As fast as the Coronavirus seems to be spreading, so too does our understanding of who’s at risk and how we can best protect ourselves and our loved ones. Since last week, one fact has become quite clear: According to the CDC, older adults, and especially those over 80 or with serious underlying chronic disease, are most at risk for severe or even fatal consequences from COVID-19. The word “older” has been left undefined, given that chronological age alone doesn’t necessarily convey your health status: an active and healthy 75-year-old with no chronic disease may be much healthier than a 55-year-old with asthma and diabetes. However, given that we know the immune systems of all older adults diminish in time, it’s best that if you have any doubts about your health status, especially if you’re over 60, listen to the CDC and do the following: avoid crowds, stay close to home, avoid cruises and air travel, stock up on medications and supplies and employ common-sense precautions like hand-washing and distancing yourself from someone who appears sick. As The Washington Post makes clear, “This is a situation sufficiently alarming that people who are vulnerable should alter their normal way of living.”

We have also come to learn more about the virus and its spread. Science correspondent Helen Branswell, writing in STAT, makes one very important point: While 80% of those infected do not develop severe disease, the virus spreads most quickly and easily early in the infection, at the point when you may not even have any symptoms of being sick. So even if you believe yourself to be well, you may want to take precautions, especially around older loved ones, as it’s possible you could be shedding virus and infecting those around you. Writer Eli Pariser, in his opinion in The Boston Globe, also underscores an important point about the virus and older adults. Given that there are 72 million Americans over age 60, even a low fatality rate could mean hundreds of thousands of people could become seriously ill and die, and it’s up to health care systems, and society more generally, to prepare for such a possibility. In fact, we’ll need some intergenerational understanding as the lives of millions of younger people will be disrupted for what will likely be a disease mainly affecting older adults.

And, as we have seen from the state of Washington, nursing homes and other long term care facilities and settings seem to be the epicenter for disease outbreaks. Even before the outbreak of COVID-19, infection control measures in nursing homes were subpar, and in fact, insufficient infection control measures are the most frequently cited violations in nursing homes. The CDC has in place questions you should be asking your loved one’s long term care facility about their infection control measures. In fact, given concerns about insufficient infection control as well as the fragility of the resident population, there are now calls for such facilities to limit or even restrict visitors except for essential personnel. Both the Federal Center for Medicare & Medicaid Services as well as the American Health Care Association (the largest nursing home association in the US) have now called on nursing homes to actively screen and limit visitors to facilities. Finally, in recognition of the front-line workers both in facilities and in the home setting who form the backbone of hands-on long term caregiving, there is the need to ensure that such caregivers, often minority women with few benefits, sick pay or health insurance, need to also be supported in this time of crisis– both for their own health as well as for the health of those they care for.