**6.3 Geriatrics**

Older adults were susceptible both to the virus and to its psychological impact as they have unique physical, psychosocial and environmental vulnerabilities owing to frailty [37]. Latest reports from Nature Medicine quoted those below 30 and above 59 years were 0.6 and 5.1 times more likely to die after developing symptoms respectively. According to the Centre for Disease Control and Prevention (CDC), people having chronic illness such as chronic lung diseases, asthma, serious heart conditions and diabetes are at an increased risk of COVID-19. Moreover, mental health disorders are a common comorbidity among older adults, which may get exacerbated by their fear and trepidation of being vulnerable to severe illness from COVID-19 [34]. This form of stress is associated with reduction in immunity compounding the already weakened physiological defense systems in an elderly. Recently, a study found that 18% individuals who received a COVID-19 diagnosis were later diagnosed with a mental health disorder such as anxiety or mood disorder and both was found to have a higher prevalence in the older age group as compared to middle aged and youngsters [38]. Neglected older people can even serve as vulnerable 'hidden pockets' of viral load that can contribute to increased infection spread due to under-reporting of the psychiatric symptoms in them. This leads to under-detection of symptoms, faulty treatment and increased prevalence of them being asymptomatic carriers. Higher viral load and virulence among geriatrics increases the fatality rate from 3.6% in 60–69 yrs. suddenly to 18% in more than 80 years [37]. Loneliness, especially when chronic and associated with lack of physical activity is a potent risk factor for depression and cognitive disorders. In 2018, an estimated 27% adults aged 65 and above were reportedly living alone [34]. In face of older elderlies not being well-versed with technology, their inability to conduct virtual meetings led to increase distancing during the pandemic. Finally, the social stigma of ageism magnified by COVID-19 outbreak led to marginalization, segregation, abuse, increased institutionalization and suicidal ideation among senior citizens. Banerjee et al. has shown increased depressive disorders, PTSD and adjustment reactions in geriatrics due to the pandemic [38]. On the other hand, poor perception of one's own health could lead to health-related anxiety which may further result in depression, headache, insomnia, and even suicidal tendency in the aged [33].

### **6.4 Females**

Females reported elevated distress due to closure of schools and day care with increased household chores along with their regular professional work during times of crisis and quarantine. Apart from this, women also faced the brunt of domestic violence, which was reportedly at an all-time high since last 10 yrs. in India during COVID lockdown [30]. Generally, both prior to and during the pandemic, women have reported higher rates of anxiety and depression compared to men. Further, it was observed that the recovery rate of unemployment

post-national lockdown in India was lower in case of females as compared to males and the gaps seems to have widened [6].
