Rwanda’s Ministry of Health continues to encourage the general public to take the preventive measures of thoroughly washing hands with soap, sanitising, staying home, and social distancing, to prevent the spread of COVID-19.

The most lethal of coronavirus cases are seen in the elderly, as they are immunocompromised (reduced ability to fight infections and other diseases). However, health experts warn that young and seemingly healthy people shouldn’t be misguided to think that they are ‘safer’ from the pandemic. They should be just as concerned about the disease because a good number have, unfortunately, been admitted to hospitals with severe symptoms of coronavirus.

According to Dr Menelas Nkeshimana from University Teaching Hospital of Kigali (CHUK), at the start of COVID-19, initial reports described it as ‘a disease mainly affecting the elderly population and those with other health complications’.  

He notes, "As our knowledge about this novel disease increased, we quickly realised that everyone was and is at risk to be infected, including the younger population. Through exchanges with our colleagues from the USA, we came across a series of cases of very young people with severe COVID-19, requiring Intensive Care Unit admission.”

Nkeshimana adds that it remains unclear what other underlying conditions or lifestyle would put those youngsters at such a great risk of severe disease and or death. In general, respiratory infections are severe in people with chronic lung injuries, such as those who smoke, or chronic exposure to dust, mines, biomass smoke, among others.

He also says that in mid-March, the Centers of Disease Control and Prevention-CDC, released a weekly morbidity and mortality report describing 508 patients (20 per cent in the age group from 20 to 24) who had required hospitalisation, among whom 121 had severe COVID-19 infection, requiring ICU admission. On the latter, 12 per cent were in the age group between 20 to 24 years. This alone demystifies the issue of age and COVID-19 infection.

Nkeshimana says that young people are at a risk of severe COVID-19 infection, and the risk increases with age. Young people with mild disease can be a risk to other susceptible population groups, for example, elderly population, people with multiple comorbidities, if not well managed.

He says, successful control of COVID-19 pandemic requires collaborative efforts beyond personal risks, in order to timely achieve common goals that are; source control, cut-off of the transmission chain, and protection of the vulnerable population.

For Dr Kenneth Ruzindana, a consultant at CHUK, although there have been severe cases of coronavirus that have been reported in children and young adults, including new born cases, most children or young people appear to have mild or moderate disease and recover within two weeks of getting infected by the disease.

He says, children and young adults of all ages can be infected by COVID-19, although they appear to be affected less commonly than adults. The age distribution for COVID-19 and all cases that have been reported worldwide, about less than four children between ages of 10 and 14 are accounted for about 20 per cent of all the cases, and anywhere between 15 to 17 years, they are accounted for 27 per cent of all the cases. Although infants of less than one year of age have also been reported, the proportion of all cases that have occurred in infants is less than one per cent.

"While it is true that COVID-19 seems to mostly, seriously, affect older people, particularly, those with pre-existing conditions like lung diseases, diabetes, it could be that an elderly person’s immune system may not be able to fight off the disease well, and the virus can be more easily replicated, overwhelming the body, and causing multiple system failure,” he states.

But as more knowledge keeps coming up, it has become apparent that there are more people who are younger and still get very sick, and die, he adds.

Ruzindana also points out that for some time, it has been known that this disease was not only an elderly disease, it has become clear that the young and healthy are by no means invulnerable to this virus and could become sick enough to require hospitalisation.

Data that is carried out by the Centers of Disease Control and Prevention-CDC, shows that even though 80 per cent of coronavirus deaths are among older adults, young people can be at risk due to behaviours that can damage their lungs, like vaping.

For Ruzindana, consumption of alcohol can also weaken a person’s immune system, hence exposing them to higher risks of infections. However, failure to practice social distancing, not wearing a mask or failure to wash hands with soap, can increase a person’s risk to coronavirus, regardless of their age.

CDC also emphasises that young people risk transmitting coronavirus to other people, like relatives, and the people who are at risk because of heart disease, stroke, high blood pressure, asthma, chronic obstructive pulmonary disease (COPD), cystic fibrosis, and kidney disease — and other issues that cannot be seen, such as autoimmune disorders, like, lupus or those who recently had cancer treatment.

Research

According to Science&Health, another factor being investigated is the infectious dose, or the amount of virus a patient was exposed to when they first became ill. Could it affect how sick someone becomes, regardless of their age or health? This can be determined through epidemiological studies, where researchers compare groups of patients to learn more about how they first became infected and whether higher levels of viral exposure correspond to sicker patients.

Some are looking into genetic differences. Our genes can affect the way our immune system responds to an infection, which could explain why some people fare worse than others. "The possibilities, unfortunately, are endless,” said Dr Jean-Laurent Casanova, an investigator at the Howard Hughes Medical Institute and physician at Rockefeller University Hospital. "Between the first encounter with the virus and death, you can imagine that there are lots and lots of steps. At any of these steps, a defective immunity in any of the cells encountered by the virus can be responsible for severe disease and therefore death.”

Luckily, many of the studies needed to determine why some young people get severe infections are already underway, and we could see preliminary results in a matter of months. But it may take years to fully understand why COVID-19 affects people differently, Science&Health states.

Health experts and scientists urge everyone to quarantine themselves, if they think that they have been infected. Young adults and people of all ages should follow guidelines to protect themselves from COVID-19 and know what to do if they feel sick. However, there is emphasis that COVID-19 can be severe among persons of all ages.