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BSI response to paper commenting on COVID-19 risk in people aged 60-69

22 April 2020

A new commentary published in the Journal of the Royal Society of Medicine has discussed the evidence around current UK Government guidelines for social distancing/isolation for COVID-19 for people aged 60-69. In response, the British Society for Immunology has released the following statement.

Prof Arne Akbar, President of the British Society for Immunology, said:

“This commentary paper offers the authors’ point of view on the current UK guidelines regarding age and risk of severe disease from COVID-19.

“As we get older, so do our immune systems, which results in them becoming slower and less effective at fighting off infections that we have previously come across.  In addition, our capacity to respond to new infections is also decreased.  We have witnessed evidence of this in the current Coronavirus pandemic, with the number of fatalities significantly increasing in older age groups.  Older people are also more likely to have other health conditions, such as heart disease or diabetes, which again can affect how well their immune systems can fight off infection.

“There are many changes to the immune system in older age which contribute to it functioning less optimally. Physical changes to the lungs of older people mean that they have poorer cough strength and reduced functioning of cilia, the fine hairs that line the airways. This results in a decreased ability to clear mucus, which traps infections in the lungs where they can build up. The immune cells, whose job it is to clear infections, also don’t function as well in older people. With Coronavirus infections, what seems to be happening in older patients is that their immune systems are less able to move through the different stages of immune response needed to clear the disease. Instead, they get ‘stuck’ in the early stage of immune response, which results in a bigger build-up of debris in the lungs and more inflammation, leading to more serious symptoms. The immune decline as we get older is not synchronized and some individuals may experience the decline earlier than others. The cut-off point to identify older persons for current Government guidelines is over 70 years of age, but some people may start to have declining immunity a decade earlier. There is currently no rapid and reliable test to identify how quickly the immune system ages in different people.

“For all people, it’s crucial to follow the Government’s current social distancing guidelines to stop the spread of COVID-19. This not only reduces the likelihood that you will contract COVID-19 but also stops the virus spreading to vulnerable people, such as older people, who likely to experience more serious symptoms.  The changes that happen to our immune systems as we get older are not necessary reflected in how healthy we feel – you can be a very fit 65-year-old, but your immune system will not work as well as it did when you were 20.  It’s important that we’re all aware of these changes to our susceptibility to infectious disease and take the appropriate precautions to minimise our chances of encountering Coronavirus.  While sticking to the social distancing guidelines can be tough, it really does make a huge difference to stopping the spread of the SARS-CoV-2 virus and protecting vulnerable people.”

The full paper that this statement is in response to can be found at: Osama et al. 2020 Protecting older people from COVID-19: should the United Kingdom start at age 60? Journal of the Royal Society of Medicine