key: cord-0914398-bzezsyf8 authors: Osama, Tasnime; Pankhania, Bharat; Majeed, Azeem title: Protecting older people from COVID-19: should the United Kingdom start at age 60? date: 2020-04-21 journal: J R Soc Med DOI: 10.1177/0141076820921107 sha: df356bdcf57d424968991778242d5c9491b01f36 doc_id: 914398 cord_uid: bzezsyf8 nan rates being observed in those above the age of 70 years, a case fatality rate of 3.6% in the 60-69 years age group is still substantial. 5 Overall, intensive care is required in about 5% of people with COVID-19 infections; 6 patients requiring critical care, such as respiratory support, are usually older with a median age of 60 years. 6 Furthermore, non-communicable diseases are common in older people. 7 In the UK, around 52.8% of those in the 65-74 years age group have two or more medical conditions. 8 In those above the age of 65 years, arthritis, hypertension, respiratory disease, cancer and diabetes are found in 62.6%, 55.9%, 24.4%, 23.7% and 21.6%, respectively. 8 The risk of COVID-19-related complications and deaths increases in those with underlying health issues; 4,5 40% of cases requiring critical care have co-morbidities. 6 While the death rate in those with no reported co-morbidities is 0.9%, the death rate is 10.5%, 7.3% and 6.3% in those with cardiovascular disease, diabetes and chronic respiratory disease, respectively. 5 The US Centers for Disease Control and Prevention reports that 80% of COVID-19-related deaths are in those aged 65 years and over. 9 Furthermore, the Centers for Disease Control and Prevention reports that 31% of cases, 45% of hospitalisations and 53% of intensive care unit admissions occurred in those aged 65 years and older, 9 in line with evidence from China where 80% of deaths were in those above the age of 60 years. 10 In the US, those in the 65-84 years age group accounted for 25% of cases, 46% of intensive care unit admissions and 46% of deaths. 9 In Italy, a country of similar economic and social development to the UK, the case fatality rate was 7.2%, compared to China's case fatality rate of 2.3%. 11 However, both Italy and China have similar case fatality rates for those aged 60-69 years (3.5% in Italy and 3.6% in China). 11 Other western countries, including Switzerland and France, encourage those aged 65 and older to enforce strict public health measures due to their increased risk of severe illness and death from COVID-19. About 7.3 million people aged between 60 and 69 years live in the UK. 12 While this group is at a lower risk of severe illness when compared to those aged 70 years and older, their risk is still considerable. Hence, the UK's current policy places these 7.3 million individuals at increased risk of severe illness and death. The UK's policy is also at variance with the World Health Organization, which states that those above the age of 60 years are at the highest risk, 4 requiring additional preventive measures. National and global spread of COVID-19 is accelerating. To reduce COVID-19-related hospitalisations, intensive care unit admissions and deaths, we recommend that those aged between 60 and 69 years are particularly stringent when implementing public health measures such as social distancing and personal hygiene. In the absence of government guidance, people in this group can make their own informed decisions on how to minimise their risks of COVID-19 infection. This can include isolating themselves in a similar manner to that recommended by the UK government for people aged 70 years and over. Competing Interests: None declared. Funding: None declared. Ethics approval: Not required. Contributorship: TO wrote and finalised the article. AM and BP revised the draft and provided critical feedback. The final version of the article was approved by all authors. Rolling Updates on Coronavirus Disease (COVID-19 COVID-19's Stop-Gap Solution until Vaccines and Antivirals Are Ready Guidance on Social Distancing for Everyone in the World Health Organization. Coronavirus disease 2019 (COVID-19) Situation Report -51 Global Covid-19 Case Fatality Rates. CEBM Research Oxford COVID-19 Evidence Series Care for critically ill patients with COVID-19. JAMA 2020. Epub ahead of print on 11 Multi-morbidity Predicted to Increase in the UK Over the Next 20 Years COVID-19) -United States Novel Coronavirus Pneumonia Emergency Response Epidemiology Team. The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China Case-fatality rate and characteristics of patients dying in relation to COVID-19 in Italy. JAMA. 2020. Epub ahead of print on 23 Acknowledgements: AM is supported by the NIHR NW London Applied Research Collaboration.Provenance: Not commissioned; editorial review.