symptoms on an ongoing basis.

Four Phases of COVID-19

There are four stages to COVID-19: prevention, infection, inflammation and recovery.  A person's ability to move through the four phases determines how sick they get and how long it takes them to recover, if infected.
  1. Prevention.  Public health policy is primarily focused on the prevention phase with their recommendations for social distancing, washing hands, disinfecting surfaces and wearing masks when unwell or unable to social distance.  The naturopathic profession adds to this by emphasizing the importance of focusing on overall health and addressing lifestyle factors as a means of ensuring that you are equipped to handle life challenges, including viruses and other pathogens when you encounter them.  It is also important to work with your naturopathic doctor or other health professional if you have or suspect underlying health issues such as diabetes, cardiovascular disease, chronic inflammation, obesity, respiratory conditions or other lifestyle-related conditions that might impact your ability to heal.
  2. Infection.  When someone feels that they have become infected it is important to get tested and to follow the recommendations given.  The chart above highlights the symptoms that may be associated with being infected.  If you do experience any of these symptoms and they are new to you or are accompanied with an overall sense of being unwell, it may be beneficial to get tested.
  3. Inflammation.  The inflammatory phase is the one that appears to be the most concerning for COVID-19.  The fatality risk associated with COVID-19 is associated with the tendency in some people for an excessive or persistent inflammatory response. When the inflammatory response is high the symptoms are apparent and if they result in shortness of breath or difficulty breathing it is important to seek medical care directly.  At times, the inflammatory response is more low-grade and persistent. In this case the symptoms are less extreme, but can weaken a person overtime. 
  4. Recovery.  The aim of the recovery phase is to resolve inflammation in order to inhibit tissue damage and to restore and optimize functioning in the body.  Continual clinical surveillance, such as blood work, is an important step to ensure that the body has fully recovered after being sick with COVID-19 or any other infection.

When Are Your Symptoms A Concern?

Research continues to point to the fact that the majority of those that have COVID-19 will not have any noticeable symptoms or will experience mild symptoms that resolve without medical intervention. Trusting your innate healing ability is a foundational principle of naturopathic practice.  It is also true that if the body is struggling to recover, you will have symptoms that will help to guide your medical practitioner to determine the cause.

If your symptoms come on suddenly AND you feel exhausted or unwell for more than three days it would be worthwhile to contact your medical practitioner or Public Health and get tested.  It may also be concerning if your symptoms are accompanied by a loss or altered sense of  smell that doesn't seem to resolve. This study also highlighted that an altered sense of taste and/or smell often proceeded other symptoms.

In naturopathic practice we acknowledge the "never-well-since" aspect of any illness or accident. Generally speaking the body is designed to handle life's stressors and challenges and to heal, but at times it gets stuck and the body doesn't recovery properly.  This healing process can become stuck due to nutrient deficiencies, other underlying conditions, medications or environmental factors and at times it is unable to heal due to the psychological impact of the injury.  Anytime that a person feels that they have "not been well since  . . . ", it is important to talk to your naturopathic doctor or other health practitioner to figure out what needs to be addressed for the body to heal.  If someone feels that they were unwell earlier this year and that they haven't fully recovered it would be helpful to have laboratory tests done to ensure that the inflammatory phase of COVID-19 was properly resolved and that the body has fully recovered from COVID-19

COVID-19 is a new disease and the information that we have on it is changing and evolving all the time.  What is the most important is your overall health and safety.  If you have any questions, please talk to health practitioner.

Associated Blogs

Don't Wait Until You're Sick To Get Healthy

Food And Immune Health

A Crash Course on Respiratory Health


Giacomo Spinato, Cristoforo Fabbris, Jerry Polesel, et al. Alterations in Smell or Taste in Midly Symptomatic Outpatients with SARS-CoV-2 Infection. April 22, 2020.  JAMA doi:10.1001/jama.2020.6771

Yanuck SF, Pizzorno J, Messier H, Fitzgerald KN. Evidence Supporting a Phased Immuno-physiological Approach to COVID-19 From Prevention Through Recovery. Integrative Medicine: A Clinician's Journal.  May 2020

Maggini S, Pierre A, Calder P. Immune Function and Micronutrient RequirementsChange over the Life Course. Nutrients. 2018.

Marinosci A, Landis B, Calmy A. Possible Link Between Anosmia and COVID-19: sniffing out the truth.  Eur Arch Otohinolaryngol. 2020 April 17. 1-2.  PMID: 32303881.

B12 Deficiency, a Growning Concern in Children and Adults

By Dr. Iva Lloyd, ND

Vitamin B12 is a water-soluble vitamin that is naturally present in foods that come from animals, including fish and shellfish, meat (especially liver), eggs and milk products, as well as fortified cereals and other fortified foods. With changes in dietary patterns and other factors, vitamin B12 deficiency is becoming a major concern.

Symptoms of Vitamin B12 deficiency

Vitamin B12 is required for proper red blood cell formation, neurological function and DNA synthesis.

Signs of B12 deficiency in adults include:

Signs of B12 deficiency in children include:
  • developmental delays or regression in behaviour and impaired neurological development including seizures, mental retardation and even Autism.
  • irritability, apathy, as well as, ADD and ADHD type behaviour. 
  • Treating B12 deficiencies in children is critical for their development, both physically and mentally.

What causes a deficiency?

A deficiency of B12 can be caused by:
  • food intolerances can result in blow B12 levels
  • digestive issues, especially hypochlorhydria (low stomach acid) or any condition that impairs the mucosal lining of the gastrointestinal track
  • decreased consumption of dietary red meat, fish or eggs
  • vegetarian diets increase the risk of deficiency for both an individual and for any breastfed children
  • increased consumption of folate-fortified foods and supplements
  • some parasites and bacteria compete for the available B12 which can result in a deficiency
  • there are some conditions such as Multiple Sclerosis, endocrine disorders, hemorrhage and other conditions that deplete B12 levels
  • surgeries that involve the removal of part of the colon often results in B12 deficiency
  • exposure to medication which depletes B12 status or block Intrinsic-Factor-mediated B12 absorption (birth control, antacids, heartburn medications, anti-epileptics, etc.) 

The Link between folate and Vitamin B12

Over the last twenty years specific foods have been fortified with folate. Folate fortification and maternal supplementation were a public health initiative aimed at reducing folate-deficiency neural tube defects at a time when populations were eating large amounts of red meat (B12 rich) but few fruits and vegetables (folate-rich).

Part of the rise in Vitamin B12 deficiency rates is due to the high amounts of folate-fortified foods that individuals have consumed over an extended period of time. High levels of folate block Vitamin B12 and can both mask and exacerbate B12 deficiency symptoms.

Testing for Vitamin B12 deficiency

The normal blood testing for Vitamin B12 levels is often not diagnostic and normal values do not exclude B12 deficiency. If you experience any of the symptoms above, I encourage you to ask your naturopathic or medical doctor to run a blood test for both Vitamin B12 levels and for RBC folate.  A high level of folate will result in a Vitamin B12 deficiency, even if your blood level of Vitamin B12 is normal.

Because of the strong link between Vitamin B12 levels and decreased cognitive function, it is often recommended that anyone with signs of memory loss be tested for Vitamin B12 deficiency.

Another way to gauge Vitamin B12 deficiency is to request an intra-muscular injection of Vitamin B12 and see if you notice any symptoms.  Generally speaking, a positive result to a Vitamin B12 injection will be noticed within 48 hours.

Treating Vitamin B12 deficiency

Monthly intra-muscular injections of B12 are the most efficient way of building up low levels of B12 in the body. Often after the first injection there is a notable improvement in either energy, cognitive function or sleep. Vitamin B12 injects are generally regarded as very safe.

Depending on your levels, it can take between 3 and 6 months, or more, to re-establish normal B12 levels. For mild symptoms or once levels have been re-established with intra-muscular infections, sublingual Vitamin B12 may be indicated, especially if there is also a decreased consumption of B12 rich foods.

There are three types of B12:
  1. cynocobalamin is the most common and least expensive form of B12. It is the form that is often used in the United States for intra-muscular injections.
  2. hydroxycobalamin lasts longer in the body and requires less frequent injections. It is often considered more potent than cynocobalamin.
  3. methylcobalamin is the most expensive form of B12. It is more effective when B12 injections are being used for cognitive concerns or for peripheral or diabetic neuropathy.
If you suspect that you have a B12 deficiency and you have been taking B12 injections without much improvement, I encourage you to request a different form of B12.

Vitamin B12 deficiency is very common and is very easy to treat.  If you are suspect that you may be deficient I encourage you to get tested.  For more information talk to your naturopathic doctor.