We have all heard the news about seniors being at increased risk of severe illness with coronavirus. It has especially taken a toll on those living in nursing homes. However, what has not been explained well is that it is not just about the number of your age. Research on covid patients indicates that your level of health, or lack of frailty, may be more important than how old you are.

Frailty and Coronavirus
Since the start of the coronavirus pandemic, health care providers have been searching for the best indicators to help them evaluate the risk of serious illness with covid and guide treatment decisions. While advanced age tends to correlate with increased risk and is an easy number to use, it’s not the best indicator for patients.
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Most of the association between increased age and increased risk of severe illness is due to increasing co-morbidities that are more common as we age. Co-morbidities is just a special term for various health issues or chronic diseases. These could include obesity, diabetes, cardiovascular disease, hypertension, and pulmonary disease among many others.

What's Your Frailty Score?
Researchers have found that frailty is a better indicator than age or co-morbidities when determining someone’s risk of severe illness with covid. Consider the chart to the right which makes assessing frailty easy. The frailest are those that are completely dependent on others for basic needs and/or approaching the end of life. A recent study published in Lancet found that the frailest are at much higher risk of death or prolonged hospital stay with covid. This is true regardless of age or co-morbidities. It is those in the 7-9 categories of frailness that are at high risk of death or severe illness.

Based on this research, we should worry less about our age and more about our frailness. Take steps to increase your health and reduce your frailty score to limit your risk with covid.

As with other viruses, research indicates coronavirus is more likely to cause harm in those patients with low levels of vitamin D, and sun or UV light is an effective method of disinfecting and killing the virus. How does the sun relate to vitamin D levels and why does it seem to help against coronavirus and other viruses?

Research on Vitamin D and Coronavirus
Several studies around the world have been published that demonstrate a link between low levels of vitamin D and increased risk of severe illness from coronavirus. These studies have shown a link across large populations as well as individuals that have been infected. These results are consistent with prior research that has shown vitamin D plays a role in protecting against acute respiratory infections. Coronavirus treatment protocols in some hospitals have included vitamin D supplementation with other procedures and medications to combat the infection.

Researchers believe that vitamin D exerts a positive effect on modulation of our immune system in multiple ways. One of these ways may include its relationship with macrophages which are special cells that locate and “eat” microbes found in our body. Another way is reducing an excessive inflammatory response of the immune system. Others acknowledge the value of vitamin D but believe that the positive effects of vitamin D on coronavirus infection may relate more to its wide-ranging benefits on reducing chronic diseases.

Let the Sun Shine on Coronavirus
Hospitals have used UV light emitting technology for years to disinfect rooms or equipment. It damages a virus’s genetic material and their ability to replicate. The coronavirus pandemic has generated increased interest and research into the effects of sunshine and UV light on disinfection. The results of a recent experiment at the National Biodefense Analysis and Countermeasures Center in Maryland noted sunlight reduced the life of coronavirus (airborne or on surfaces) from hours to a few minutes.

Utilizing the Benefits of Sunshine and Vitamin D to Reduce Coronavirus Risk
Considering the research noted above, sunshine can help us in two important ways. Exposure to sun helps disinfect areas with coronavirus, whether it be in the air or on surfaces. Sun exposure also is our primary method of vitamin D production. It is hard to obtain enough vitamin D from our food alone, so sun exposure or supplementation is necessary to increase our vitamin D to a healthy level. Spend time outdoors with sun on a significant portion of the skin until the skin starts to appear a little rosy. Those living in Northern areas and those with darker skin tones require more time outside for vitamin D production. Avoid sunburns which can increase the risk of cancer. Unless one takes high doses of vitamin D for a prolonged period, the risk of toxicity is low. The low risk and high potential for benefit makes increasing vitamin D a reasonable strategy to reduce your risk with coronavirus or other respiratory infections.

The covid-19 / coronavirus pandemic has shown that everyone exposed to a virus or infectious microbe does not experience disease. Few experience severe illness and many don’t even experience mild symptoms. If disease is as simple as being exposed to a germ, why do some people avoid becoming sick?
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What Happens With Exposure to Coronavirus?
Exposure does not equal infection and infection does not equal illness. The graphic below illustrates possible outcomes of exposure to coronavirus. Data indicates that 80% or more of confirmed cases of infection do not experience significant symptoms of illness. So, the large majority of those exposed and infected do not even know it because they do not become ill. This does not account for the even greater number of those exposed to coronavirus but have not been confirmed due to a lack of symptoms and limited testing. As testing increases, we may find that more than 90% of those exposed do not become sick. Some exposed cases may not test positive due to strong resistance or low exposure.

Of the less than 20% of confirmed cases that experience symptoms of illness with coronavirus, most are mild and fewer are severe. An even smaller fraction (those with pre-existing health problems) experience such severe illness it leads to death (see our article about pre-existing conditions).

As you can see in the picture, confirmed cases can be illustrated as a triangle, with a large majority experiencing no illness, and ever smaller portions experiencing greater degrees of illness or death. Surrounding that is the unknown (likely large) number of those exposed but not confirmed cases. Though infectious diseases can vary in transmission and virulence, this is similar to the presentation of many illnesses.

Reducing Risks
We are exposed to good and bad microbes every minute of the day and most of the time we experience little effect on our health as our immune system does its job. Many microbes are essential to our health, serving as a layer of protection or aiding our digestion among other benefits.
For those viruses or microbes that may be harmful, we have three ways to assist the body’s natural fighting ability:

1. Reduce exposure – there has been significant debate over the effectiveness of various methods (cleaning, gloves, masks, etc.), but these methods are all potential ways to reduce exposure and therefor risk of illness
2. Improve health to minimize risk of illness – less information has been shared on how to support our immune system to prevent or minimize illness. These methods include healthy lifestyle habits like regular exercise, nutritious eating, adequate sleep, and stress-reducing activities to increase resistance to infection.
3. Health care once illness has occurred – for the minority of those infected that experience more significant illness, health care is of course provided to counteract the infection.

The best strategy is to take reasonable steps to not only reduce exposure, but especially work to improve your health and reduce your risk of a severe infection.