COVIDcast

Dr. Jacqueline McMillan (JM): Depending on when the time is for a second wave, it may well overlap with the flu season. And so it's going to be a particularly challenging time for older adults and the general population and for the healthcare system.

 

Nuvyn Peters (NP): The quote you just heard was from Dr. Jacqueline McMillan. And this is UCalgary COVIDcast. I’m Nuvyn Peters. Thanks for joining us. COVID-19 is a disease we haven't seen before, and seems to disproportionately affect older people. But why is that? While health officials make the best decisions they can with the information they have at the time, we need to know more. Today on COVIDcast, we're speaking with Dr. Jacqueline McMillan, a clinical assistant professor with the Department of Community Health Sciences in the Cumming School of Medicine here at the University of Calgary. Jacqueline is a lead researcher on the Canadian Longitudinal Study on Aging. Her team is looking into how and why older people are more vulnerable to COVID-19 and what we can learn from this pandemic so we're better prepared for the future. Dr. McMillan, thank you so much for joining us today. I must admit, your area of research is getting a lot of visibility in terms of the impact of COVID on our older members of our community and of society. Can you talk to us a little bit about why that is? What are you finding that would as part of the disease or as part of just the aging population that makes them more vulnerable to COVID-19?

 

JM: Thank you for having me. I think that this pandemic has really brought to light some of the vulnerabilities of older adults, and there's a few different factors that have been noticed in other populations that are also being noted now that we are seeing it here in Canada. And it's that with age, the risk of adverse outcomes from a COVID-19 infection certainly increase. And so there's a few things to think about. One of them is related to the risk of acquiring the infection. And so older adults may be more likely to be in a congregated living environment, and so they're less able to socially distance perhaps. But then the severity of adverse outcomes or severe infection is also higher. Older adults may have weakened immune systems. They may have the comorbidities that are associated with serious outcomes like hospitalization and mortality, and they are often frailer people. And so they're less likely to be able to rebound from a severe infection, unlike younger people who have few to no comorbidities.

 

NP: Is this a unique aspect of COVID-19, or do you find that with other coronaviruses? I mean, certainly with the flu in general, we know that the older population is perhaps more at risk of having significantly more negative reactions or results from that. But is there something different about COVID-19?

 

JM: I think there are both situations. I think infections and respiratory infections are risky to all older adults because they may be more likely to have chronic lung disease, like chronic obstructive pulmonary disease or chronic bronchitis or emphysema. They may have asthma. They may have heart failure or other things that make their breathing at baseline a little bit more vulnerable to having an infection on top of that. But then in addition, with the coronavirus, there does seem to be something in particular that is leading to these really severe respiratory conditions. There are many older adults who may appear to be doing well or having mild infection, and they do deteriorate quite quickly. And so there has been some terminology around silent hypoxia or looking well, but then when you actually take their blood oxygen levels, they actually don't look very well and their oxygen levels are really quite low, and they appear on the surface to be tolerating it, but in reality they deteriorate quite quickly. And so there does seem to be something about the effect of COVID infection and this form of coronavirus that is particularly aggressive. And I think there's a lot that we still don't know about the virus. And as we're tracing the cases and seeing the background prevalence, we'll learn more over time, but there is something that's particularly worrisome for our older adults.

 

NP: And here in Alberta and in Calgary in general, we see every day the announcements about COVID and its impact on those communities, our senior communities and the assisted living centers, and as you mentioned earlier, people that are living in quite closed off quarters. What can people take away who perhaps have a parent or a grandparent or a loved one in a senior center? What are some things that they could be doing to ensure that they minimize the risk of their loved ones?

 

JM: That's a really excellent point, and I think that until we have vaccine trials or treatment trials that show us some effective treatments or preventative measures, the best prevention is to socially distance ourselves or physically distance ourselves from one another to help mitigate that risk. And so if you have a family member or a loved one who's in a congregated living environment, I think that those environments are already taking those measures. They're doing the best they can to help people to remain physically distant. And I think that knowing how important social contact and family support is to try and connect with our loved ones in another way, whether it's through the telephone or through things like video conferencing with family or Zoom conference with family, just because those kinds of supports really allow us to be particularly resilient if we know that we have that kind of contact coming up. Because it can a really isolating and hard time to be in a congregated living environment right now as many of us have seen in the news and heard from family and friends.

 

NP: Right. And I think the longer that this physical distancing goes on, the harder it is also. You see elements of society reopening, yet there seem to be, rightfully so, pretty strict guidelines around those that are most vulnerable among us and those members of our senior aging communities.

 

JM: Yes, absolutely. And I think that rightly so. We've seen that they're the most heavily impacted. And as many measures as we can put in place to support them in place as we move through this is the best approach at this point.

 

NP: Can you talk to us a bit about a fascinating study that you're involved with, Canadian Longitudinal Study on Aging? It seems particularly relevant now in light of COVID-19 and its impact on the older community.

 

JM: The Canadian Longitudinal Study on Aging was developed back in 2012, and there's about 50,000 participants across Canada in all of the 10 provinces. And those participants are followed up every three years. In 2015 to '18 was the first follow-up, and then we're currently in the midst of the second follow-up. And so what we found is that right now in our second follow-up is when the COVID pandemic arose. And so we really pivoted this study and retooled a lot of the infrastructure that was already in place for the Canadian Longitudinal Study on Aging to look at our participants who are already enrolled and determine what is the impact of COVID on these individuals. The baseline CLSA study has tremendous amount of data related to physiological data like height and weight and blood pressure. There's also cognitive data, psychosocial data, like quality of life and depression, anxiety, as well as socio-demographic data. What we've done in light of COVID-19 is introduce a survey-based study of about 42,000 participants who are already within the Canadian Longitudinal Study on Aging. And then they're completing a survey at baseline, and then either weekly or biweekly, depending on whether it's a web based questionnaire or telephone, and then monthly. We'll follow them for about six months and collect data related to their baseline characteristics, so their baseline health, like do they have diabetes, hypertension, cardiovascular disease, but then also things related to the impact that COVID-19 may have had on their daily lives.

 

NP: Are you looking at mental health and wellness through the study as well?

 

JM: We are. The baseline questionnaire, in addition to the health status of the individual, asks people about symptoms of COVID, whether they've been tested for COVID or hospitalized, the severity of their symptoms, but then also things related to mental health, so anxiety or depression, impact on sleep, impact on well-being in general, and then other behavioral considerations like have you had to quarantine, what does your dwelling look like? What does quarantine look like when you live alone versus living in a multifamily or multiple individual dwelling, and things like how has this impacted your occupation, your income, your ability to work, your ability to seek healthcare, like see your primary care provider, get prescriptions refilled. It really expands beyond just the immediate medical consequences of having COVID to really address the fact that COVID is impacting all of us well beyond just our health. That data will be collected. As I said, the baseline questionnaire is being done right now, mid-April until about mid-May, and then there's also... Many of our participants have already started on the biweekly or weekly questionnaire, and then in about a month or so, they'll begin the monthly questionnaires. We do have a bit of preliminary data, but it's very, very early at this time.

 

NP: And because this is a Canadian study, are you finding any differences either province to province or region to region based on perhaps that province or region's strategy for managing COVID in the community?

 

JM: You know, I think that we will see those differences because there are early findings that are response rates. We've had a wonderful response rate of about 25,000 respondents so far who have completed the baseline, but we are noticing differences regionally. For instance, Canada has had perhaps more of an effect in the areas of Ontario and Quebec with the COVID infection, and so we're seeing higher response rates in that area. And it maybe related to the impact it's having on individuals who live there. And I think that we might over time see that some of the public health measures that are varying slightly from province to province may have differential impacts across the country as well, depending on the public health measures and the timing of those.

 

NP: Looking at countries and their response to COVID and the differences associated with a different country's strategy, if you look at say Italy or the United States or China, and that long-term impact on the older population, are there any conclusions that can be drawn thus far?

 

JM: Right now, we haven't done any comparison between countries using our CLSA data. We will be able to compare regions across Canada, but at this time we haven't been able to compare between Canada and other countries so far from what we're looking at or the data we have.

 

NP: Yeah, it's interesting. I mean, I look at a strategy of a country like Sweden, and my grandmother lives in Sweden. When I talk with her, her experience managing through COVID, and she's in her mid-eighties, is very different than I think our approach here in Canada. And you can't help but wonder, who's going to come out on top here? Which strategy is the right approach?

 

JM: Right. Yeah. I think you're exactly right. And I think that one of the best learnings and one of the things that Canada has done really well is that a well-prepared healthcare system really can dampen the severe effects of the COVID-19 infection. And so we were quite prepared and we had lots of public health measures in place. And so I think that hopefully we'll see in the long run that we've maybe helped mitigate some of the severity of the infection by being as well prepared as we were, but I think if it is early time still.

 

NP: You know, that whole concept of flattening the curve, that is part of our daily language. And prior to COVID, if you were to say that term to someone, no one would know what you were talking about. And even words like physical distancing or social isolation, it's interesting to see how that's become just part of our vernacular. I want to pivot for a moment and talk about this potential second bounce. As society starts to reemerge, and we see these relaunch in various communities, there is this risk of this other bounce of the disease. And as we get on further in the calendar year, as we enter flu season, what risk is there particularly for our older populations with COVID?

 

JM: That's really an important point that you're making is that depending on when the time is for a second wave, it may well overlap with the flu season. And so it's going to be a particularly challenging time for older adults and the general population and for the healthcare system. And I think that sort of speaks to the importance of this CLSA COVID study and what the learnings from it may provide as we prepare for that second wave because there may well be a need for many of these measures to be in place to some degree or another. And if we're finding from our early research that it has been particularly challenging for older adults to physically distance, if it's meant that they weren't able to see their healthcare provider in a timely fashion or to have prescriptions refilled, it does give us the benefit of time to say, how can we lessen the burden of what we're needing from the public health perspective? Certainly it's imperative that we follow the public health measures, but how can we lessen that burden for older adults?

 

NP: I'll ask you before we close to speculate on the prospects of a vaccine. We're asking many of our healthcare and medical research participants at our COVID study. You hear everything from "we're almost there" to "24 months from now." What are your thoughts on either whether it's treatments, drugs, or a vaccine, and how likely are we to see that in our near future?

 

JM: Yeah, that's a great question. I think that I want to be realistic, but also hopeful. A realistic answer is that vaccines take years to develop, but the hopeful answer is that we haven't recently seen this global concerted effort to find a vaccine. And so it isn't these individual silos trying to find the answer right now. People are like never before they're combining their efforts. And so I think that my hopeful side wants to believe that maybe some of those estimates that say in the next 12 to 18 months as a realistic timeframe, that would be the best case scenario. I think that in the interim we do the best we can, but that would be the best case scenario. And with respect to treatments, I think there are some very promising treatments. There's been some early studies that there may be some promising treatments, but I think at this point, many of the studies have been observational and they've been quite selective in the types of participants who are enrolled. It's the very sick patients in hospital. And rather than being our ideal randomized controlled trials, it's been more the observational nature of trials. I think that it may be a bit premature to be too hopeful, but there are some promising treatments that hopefully will be more broadly available when this second wave may come.

 

NP: Yeah. I wonder if this has fundamentally changed the way post secondary institutions and other groups doing medical research and vaccine development how they work together. I mean, I don't know if we've ever seen this type of collaboration and the sense of urgency on a global scale as we do now.

 

JM: Absolutely. And I think it is really heartening to see that when there is a real need there, that people do come together and that there is that collaboration that you mentioned, because that's ultimately what everyone around the globe needs right now. And so it doesn't matter whose name is at the front of that paper. I think that we just need to come together and hopefully find the vaccine or the treatment that is going to work.

 

NP: Wise words of wisdom of being realistic, but helpful. We will end our podcast there, but I want to thank you so much, Dr. McMillan, for joining us today here on UCalgary COVIDcast.

 

JM: Oh my pleasure. Thank you very much for taking the time and the interest in this study. Thanks again.

 

NP: This has been UCalgary COVIDcast. To subscribe or to listen to past episodes, or to get more online resources for coping with the coronavirus pandemic, please visit ucalgary.ca/covidsupport. A special thanks to Dr. Jacqueline McMillan for taking the time to chat with us today. I'm Nuvyn Peters. Thanks for listening.