Protecting 60 Plus and Vulnerable Population from

the Invading Invisible Enemy

Dr.K.Kolanda Swamy.
MBBS, MAE, DPH, DIH, DBE,
PG in Global Health (Japan),
PG in HFW Management.
Public Health Expert in Infectious Diseases Control,
30th June, 2020 Immunisation, MCH and Disaster Management.
Comprehensive Protection of 60 Plus and
vulnerable population will save precious
lives of Senior Citizens and others.
 Vulnerable Population to COVID-19

• Older adults and people of any age with serious underlying

medical conditions are at higher risk for severe illness from
COVID-19.

• Appropriate Control of underlying conditions will reduce the

vulnerability considerably

• People with reduced innate immunity are at a higher risk

• Improving innate immunity will reduce vulnerability

60 Plus and Vulnerable Population
 Vulnerable Population
• 60 Plus people
• Immuno-compromised conditions resulting from
• Cancer chemotherapy
• Radiotherapy
• Smoking
• Bone marrow or organ transplant
• HIV/AIDS
• Prolonged use of corticosteroids/other medications and
• Any other similar conditions.
 Vulnerable Population
• Those who underwent transplant procedures.
• People with Chronic Kidney Disease (CKD) undergoing dialysis
• People with Chronic/Acute Liver Diseases
• Severe obesity (BMI 40 or higher)
• Severe Nutritional Deficiencies
• People with dementia
• People with severe disabilities
 Vulnerable Population
• Uncontrolled diabetes mellitus

• Uncontrolled hypertension

• Extremely obese people

• Chronic Obstructive Pulmonary Disease (COPD)

• Bronchial Asthma

• People with chronic lung diseases

 Vulnerable Population
• People with serious Heart diseases

• People with haemoglobinopathies

• Endocrine disorders

• Any other severe co-morbid conditions

• People living in long term care facilities like Mental

Hospitals, Old Age Homes, Homes for mentally retarded and
similar facilities
 Vulnerable Population
• 60 plus people who have to move out for livelihood.
• Pregnant mothers with
• heart diseases
• gestational diabetes mellitus
• pregnancy induced hypertension
• Other co-morbid conditions

• Lactating mothers
• Children below 10 years
Innate Immunity
 What is Innate Immunity?
• Inherent Resistance of the human body to infections

• It is not related to previous infection or immunisation

• Body defence mechanisms like epithelial surfaces, cough,

sneezing, vomiting, diarrhoea, saliva, tears,
contribute to innate immunity.
 Innate Immunity and Influenza Viruses
• Epithelial integrity

• Ciliary function of respiratory mucosa

• Nasal and mucopolysaccharides in respiratory and

nasal secretions
• are capable of fighting influenza viruses.
 Innate Immunity and SARS CoV-2
• SARS CoV-2 infection in individuals with weak innate
immunity results in COVID-19.

• Cytokine storm affects the epithelium of the lungs

• Vitamins and minerals protecting the epithelial integrity

needs to be given as prophylaxis as well during treatment of
COVID-19 patients.
 Factors affecting Innate Immunity
• The ability of innate immunity to fight the invading
microorganisms is reduced
• With increasing Age

• Nutritional deficiencies particularly vitamins, micro-nutrients and

proteins

• Co-morbid conditions

• Hormonal imbalances like hypothyroidism

• Tobacco Smoking
 Tobacco and Innate Immunity
• Tobacco in any form, particularly smoking severely impairs the
ability of Respiratory Tract to fight against Corona Virus

• Benefit of quitting smoking starts in the next few days to the

individual and family members.

Made for each other:

Corona Virus and Smoking
General Principles for Protecting 60 Plus and Vulnerable
 Stay Home
• Avoid moving out till SARS CoV-2 pandemic is
controlled
• Respiratory hygiene and frequent hand wash should
be practised
• Family members entering the house should
wash their feet first, hands next and
lastly face thoroughly with soap and water.
Do you really want
to go out?
 Wash Hands
• Hand Wash with soap and water for 30 seconds annihilates
corona viruses

• Corona virus can enter anywhere

• Even if one remains inside the house frequent hand wash is

a must, because corona virus can enter through any
essential household commodity
Hand Wash Method
 I am not going anywhere?
Why should I wash my hands?

Corona Virus can enter through any essential

household commodity like grocery packets,
vegetables, water canes, cylinders, bags, food
parcels, posts and so on.
Wash Hands often and Stay Safe
 Avoid Close Contact
• Should remain inside the homes in separate rooms, wherever
possible
• If separate rooms are not available, maintain a safe distance of
at least two metres distance
• Avoid visitors/relatives
• Use electronic mode of communications to the extent possible
• Villages with sparse population are low risk areas
• Those who have native homes may move temporarily
Social Distancing within homes is
absolutely essential to safeguard
the health of 60 Plus and
vulnerable
 Clean and Disinfect

• Surfaces touched by hands should be frequently

disinfected

• Soap and disinfectants may be used liberally

• Natural ventilation to be encouraged:

• natural ventilation quickly disperses the viruses from air.
 Face Mask

• Avoid moving out for any reason

• If absolutely essential like going

to a health facility, wear a good
quality mask
 Avoid all travel

• Avoid all kinds of travel

• Wherever possible 60 plus and vulnerable population

living in towns may go to their villages for the time

being
60 Plus people
 Why 60 Plus people are vulnerable?
• Innate immunity decreases with increasing age
• Likely to have undiagnosed co-morbidities
• Out of concern for younger family members they may tend
to go out
• May live alone and may tend to neglect proper nourishment
• May not be having right information on COVID-19 prevention
 Volunteers
• Any 60 plus couple or other vulnerable person lives alone,
young neighbours/volunteers can help them in
• Getting the family vegetables, other essentials, medicines

• Household assistance like payment of telephone bills, electricity

bills

• Facilitating any assistance requested by such people

• Volunteers can guide them in online mode of transactions, home

delivery orders, tele-medicine facilities etc
 Social Support for 60 Plus and vulnerable

• 60 plus couples or other vulnerable persons should be

supported by the society
• Volunteers helping neighbours

• Those who have to necessarily work to be supported by permitting

to work from home

• Posting/placing them in low risk areas

• Possible economic assistance

People with co-morbid conditions
• To be admitted in separate room if admission is
required
• Should be tested for SARS CoV-2 by RTPCR
• If negative, may be moved to general ward or
shared rooms
• Diabetes or hypertension to be checked
• Innate immunity boosting medicines and diet to be
prescribed.
• Younger age people should be discouraged from
people with co-morbid conditions
 Diabetes
• Type 2 diabetes increases the risk of severe illness from
COVID-19.
• Continue anti-diabetic drugs and insulin as usual.
• Test blood sugar and keep track of the results, as directed by
the doctor.
• Make sure that at least a 30-day supply of diabetes medicines,
including insulin are available at home.
• Follow the advise of the doctor
• Contact doctor immediately if sick
 Serious Heart Conditions, Cardiovascular and
Cerebrovascular Diseases
• Heart failure, Coronary artery disease, Congenital Heart Disease,
Cardiomyopathies, Pulmonary hypertension, other cardiovascular
or cerebrovascular disease, such as hypertension (high blood
pressure) or stroke, may increase the risk of severe illness from
COVID-19.
• Prescribed Medicines to be taken regularly
• Diet and exercise schedule to be followed regularly
• 30 days supply of medicines should be available at home
• Consult doctor in case of sickness or symptoms
 Bronchial Asthma
• Keep asthma under control.
• Continue current medicines, including any inhalers and steroids
• Make sure that medicines for 30 days are available at home
• Learn to use inhaler
• Avoid the known asthma triggers
• Keep measuring SpO2 level: If less than 95 percent consult
doctor immediately
• Consult doctor immediately if any symptoms of COVID-19
 Cleaning and disinfection of home/room of a
person with Bronchial Asthma

• Healthy member of the household who doesn’t have asthma,

clean and disinfect the house.
• When cleaning and disinfecting
• Make sure that people with asthma are not in the room.
• Minimize use of disinfectants that can trigger an asthma attack.
• Open windows or doors and use a fan that blows air outdoors.
• Spray or pour spray products onto a cleaning cloth or paper towel
instead of spraying the product directly onto the cleaning surface.
 Chronic Lung Diseases
• COPD (including emphysema and chronic bronchitis) and other
chronic lung diseases such as idiopathic pulmonary fibrosis and cystic
fibrosis, increase the risk of severe illness from COVID-19.
• Current medicines, including those with steroids in them to be
continued
• Make sure that you have at least a 30-day supply of medicines are
available at home
• Avoid triggers that make symptoms worse.
• Consult doctor if any sickness occurs
 Chronic Kidney Disease (CKD)
• Continue medicines and diet as advised by the doctor
• Make sure that at least 30-days supply of medicines available at home
• Healthcare team to be in contact as often as possible, especially if any
new signs or symptoms of illness occur
• If on dialysis:
• Dialysis Centre and healthcare provider to be contacted if sick or have any
concerns.
• To be on regular treatments.
• Plan to have enough food on hand to follow the diet schedule
 Immunocompromised Conditions
• Many conditions and treatments can cause a person to be
immunocompromised
• Organ or bone marrow transplant
• HIV with a low CD4 cell count
• prolonged use of corticosteroids or use of other immune
weakening medicines.
• Cancer chemotherapy or radiotherapy
• Recommended medicines or treatments and the advice to be
followed
• 30-days requirement of medicine should be available at home
 Liver disease
• Chronic liver disease, particularly cirrhosis (scarring of
the liver), increases the risk for severe illness from
COVID-19.
• Prescribed medicines to be taken regularly
• 30-days supply of medicines to be available at home
• Consult doctor in case of illness or symptoms
 Obesity
• Obesity, defined as a Body Mass Index (BMI) of 30 or above,
increases the risk of severe illness from COVID-19.
• BMI above 40 increases the risk manifold.
• Medicines prescribed for any underlying health conditions to be
taken regularly
• Nutrition and physical activity to be followed as recommended.
• Consult doctor in case of sickness or symptoms
 Haemoglobinopathies

• Haemoglobin disorders such as sickle cell disease and

thalassemia increase the risk for severe illness from
COVID-19.
• Treatment schedule should be followed properly
• Should be in touch with the doctor and health care
provider
 Neurologic conditions such as dementia

• Neurologic conditions such as dementia may increase the

risk of severe illness from COVID-19.

• Take medicines as prescribed.

• 30 days supply of medicines should be available at home

• Consult doctor in case of sickness or symptoms

 Smoking
• Tobacco smoking increases the risk of severe illness
from COVID-19.
• Current smokers should quit.
• Past smokers should not start again
• If never smoked, don’t start.

Corona Virus likes Smokers

 Children with Certain Underlying Conditions

• Children with serious genetic, neurologic, metabolic disorders, and with

congenital heart disease are at increased risk for severe illness from
COVID-19.
• Similar to adults, children with obesity, diabetes, asthma and chronic
lung disease, or immunosuppression are at increased risk for severe
illness from COVID-19.
• Medicines prescribed for the underlying conditions to be given regularly

• 30 days supply of medicines should be available at home

• Consult doctor in case of sickness or symptoms

People with Multiple Underlying Conditions

• The more underlying medical conditions, the greater

their risk is for severe illness from COVID-19.

• Medicines and treatment to be continued as prescribed

• 30 days supply of medicines should be available at home

• Consult doctor in case of sickness or symptoms

 Cancer Patients
• To be admitted in separate room if admission is required

• Should be tested for SARS CoV-2 by RT-PCR

• If negative, may be moved to general ward or shared rooms

• Diabetes or hypertension to be checked

• Innate immunity boosting medicines and diet to be prescribed.

• Younger age people should be discouraged to be with them

 Physically Challenged Groups and Risks
• People who have limited mobility or who cannot avoid
coming into close contact with others who may be
infected, such as direct support providers and family
members
• People who have trouble understanding information or
practicing preventive measures, such as hand washing
and social distancing
• People who may not be able to communicate symptoms
of illness
 Long Term Care Centres
• People housed in Long Term care Centres/Homes are at
risk of infection by virtue of the physical/mental condition
of the inmates, they may not be in a position to maintain
• Respiratory Hygiene

• Hand Hygiene

• Personal Hygiene

• Surface Hygiene
High Risk People living in Long Term Care Centres

• People with severe physical challenge

• Old age

• Mentally not well

• Children with mental retardation

• Any similar conditions

 Long Term Care Centres
• Anyone entering and leaving a Long
Term Care Centre should wash hands
with Soap and Running water

• Everyone should wear good

quality face mask properly

• Thermal screening of all by using non-

touch thermal scanners
Visitors to Long term Care Centres

• Visitors should be completely

banned.

• Video call facilities may be

arranged if absolutely warranted
 Why Special Care in a
Health Care Facility for
60 Plus and vulnerable?
 Why Special Care in a health facility for
60 Plus and Vulnerable?
• Likely to get infected more than others

• Likely to develop severe complications than

others

• They need to be protected from being infected

when they come to a health facility

• Separate place and timing to be followed in all

health facility for vulnerable population
 Why Special Care for pregnant mothers and
children?
• For any kind of Influenza Like Illness (ILI), pregnant, lactating and
children are vulnerable
• Risk of getting severe form of COVID-19 is high for mothers with
• Gestational Diabetes Mellitus (GDM)
• Pregnancy Induced Hypertension (PIH)
• Heart diseases
• Severe hypothyroidism and
• other comorbid conditions
Why all Pregnant Women should be RT-PCR tested for Corona
virus, five days before EDD or immediately on admission in a
separate room in a health facility?

• Two-thirds of deliveries occur in government hospitals:

Unless Corona positive mothers are admitted in separate
rooms, High Risk Pregnant mothers will be at risk.
• Testing will enhance the Confidence of doctors and nurses
• Since pregnant women, do not venture out much, testing
all pregnant women will be an excellent default sample
for detecting the entry of infection in an area.
Care of Pregnant Women
▪ Pregnant mothers with pre-existing co-morbid
conditions and pregnancy related high risk conditions
▪ Antenatal visits should be regular
▪ 30 days medicine should be available at home
▪ Should be aware of danger signs
▪ Mobile numbers of area Village Health Nurse (VHN)/
Urban Health Nurse (UHN) and PHC MOs should be
available readily
Improving Innate Immunity
 Innate Immunity boosters
Nutrition Key Functions related to COVID- Sources
Component 19
Proteins Essential for production of Milk, egg, meat,
antibodies, enzymes, hormones, fish, pulses, nuts,
plasma proteins, haemoglobin beans
and coagulation factors

Vitamin-A Necessary for epithelial Liver, eggs, butter,

integrity: cheese, whole milk,
Anti-infective nature helps in fish, meat, papaya,
immune response to infections mango, carrots
 Innate Immunity boosters
Nutrition Key Functions related to Sources
Component COVID-19
Vitamin-D Essential for collagen Sunlight, cheese,
maturation, butter, egg, fish,
Essential for normal growth milk

Vitamin-C Essential for epithelial integrity Tomato, orange,

and collagen formation lemon, guava, amla,
Collagen provides supporting green leafy
matrix for blood vessels vegetables
 Innate Immunity boosters
Nutrition Key Functions related to Sources
Component COVID-19
Zinc Essential for most of the Cheese, butter, egg,
enzymes, fish, milk
Insulin formation requires zinc,
Immunity function
Nutritious Essential for boosting innate Fruits, green leafy
food immunity vegetables, egg,
fish, meat
 Prophylactic Medicines
Medicine Dose Duration
Tab.Vitamin C 500 mg daily 10 days
Tab.Multi Any Available preparation 10 days
vitamin
Zinc 20 mg or any available 10 days
preparation
Kabasura Adults-60ml Seven days :Two days
Kudineer Children-30 ml gap and seven days
Total: 14 days.
Method for preparation and usage of Nilavembu Kudineer and
Kabasura Kudineer Herbal Powder (for single person)

• Dissolve 5 gm of Nilavembu Kudineer or Kabasura Kudineer Herbal

powder in 240ml of water and boil it well and reduce to 60 ml, filter
the same and drink this within 3 hours.

• Dosage advised is 60 ml for Adult and 30 ml for Children.

• To be taken for 7 days. After two days gap to be taken for another 7
days (Total:14 days)
 Innate Immunity Improving Activities
• Evening walking or working or standing under sunlight

• Physical exercise

• Yoga and Pranayam

• Quitting smoking

• Quitting alcohol
 Signages on the doors of
60 Plus and Vulnerable People

• Relatives/friends should avoid visiting

blue stickered houses
• Family members will get reminded
every time they go out and return home
• Before entering the house they should
leave chappals outside
Hand wash, Cleaning, Disinfection, Hand Sanitisers
and Social Distancing
Improving the Innate Immunity of 60 Plus,
appropriate treatment of co-morbid
conditions, infection prevention measures
and seeking care early can save lives.

Thank You
Knowledge about the invisible and intelligent
enemy with strategic warfare capabilities is

Power
How Corona Virus Spreads?
 1.Sneezing, Coughing, Laughing and Talking
• Micro droplets directly infect when breathing the air
contaminated with Corona virus by
• Sneezing
• Coughing
• Laughing and
• Talking

• Less than 20 percent of transmission occurs in this way

(air-borne transmission)
 2.Through Hands
• Hands are contaminated by
• Droplets formed during sneezing, coughing, laughing and talking, settles
on surfaces and such surfaces get contaminated with Corona virus
• Hands of an infected person gets contaminated while sneezing/coughing
and all the surfaces touched by the infected person get contaminated

• When face, eyes, nose and mouth are touched by the

contaminated hands, the infection spreads
• More than 80 percent of transmission occurs in this way
(Hand borne transmission)
 Strategies to block and or destroy the virus
1.Universal use of face masks (<20 %)
• Prevents air-borne transmission

• Prevents surface contamination

2.Hand wash with soap and water (>80 percent)

• Prevents hand borne infections

• Frequent Hand washing by the infected person also prevents the

contamination of surfaces frequently touched by the hands
 Strategies to block and or destroy the virus
3.Disinfection of Surfaces frequently touched by hands
• Prevents surface borne transmission

4.Natural ventilation
• Disperses the viruses from the air
• Reduces surface contamination

5.Social distancing of one or two metres distance

• Prevents airborne transmission
 Source Reduction Strategies
1.Universal Face Mask
• Denies source to air and consequently surfaces
2.Surface Cleaning
• Denies source to hands
3.Hand wash by infected people
• Denies source to surfaces frequently touched by the
hands
4.Hand wash by all
• Denies source to infect humans by all means
Estimated longevity of Corona Virus in the environment

1.Under Sunlight
• Few hours
2.Naturally ventilated east-west facing room
• One or two days
3.Cool conditions
• Four to five days
 60 Plus and
Vulnerable Protection Strategy
 Will it succeed?

• Will it really work?

• What is the logic behind it?

• Is it feasible in a country where large number of people

are living in cramped houses?

• Can immunity be improved for 60 plus and vulnerable?

 Is it logical and scientific?

• Delaying the lightning spread of Corona virus to the extent

possible, Protecting the 60 Plus and Vulnerable and reducing the
mortality are the worldwide strategies.

• Corona virus spread is linked to human activity particularly

outdoor activity.

• Slowing the spread will lead to the spread mostly to healthy and
young since they are active.
 Is it logical and scientific?
• Gradual development of Herd Immunity among the people beyond
40 percent will slow down the virus and once the herd immunity
reaches 60 percent it will cripple the ability of the virus.

• Population aged >60 in India (8%) and Tamil Nadu (10.5%) +

vulnerable population due to various co-morbid conditions which
increase the risk to severe COVID-19 are well below 20 percent.
 Herd Immunity
• When 60 percent of young and healthy develop Herd
Immunity, it will protect the 60 Plus and vulnerable.
• Controlled and safe movement of young and healthy and
active economic activity for at least one year from the
beginning of the pandemic, or
• in other words protecting the 60 Plus and vulnerable will
save the lives during this pandemic.
 Is it possible in Poor Resource Setting Countries?
• The strategy is proving to be useful even in countries with poor
housing infrastructure and low resource settings.
• What we need to do is
• Staying at home
• Hand wash
• Face Mask
• Surface cleaning
• Social distancing
• Control of co-morbidities
 Innate Immunity among 60 Plus and Vulnerable

• Innate Immunity can be improved in any population

group by
• Good nutrition

• Nutritional supplements including vitamins and minerals

• Exercise, Yoga including pranayama

• Exposure to evening sunlight at least for half an hour

 Caution

A war can be lost after fighting, but

giving up the war even before fighting,

that too with a microorganism will
go down in the History of Mankind.
 References & Acknowledgement

❖ World Health Organisation (WHO)

❖ Centers for Disease Control and

Prevention (CDC)