Secrets to longevity: The Methuselahs that survived COVID‐19

To the Editor: The coronavirus disease‐2019 (COVID‐19) was declared a global pandemic on the March 11, 2020, resulting to date in more than 197 million cases and 4.2 million deaths around the world. Since the early phases of the pandemic, old age was identified as a major risk factor for morbidity and mortality, along with comorbidities. ¹

To date, at least 252 people aged 105 years or more have tested positive for the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) that can cause COVID‐19. ² One hundred of these Methuselahs have successfully recovered from a SARS‐CoV‐2 infection. Among them are a dozen of supercentenarians, that is, people of at least 110 years of age, including the current second oldest living person (verified) in the world, Ms Lucille Randon from France, who is 117 years and 171 days of age (born on February 11, 1904). Ms Randon recovered from a SARS‐CoV‐2 infection in January 2021, when at the age of 117 years (Figure 1). ³

FIGURE 1.

Ms Lucille Randon is the oldest person to survive a severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection at the age of 117 years. She is currently the second oldest verified person in the world.Source: Public domain via Gerontology wiki. Accessed July 21, 2020. https://gerontology.wikia.org/wiki/Lucile_Randon

Another supercentenarian, Ms Iris Estay from Chile, remarkably recovered from a SARS‐CoV‐2 infection twice, testing positive for the virus first in September 2020 and recovering in October, but then testing again positive in February 2021 and recovering in March. ⁴ Ms Estay was vaccinated in April 2021, becoming one of the oldest people to receive a SARS‐CoV‐2 vaccine. ⁵

Epidemiological analyses have described age and certain comorbidities as the major risk factors for COVID‐19 morbidity and mortality. In March 2021, the Centers for Disease Control and Prevention (CDC) reported that 80% of the people who were hospitalized in the United States with COVID‐19 were either overweight or obese. ⁶ The CDC also reported that 95% of more than half a million adults hospitalized with COVID‐19 in more than 800 U.S. hospitals had at least one comorbidity, with hypertension, diabetes, and obesity being the most common. ⁷ The same report identified obesity as the strongest risk factor for mortality in this cohort, followed by anxiety and fear disorders, and diabetes with complication. ⁷

Current global epidemiological efforts are focused on identifying risk factors for morbidity and mortality, as this information is of utmost importance in order to protect the populations that are most at risk. As we emerge from the pandemic, it will be of value to also extract information on the determinants of health, wellness, and longevity, such as why some older persons can survive the SARS‐CoV‐2 infection, even when they have surpassed the average global life expectancy by more than 40 years, whereas others do not. ²

Photographs of the older persons surviving SARS‐CoV‐2 depict people within a normal weight range that do not, phenotypically at least, manifest any signs of metabolic syndrome. ² Metabolic syndrome has been implicated in the attenuation of the immune response, with both obesity and diabetes independently affecting the structure, migration, and function of the cells, tissues, and other components of the immune system. ⁸ In addition to these conditions, physical activity reportedly protects against adverse outcomes in people with SARS‐CoV‐2, with prior cardiorespiratory fitness and strength conferring protection even many years later in people with SARS‐CoV‐2 infection, independent of other risk factors such as overweight. ⁹ , ¹⁰

Unfortunately, the list of surviving older people with SARS‐CoV‐2 does not contain demographic or medical information to facilitate an insight with regard to the factors that promote a healthy immune system and longevity in the aging population. ² It is therefore not known if the survivors were engaging in physical activity either during the recent years prior to the infections or during earlier years of their life. It is also not known if they had comorbidities that were managed. The only available information, other than the age of the survivors, is any inferences that can be made via the hospital discharge pictures and short, unverified biographical notes. This perspective attempted to draw some conclusions based on preliminary data and inferences that have known limitations. Future epidemiological efforts should focus on elucidating the determinants of health and wellness in very old populations to facilitate an insight on how to live a long and healthy life.

CONFLICT OF INTEREST

The author declares no conflict of interest.

AUTHOR CONTRIBUTIONS

George Siopis conceived the idea, analyzed the data, and wrote the manuscript.

SPONSOR'S ROLE

None.