To the Editor:
Older people and people with preexisting medical conditions seem to be more vulnerable
to becoming severely ill with the coronavirus disease 2019 (COVID‐19). Since the best
way to prevent and slow down transmission is to be well informed about the virus,
the disease it causes, and how it spreads, the Instituto Nacional de Ciencias Médicas
y Nutrición Salvador Zubirán's (INCMNSZ) geriatric medicine department has made a
hotline available to field older adults' inquiries about COVID‐19 (Figure 1).
Figure 1
Hotline for older adults for coronavirus disease 2019 (COVID‐19), Mexico City, Mexico.
Due to the fact that the INCMNSZ, a public tertiary care center in Mexico City, Mexico,
has recently become a designated care site for COVID‐19, most outpatient clinics are
on hold or working via telephone call or telemedicine, allowing medical staff to answer
the hotline queries for now. The hotline is open 7 days a week, from 9 am to 7 pm.
I am the attending geriatrician on hotline duty. That is no coincidence: I am self‐isolating
due to immunosuppressive therapy (APNR). Yet, just as Ray Bradbury's character in
Fahrenheit 451 stays in her burning house rather than abandon her burning books, I
do not stay at home for nothing.1
Although emphasizing the importance of preventive measures, trying to best address
concerns, and stopping patients from unnecessarily visiting the emergency room are
our main objectives, it is the human experience I would like to write about. In 10 days,
I have received 64 calls and text messages about and from older adults. I have classified
the addressed issues in the following areas: logistical doubts, preventive measures,
patients with respiratory symptoms, and reminders of an unprepared health system.
During these few days, I have addressed a myriad of concerns related to COVID‐19.
I have the impression that I have not been speaking with individuals, but with entire
families. Such interactions, I believe, carry with themselves the possibility of valuable
information being disseminated, information much needed to attain the best possible
outcome given the particular circumstances of Mexico.
Most logistical doubts have been about canceled outpatient clinic appointments at
the INCMNSZ. A few days ago, a 92‐year‐old gentleman with long‐standing Crohn's disease
texted the line. He was worried about his canceled clinic appointment since it was
meant for treatment adjustment. When the on‐call gastroenterology specialists' team
was able to program a telephone call consultation for him the next day and his concern
was mitigated, he sent me a picture of himself, the message attached read, “so you
get to know me.”
A second group is composed of older adults and their loving family/friends/neighbors
wondering what they can do to reduce their risk of infection. This one has been encouraging
and heartbreaking at the same time. On the one hand, I have been able to underscore
the importance of preventive measures, to solve relatively simple doubts, and to knock
down a few myths on the way. On the other, these calls are a frequent reminder of
how unfortunate the conflicting messages sent to the population by influential politics
and business figures have been. For instance, I received a message from a worried
young woman whose 80‐year‐old grandmother did not want to comply with preventive social
distancing. She had seen the head of the Mexican government affirm on national television
that Mexicans could continue hugging and kissing safely in spite of the pandemic.2
Conversations with this group are also an attestation of how conflictive the concepts
of preventive social distancing and lockdown are with survival for a great proportion
of Mexicans who earn their living on a day‐to‐day basis.3
Interlocutors in the third group are those looking for guidance in the presence of
respiratory symptoms. With this group, I have shared information regarding warning
signs to go to the emergency room and regarding home care isolation, a sensitive matter
when overcrowded households are not unusual4 and when trained healthcare workers able
to assess if the residential setting is suitable for the purpose are nonexistent.
In Mexico, approximately 26.7% of older adults report overcrowding, 20.7% share their
bedroom with 1.5 to 3.9 other persons, and 6% share their bedroom with 4 or more other
persons.5
The last group are those not calling about COVID‐19. A 60‐year‐old woman diagnosed
with rheumatoid arthritis called the hotline. She was looking to receive financial
aid from the government since she did not have any social security benefits and was
unable to purchase her medications. This is not an unusual scenario for a physician
working in Mexico; basic medical expenses are frequently uncovered and advanced medical
care scarce or frankly unavailable in some regions, a hint of the lack of readiness
of our healthcare system to face emerging contingencies, such as a pandemic.