CENTRE OF EXCELLENCEON LONGEVITY

COVID-19 AND THE ELDERLYTHE SCENARIO IN QUEBEC

MONTREAL, APRIL 12TH 2020

CEEXLO.CA

PROPERTIES:ü VERY contagious infectious diseaseü Transmission: Human — close PHYSICAL contactü RESPIRATORY impairment +++ü Varied clinical forms:

• A- or pauci-symptomatic: 80%• Serious, with hospitalization ± res: 20%

ü High mortality rate for the ELDERLY:In Quebec, they account for 90% of deaths to date

PECULIARITIES:ü New virus for humansü NO IMMUNITYü NO TREATMENT:

• Medication to decrease viral load or strengthen immunity, and help fight virus

• Vaccine to immunize against virusü Only effective response:

>> PHYSICAL AND SOCIAL DISTANCING

PROBLEMS:ü Screening is NOT SENSIBLE:• 59% = high rate of false NEGATIVES• Sick persons frequently go undetected, especially if

asymptomaticü Diagnostic: • NO immunological test is currently dependable• Solution needed to identify RECOVERED PERSONS;

essential to the Quebec context

TWO POPULATION INFESTATION SCENARIOS EXIST, CONTINGENT ON THE MOMENT WHERE SOCIAL AND PHYSICAL DISTANCING ARE MANDATED.

“LATE” – AMERICAN SCENARIO PROPERTIES “EARLY” – QUEBEC SCENARIO

HIGH Rate of infection LOW

PEAK Population progression profile

FLAT

SHORT Duration LONG

• Many sick persons• Healthy + frail persons• High mortality rate in COVID-19 patients (the frailest die)• SIGNIFICANT flow of patients into an OVERLOADED health care system• INCREASED MORTALITY in chronically ill patients… who die because the

health care system becomes overloaded with COVID-19 patients

Consequences • Few sick persons• Healthy persons, enabling a low mortality rate in COVID-19 patients

(the frailest are isolated)• LOW flow of patients into an NON-OVERLOADED health care system• However…• RISK of increased mortality in chronically ill patients (through health

care system reorganization and virus fears)

• QUICK exit from epidemic period• Remaining population: LEAST FRAIL (HEALTHY) persons

Results • SLOW exit from epidemic period• Remaining population: HEALTHY + FRAIL persons

• Mitigated economic consequences due to quick recovery• Managing isolation reversal: EASY, as risk of a second wave is low and

lessened — with no or low epidemic risk (if 60% of pop. is immunized) and no virus mutation

Prospects • Grave economic consequences due to slow recovery• Managing isolation reversal: DIFFICULT, as risk of multiple waves is

HIGH

COVID-19 AND THE ELDERLY: WHAT DO WE NOW KNOW ABOUT THIS PANDEMIC?

CEEXLO2020, Dr Olivier Beauchet – ALL RIGHTS RESERVED

PECULIARITIES OF “EARLY” QUEBEC SCENARIO

ELDERLY PERSONS ≥ 70: High risk of complications and death due to increased FRAILTY

WITH isolation, there is a risk of 3 consecutive waves:

• WAVE 1: “Geriatric” elderly PATIENTS in CHSLDs, and RESIDENTS of elder care facilities die of COVID-19

• WAVE 2: “Geriatric” elderly PATIENTS LIVING AT HOME die of existing morbidities due to a DISRUPTION in their care continuum

• WAVE 3: Generally healthy elderly PERSONS living at home become more frail throughout isolation and die of existing morbidities due to an ABSENCE of care

Upon REVERSAL of isolation, there may come a last wave:

• WAVE 4: The healthiest elderly PERSONS living at home become more frail throughout isolation and die of COVID-19 during a second epidemic wave

COVID-19 AND THE ELDERLY: THE SCENARIO IN QUEBEC

CEEXLO2020, Dr Olivier Beauchet – ALL RIGHTS RESERVED

CHSLDs ELDER CAREFACILITIES

ELDERLY PERSONSLIVING AT HOME

GENERAL POPULATION:

• Young persons• Healthy individuals• Proportion of asymptomatic carriers:üHIGHüIMPOSSIBLE TO DETECT

• Proportion of pauci-symptomatic sufferers:üHIGHüDIFFICULT TO DETECT (no consult,inaccurate screening – no serological testing)

• COVID-19 = HIGHLY contagious illness

TEMPORAL EVOLUTION

1. Early isolation

2. Asymptomatic carrierswithin general population

3. Few COVID-19 sufferers are hospitalized

4. COVID-19 sufferers in CHSLDs

5. COVID-19 sufferers in elder care facilities?

6. COVID-19 sufferers living at home?

PRIORITIES

COVID-19 AND THE ELDERLY: THE ISSUE IN QUEBEC

D-0

D-31

Ong

oing

TBD

BARRIER

PERMEABLE

IMPERMEABLE

CEEXLO2020, Dr Olivier Beauchet – ALL RIGHTS RESERVED

PRIORITIES AND SOLUTIONS

1) Relative to isolation:Put in place PREVENTATIVE measures to AVOID –MITIGATE waves 1, 2, 3 and 4

2) Relative to reversal of isolation, no matter the scenario (“stop-and-go”, geographic or group isolation): Isolate elderly persons for LONGER

1) IDENTIFY those at risk EARLIER2) ESTABLISH INTERVENTIONS ADAPTED to number

and flow of patients and elderly persons, as well as health and social care system capacity

3) RETHINK patient care chain to implement LONG-TERM changes: REMOTE SOCIAL GERIATRICS with the help of new technologies

NEEDS UNTIL VACCINE IMMUNITY

DYNAMIC

CARTOGRAPHYWHY? HOW? TECHNICAL SUPPORT? ü Tracking response effectsü Adapting responsesü Staying responsive and flexible

Elderly populations

Organizations Structures

MechanismsInteractions

ü Response markersü Community of practiceü Response coordination

➡ Web platform ceexlo.ca➡ ESOGER1 (1st level SOcio-GERiatric Evaluation)➡ COVID-HOME (HOMe follow-up for Elderly)

COVID-19 AND THE ELDERLY: WHAT MUST WE DO?

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