Novel Coronavirus (COVID‐19) Epidemic: What Are the Risks for Older Patients?

• Published in: Journal of the American Geriatrics Society Vol. 68; no. 5; pp. 939 - 940
• Main Authors: Garnier‐Crussard, Antoine, Forestier, Emmanuel, Gilbert, Thomas, Krolak‐Salmon, Pierre
• Format: Journal Article Web Resource
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01.05.2020; Wiley Subscription Services, Inc
• Subjects: Betacoronavirus; China; Coronavirus; Coronavirus Infections; Coronaviruses; COVID-19; COVID‐19‐Related Content; Humans; Letter to the Editor; Older people; Pandemics; Pneumonia, Viral; SARS-CoV-2; China
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1111/jgs.16407

In the United States, 108 cases were confirmed.1 Coronavirus family members are known to be responsible for severe acute respiratory syndrome (SARS‐CoV) and Middle East respiratory syndrome (MERS‐CoV), associated with severe complications, such as acute respiratory distress syndrome, multiorgan failure, and death, especially in individuals with underlying comorbidities and old age.2, 3 In a recently published large case series of 138 hospitalized patients with COVID‐19 infected pneumonia, the 36 patients (26.1%) transferred to an intensive care unit were older and had more comorbidities (median age = 66 years; comorbidities in 72.2% of cases) than patients who did not receive intensive care unit care (median age = 51 years; comorbidities in 37.3% of cases).4 Comorbidities associated with severe clinical features were hypertension, diabetes, cardiovascular disease, and cerebrovascular disease, which we know are highly prevalent in older adults. Previously, the China National Health Commission reported that death mainly affects older adults, since the median age of the first 17 deaths up to January 22, 2020, was 75 years (range = 48‐89 years).5 Moreover, people aged 70 years or older had shorter median days (11.5 days) from the first symptom to death than younger adults (20 days), suggesting a faster disease progression in older adults.5 Since COVID‐19 seems to have a similar pathogenic potential as SARS‐CoV and MERS‐CoV,6 older adults are likely to be at increased risk of severe infections, cascade of complications, disability, and death, as observed with influenza and respiratory syncytial virus infections.7, 8 The consequences of possible epidemics in long‐term care facilities could be severe on a population of older adults who are by definition frail and immunologically naïve towards this virus, even if the risk is of course for the moment mainly theoretical. [...]it seems essential to limit the risk of spreading the virus in facilities caring for older patients at all costs. [...]in seasonal influenza, for example, a large proportion of deaths are related to decompensation of comorbidities and complications occurring after the infection.7 Particularly, reducing incidence of venous thromboembolism, catheter‐related bloodstream infection, pressure ulcers, falls, and delirium is recommended.