Dr. Candace Walkley, an assistant professor of internal medicine and pediatrics at Sam Houston State University, spoke with Community Impact Newspaper in mid-May about the effects COVID-19 has had on the area’s senior population and care centers. This interview has been edited for length and clarity.

Why are senior citizens one of the populations more vulnerable to a virus like COVID-19?

“They have many more comorbidities, meaning other health care conditions, that put them at risk for problems if they get sick with anything. Like, if they get the common cold or if they get influenza or if they get food poisoning, they are just at higher risk. ... Some of this, too, is related to the changes that happen in the body as you age. So one of the things that happens is your immune system just doesn't function like it does when you’re younger, and so as you get older, you become just more susceptible to infection with a variety of illnesses. ... I would say probably a third reason is that many of them are in an industrialized setting, like a nursing home. They’re not necessarily in their own homes. And so when they’re in an industrialized setting, you’re going to see them more likely to be infected quickly from person to person.”

What precautionary health measures were commonly in place at facilities such as nursing homes before this pandemic?

“A nursing home is generally going to adhere to standard infection control practices, and what that means is good hand-washing between patients. It means doing the very best that you can to ensure that patients don't get infected by doing things like moving them, not letting them stay in one position for a prolonged period of time. These kinds of things, like [inactivity], encourage nursing home patients to get infected with respiratory viruses as well as skin infections. And so when you move them from their bed to a chair or back to the bed and you’re constantly moving them around, it reduces their risk for infection. ... Standard precautions also include taking care to separate people or isolate people in certain areas of the nursing home if they have a specific infection.”

How have senior care facilities responded to the crisis in general?

“Everybody has done the best that they can under the constraints that we have. There’s been constraints of not knowing. At the very beginning, we didn’t really know or understand about asymptomatic spreading of this virus, and that really made a difference in close-knit, vulnerable populations. ... [COVID-19 is] very, very difficult to contain. So you’re talking about having to implement very, very strict public health isolation and quarantine of close contact, and we’re just not necessarily able to accomplish that very well because we have a lot of essential personnel. People who have to go work in health care—they have to go to work in the food industry and the business chains that bring food. And as long as those people are having to go to work, this virus continues to circulate.”

How effective is the statewide mandate for COVID-19 testing in all Texas nursing homes?

”In patients who have what we call a high pretest probability, meaning they are in a group of people or they are in an area [where] for whatever reason the patient themselves is very likely to have an infection—if they’re in a high pretest probability group, then it makes sense to test all of them. ... It’s okay to apply these tests that we currently have on the market to them, and it’s a good thing. ... If you get a positive, it’s likely to really be a true positive because you’re testing a group that the virus is highly prevalent in. ... It makes a lot of sense to do it in a group where there’s a high risk for infection because you can immediately isolate those people out. You have control within that nursing home. You can isolate them out of the general population [and] get them completely isolated in a different part of the building, and that prevents spread. ... It’s a very good strategy for reducing deaths in nursing home populations.”

What strategies can seniors in nursing or assisted living centers use to cope with the recent changes in their daily experiences?

“I think as a society and as a community, and particularly, just out of respect for the patients themselves, it’s important for us to talk to them about what their desires are for themselves. It is important not to disrupt the health of the community as a whole, so you don’t want to let people be coming in there. You’ve got to look out for the whole group. As far as allowing people into the center, they have to be very careful about that stuff. But I think we’ve got to have a little bit of respect for what the patients themselves want. ... I know that a lot of the homes are trying all kinds of different technological advances to try to help them stay connected to their families, and that is important because loneliness kills; poverty kills. So it’s not just the virus that kills.”

How might a crisis like this change senior living facilities’ operations in the long-term?

“I’m sure there will be some families who reconsider what they do. And people will reconsider whether they want to move into assisted-living centers or whether they want to try to stay where they are. I hope it will encourage us as a nation to have a discussion about how we take care of our elderly and how we want to try to give them the quality of life that they want. I think something missing from the national discourse is that there is a disconnect between quality of life and how long a person lives sometimes. Just because we keep people alive for a long time doesn’t necessarily mean you’re giving them good quality of life, and it’s not necessarily something that they would want. I really hope this is fodder for the nation to start talking to each other, for families to talk to each other, and for them to talk to their elderly relatives and have discussions about, ‘What do you want for yourself?’”

What have seniors in the community been saying about the situation this spring?

“I see emotions right now running the gamut. The people who are the sickest who have the most comorbidities—they do have a lot of fear. It’s not just fear about the virus; it’s fear about the rest of their lives. ... As they’re staying home, they’re getting weaker and weaker, and so then, they think, ‘Well, what if I can’t get out and get my food? What if I’m too weak to walk?’ There is fear that doubles on other fear. ... Then, you’ve got others that are even somewhat ill with many medical problems, and they say, ‘There’s always something that could come get me. Every year, I potentially could die of the flu, so this is just that sort of thing, and I’m ready to go when God calls me.’ And then, there’s others that maybe don’t have as many medical problems. They tend to be healthier people, and they say, ‘Well, you know what? The priority for us is to live our lives.’ ... So I see a lot of different responses.”

Do you have any other advice about the community's relationship with the local senior population?

“As a doctor who takes care of a lot of elderly patients, I want to encourage younger people and families to do everything they can to remember the elderly people in our communities—to not just remember them in the way of [buying] something for them at the grocery store but try to remember to talk to them, to call them, to maybe even stop by and visit with them ... in whatever way that you can do it so that you can give them some real, honest, personal relationship and personal time.”