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​This guidance is based on what is currently known about the transmission and severity of Coronavirus Disease 2019 (COVID-19). The California Department of Public Health (CDPH) will update this guidance as needed and as additional information becomes available. This document is intended to provide guidance to help older adults and individuals who are at increased risk for severe COVID-19 illness.

While most individuals with COVID-19 have mild clinical symptoms, some individuals may experience severe symptoms. Reported COVID-19 infections range from no or mild symptoms to severe illness, including illness resulting in death. In general, your risk of getting severely ill from COVID-19 increases as you get older. In fact, 8 out of 10 COVID-19-related deaths reported in the United States have been among adults aged 65 years and older.

Adults of any age with the following conditions are also at increased risk of severe COVID-19:

• Cancer
• Chronic kidney disease
• COPD (chronic obstructive pulmonary disease)
• Heart conditions, such as heart failure, coronary artery disease, or cardiomyopathies
• Immunocompromised state (weakened immune system) from solid organ transplant
• Obesity (body mass index [BMI] of 30 kg/m2 or higher but < 40 kg/m2)
• Severe Obesity (BMI ≥ 40 kg/m2)
• Pregnancy
  
• Sickle cell disease
• Smoking
  
• Type 2 diabetes mellitus
  

Background

COVID-19 is an illness caused by a novel virus that has spread worldwide. As the pandemic continues, we continue to learn more about how COVID-19 spreads and how to best treat individuals with COVID-19. Person-to-person spread is the main mode of the virus (SARS-CoV-2) transmission identified by CDC. The CDC reported that, like other respiratory viruses such as influenza, the virus can spread between people who are in close contact with one another, through exposure to respiratory droplets produced when an infected person coughs, sneezes, sings, talks, or breathes. When these respiratory droplets are inhaled or contact mucus membranes, such as those in the eyes, nose or mouth, they can cause an infection.

The CDC has also concluded that under certain conditions, people with COVID-19 have infected others by airborne transmission, which occurs when smaller particles linger in the air and are inhaled. Smaller particles containing the virus can linger for minutes or hours and infect people who are farther than 6 feet away from the infected person or after the infected person has left the space. People infected with SARS-CoV-2 can have no signs or symptoms of infection but can still spread infection to others. The CDC estimates that about 50% of transmissions occur from asymptomatic or pre-symptomatic infected people who feel well and are unaware that they are infectious. CDPH is monitoring COVID-19 cases, increasing access to testing, and providing guidance and resources to prevent, detect and respond to COVID-19 cases in California.

Measures for Older Adults and Those Who Have Elevated Risk

Everyone should take steps to prevent getting and spreading COVID-19 to protect themselves, their communities, and people who are at increased risk of severe illness. CDPH recommends implementing the following steps:

• Practice physical distancing.
• Avoid non-essential travel.
• Maintain distance, at least six feet, between yourself and people who are not your household members.
• Avoid handshaking, hugging or other intimate types of greetings—greet others with a wave, nod or bow instead.
• Wear masks when outside the home.
• Always wear a mask when in an indoor setting outside of your home environment. There are limited situations where you are exempt from wearing a face covering or where you can remove it temporarily outside of your home.
• Consider wearing a surgical mask, if widely available.
• Wear a mask when within six feet of people not in your household when outdoors.
• For more information, see the Guidance for the Use of Face Coverings
• Continue with outdoor activities as local ordinances permit.
• As long as you practice physical distancing and use masks, we encourage you to continue your outdoor activities such as walks, runs and yardwork, to the extent your health allows it.
• Stay in touch with others by phone, email, or other on-line tools (like Skype and Facebook).
• Ask friends, family, neighbors, and other networks to do essential grocery shopping, picking up medications, etc. Consider on-line ordering for food and other supplies.
• Identify family, friends, neighbors, and caregivers who can provide support
• Family, friends, neighbors, and caregivers can provide support by checking in on you by phone, email, or by video chat, and ensure that you have sufficient quantities of food, medications, and medical supplies on hand.
• If in-home assistance is needed, family, friends, neighbors, and caregivers who come to your home should be well and should not have a fever, cough, or other respiratory symptoms, and should maintain physical distancing to the extent possible and wear masks when in your home.
• If someone from outside of your household must enter your home, you should also maintain physical distancing to the extent possible and wear a mask.
• Staying healthy during the pandemic is important.
• Talk to your healthcare provider about whether your vaccinations and other preventive services are up to date to help prevent you from becoming ill with other diseases.
• It is important for those at increased risk of severe illness, including older adults, to receive recommended vaccinations against influenza and pneumococcal disease.
• If you need medical care, consult your health care provider, to make an appointment and visit your provider to get the necessary care.
• Contact your health care provider to discuss alternative provision of services, such as telehealth or virtual visits.
• If you have an emergency and need immediate medical care, call 9-1-1.
• Have medications and other medical supplies on hand.
• Contact your healthcare provider to ask about obtaining extra necessary medications to have on hand.
• If you cannot get extra medications, consider using mail-order for medications.
• Be sure you have over-the-counter medicines and medical supplies (tissues, etc.) to treat fever and other symptoms.
• Have a plan for if you get sick.
• Consult with your health care provider for more information about monitoring your health for symptoms suggestive of COVID-19.
• Watch for symptoms and emergency warning signs.
• Pay attention to potential COVID-19 symptoms including fever, cough and shortness of breath. If you develop symptoms, call your doctor.
• If you develop emergency warning signs for COVID-19, seek medical attention immediately. In adults, emergency warning signs* include:
• Difficulty breathing or shortness of breath
• Persistent pain or pressure in the chest
• New confusion or inability to arouse
• Bluish lips or face
• *This list is not all inclusive. Please consult your medical provider for any new symptoms
• Practice hand washing.
• Wash hands frequently for at least 20 seconds.
• Encourage hand washing by family and friends, particularly children.
• If you can’t wash your hands, clean your hands with an alcohol-based hand sanitizer.
• Avoid touching eyes, nose, or mouth with unwashed hands.
• Use “respiratory etiquette”.
• Cover your coughs and sneezes
• Cover your mouth and nose with a tissue when you cough or sneeze.
• Throw used tissues in a lined trash can and immediately wash your hands.
• If someone within your household is sick, or if you have persons in your home who do not live with you, clean and disinfect your home regularly: practice routine cleaning of frequently touched surfaces and items (for example: tables, doorknobs, light switches, handles, toilets, faucets, and sinks) with common cleaning supplies.
• See the Centers for Disease Control and Prevention’s Cleaning and Disinfecting Your Home page regarding the prevention of disease in homes and residential communities.