Montefiore in the News

In the absence of a vaccine, building resilience and research into other medications may help protect those most vulnerable to COVID-19.

By Nir Barzilai, M.D. and Paul Irving June 16, 2020, at 10:30 a.m.

Peer-reviewed research already has identified existing drugs and compounds that may be helpful in the response to COVID-19.(krisanapong detraphiphat/Getty Images)

Despite hopeful reports from labs across the globe, there is no vaccine or generally accepted treatment for the COVID-19 virus today. Therapies and cures will take time, but time is not on the side of older adults who are at risk of hospitalization, disability and death. Data from China, Italy and the U.S. indicate those over the age of 80 are approximately 180 times more likely to die from COVID-19 than those in their 20s.

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But age is really just a number; the real culprit in the COVID-19 crisis appears to be the accumulation of age-related chronic illnesses. Individuals with type 2 diabetes, high blood pressure and cardiovascular disease are much more likely to end up in the intensive care unit than those who are metabolically healthier. Obesity is also a serious concern, while individuals with multiple morbidities – two or more chronic disorders – appear to be at highest risk. The accumulation of these conditions is characterized by a host of problems, including a compromised immune response. More than 90% of Americans over 65 have multiple morbidities – two or more chronic conditions. 

A recent study analyzing 5,700 COVID-19 patients admitted to New York hospitals found that 94% had at least one underlying chronic condition, and 88% had two. Even more dramatically, in a case report of 355 COVID-19 fatalities from the Italian National Institute of Health, virtually all victims (99.2%) had at least one preexisting medical condition.

Might biological condition be a more important risk than chronological age? If so, and chronic disease is driving COVID-19 hospitalizations and deaths, new approaches and solutions are urgently needed until vaccines and treatments are broadly available.

Building widespread resilience to mitigate the impacts of the virus should be a public priority. A multifaceted national campaign to address the "other epidemic" of chronic disease is already long overdue.

Lifestyles and interactions with the environment must change. A campaign could build on proven successes in smoking cessation and increase access to nutritious and healthy foods. Exercise, stress management and sleep – behaviors that we know can improve health and boost immune response – could be promoted. Innovations that emphasize prevention, wellness and personalized care could be shared and spread. Health literacy could be advanced and social disparities addressed to narrow gaps between the rich and poor, and to build communities where we all can live, walk and raise our families without fear of violence.

While these and other actions would elevate resilience and well-being, we are realists. Changing behaviors and system-level institutions is hard and slow work. But progress is needed, and steps can be taken now to reduce the risks. Responses to COVID-19 can't wait.

Immediate attention to the health of vulnerable populations could make a difference. African American communities are being ravaged by the virus – communities that also suffer from structural inequities and stresses and disproportionately high rates of chronic disease. Widespread testing of older adults for high blood pressure in these communities, for example, as well as access to therapies and public assistance with medication adherence and disease self-management, could save lives.

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Medicines that target age-related chronic conditions offer promise, and projects that seek to modify the basic biology of aging are ongoing. Peer-reviewed research already has identified existing drugs and compounds that may be helpful in the response to COVID-19.

One example is metformin – a low-cost, type 2 diabetes drug that has been in use for more than 60 years. Epidemiological studies have revealed that metformin use is associated with decreased risk of chronic conditions including type 2 diabetes, heart disease, certain cancers and dementia, as well as all-cause mortality. Metformin was used years ago to boost immune response and reduce inflammation as a treatment for influenza. Now, the Targeting Aging with Metformin research initiative, or TAME, is set to be launched this year by the National Institutes of Health and the American Federation for Aging Research, and will seek to determine if metformin delays multiple age-related morbidities. The hope is that metformin and other commonly used medicines could prevent the worst effects of COVID-19 by strengthening a person's biological resilience.

Ongoing research into other drugs – including Food and Drug Administration-approved rapamycin, used for many years in patients with organ transplants and certain cancers, and a raft of novel compounds – can provide insights into how the aging process can be modified to elevate health and boost immune response, perhaps even improving the performance of COVID-19 treatments when they become available.

While scientists continue their search for therapies and cures for COVID-19, we do not need to wait. Actions can be taken now to tackle chronic conditions, elevate resilience, improve how we respond to infection and ensure that more of us – particularly those most at risk – are able to fight the virus' worst effects and emerge from this pandemic with our lives.