COVID-19 in older adults: clinical, psychosocial, and public health considerations
John Mills, Keith S. Kaye, Lona Mody
Abstract
In December 2019, a new severe respiratory illness emerged in Wuhan, China and was linked to a novel beta-coronavirus that likely originated from zoonotic transmission (1). As of April 16, 2020, the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has caused over 2 million confirmed infections and 138,000 deaths worldwide (2). The rapid spread of SARS-CoV-2 has resulted in unprecedented stress on health care systems across the globe. Complications of coronavirus disease 2019 (COVID-19, the name of the infection caused by SARS-CoV-2) have been particularly severe among older adults, who are the focus of this Viewpoint. Existing literature suggests that age is an important predictor of poor outcomes among patients with COVID-19. Multiple case series have found escalating rates of severe disease and mortality with increases in age. Data from 44,672 confirmed COVID-19 cases in China revealed an overall case-fatality rate (CFR) of 2.3%, which rose to 8.0% among patients 70-79 years old and to 14.8% for those 80 years and older (3). Similar trends have been identified in early data from the United States. The Morbidity and Mortality Weekly Report (MMWR) revealed 2,449 COVID-19 cases between February 12, 2020 and March 16, 2020 and an intensive care unit (ICU) admission rate of 8.1%-18.8% and CFR of 2.7%-4.9% for adults 65-74 years of age (4). The ICU admission rate rose to 10.5%-31.0%, with a 4.3%-10.5% CFR, for those 75-84 years of age, and for patients 85 years and older, an ICU admission rate of 6.3%-29.0%, with a 10.4%-27.3% CFR, was reported.