Journal of Gerontological Nursing

Letter to the Editor Free

How to Protect Older Adults With Comorbidities During Phase 2 of the COVID-19 Pandemic: Nurses' Contributions

Debora Rosa, PhD, RN; Giulia Villa, PhD, RN; Serena Togni, PhD, RN; Loris Bonetti, PhD, RN; Anne Destrebecq, RN; Stefano Terzoni, PhD, RN

To the Editor:

On December 31, 2019, China reported a cluster of pneumonia cases of unknown etiology caused by a new coronavirus (SARS-CoV-2) associated with respiratory disease to the World Health Organization (WHO), which was later termed COVID-19. As of August 6, 2020, there were 18,614,177 confirmed cases worldwide since the beginning of the epidemic and 702,642 deaths (WHO, 2020).

The literature shows that age and some chronic diseases (e.g., cardiovascular, respiratory, hypertension, diabetes) seem to be linked to the pathogenesis of COVID-19 (Yang et al., 2020). Hypertension is prevalent in approximately 17% of patients with COVID-19, whereas diabetes, cardiovascular disease, and respiratory system diseases are prevalent in 8%, 5%, and 2% of cases, respectively (Yang et al., 2020).

At this time, when the majority of affected nations are entering a phase of coexistence with the virus (Phase 2), nurses could be one of the central points for protection of older adults. Nurses have the knowledge and skills to promote educational projects for the population dedicated to the correct use of individual safety devices; correct behavior, such as hand washing, cleaning, and disinfection of high contact surfaces; and social distancing (Di Pasquale, 2020). Nurses are also able to promote campaigns for flu vaccination for people at risk and health care workers, as indicated by the American College of Cardiology (Di Pasquale, 2020). In addition, telephone triage and telemedicine (Tolone et al., 2020) can be implemented to identify infected patients with comorbidities that put them at higher risk, as well as to monitor older adults living alone and those affected by the diseases indicated above. Nurses can also identify cases of “COVID-19 chameleon” (Nickel & Bingisser, 2020), defined as patients who are older and tend to present with nonspecific symptoms, such as weakness and fatigue. Nurses also monitor behaviors that could endanger frail older adults (Casanova et al., 2015), and measure biomarkers of cardiac damage that can help identify patients with possible cardiac lesions to predict the worsening clinical picture of COVID-19 (Di Pasquale, 2020). Nurses should also be involved in the preparation of programs and plans to ensure that they are ready to avoid or respond to more widespread virus circulation (Johnson et al., 2020).

All of the above-mentioned measures should be considered to prevent a possible second peak of COVID-19 that would once again put health care systems all over the world in crisis.

Debora Rosa, PhD, RN
Istituto Auxologico Italiano
IRCCS San Luca Hospital
Milan, Italy

Giulia Villa, PhD, RN
IRCCS San Raffaele Institute
Milan, Italy

Serena Togni, PhD, RN
Foundation IRCCS National Cancer Institute
Milan, Italy

Loris Bonetti, PhD, RN
Nursing Development and Research Unit
Oncology Institute of Southern Switzerland
EOC, Bellinzona and Department of
Business Economics, Health and Social Care
University of Applied Sciences and Arts of
Southern Switzerland
Manno, Switzerland

Anne Destrebecq, RN
University of Milan
Department of Biomedical Sciences for Health
Milan, Italy

Stefano Terzoni, PhD, RN
San Paolo Bachelor School of Nursing
San Paolo Teaching Hospital
Milan, Italy


  • Casanova, N., Bagnasco, N., Bonetti, L. & Sasso, L. (2015). Nurses' attitudes towards nutritional care and malnutrition in hospitalised older people: A survey in the Liguria Region [article in Italian]. Professioni Infermieristiche, 68(4), 219–226 doi:10.7429/pi.2015.684219 [CrossRef] PMID:26752313
  • Di Pasquale, G. (2020). Coronavirus COVID-19: Quali implicazioni per la cardiologia?Giornale Italiano Di Cardiologia, 21(4), 243–245.
  • Johnson, H. C., Gossner, C. M., Colzani, E., Kinsman, J., Alexakis, L., Beauté, J., Würz, A., Tsolova, S., Bundle, N. & Ekdahl, K. (2020). Potential scenarios for the progression of a COVID-19 epidemic in the European Union and the European Economic Area, March 2020. Eurosurveillance, 25(9), 2000202 doi:10.2807/1560-7917.ES.2020.25.9.2000202 [CrossRef] PMID:32156332
  • Nickel, C. H. & Bingisser, R. (2020). Mimics and chameleons of COVID-19. Swiss Medical Weekly, 150, w20231 doi:10.4414/smw.2020.20231 [CrossRef] PMID:32202647
  • Tolone, S., Gambardella, C., Brusciano, L., Genio, G., Lucido, F. S. & Docimo, L. (2020). Telephonic triage before surgical ward admission and telemedicine during COVID-19 outbreak in Italy: Effective and easy procedures to reduce in-hospital positivity. International Journal of Surgery, 78, 123–125 doi:10.1016/j.ijsu.2020.04.060 [CrossRef] PMID:32360932
  • World Health Organization. (2020). Coronavirus disease (COVID-2019) situation reports.
  • Yang, J., Zheng, Y., Gou, X., Pu, K., Chen, Z., Guo, Q., Ji, R., Wang, H., Wang, Y. & Zhou, Y. (2020). Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: A systematic review and meta-analysis. International Journal of Infectious Diseases, 94, 91–95 doi:10.1016/j.ijid.2020.03.017 [CrossRef] PMID:32173574

The authors have disclosed no potential conflicts of interest, financial or otherwise.


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