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Coronavirus in the elderly: a late lockdown UK cohort

Andrew D Kerr and Sybil RL Stacpoole
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DOI: https://doi.org/10.7861/clinmed.2020-0423
Clin Med November 2020
Andrew D Kerr
ANorth West Anglia NHS Foundation Trust
Roles: IMT1
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Sybil RL Stacpoole
BNorth West Anglia NHS Foundation Trust
Roles: consultant neurologist
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  • For correspondence: sybilstacpoole@nhs.net
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    Fig 1.

    Reason for presentation to hopsital, according to emergency department triage records. Abdo = abdominal; DVT = deep vein thrombosis; lac = laceration; #NoF = fractured neck of femur; SOB = shortness of breath.

  • Fig 2.
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    Fig 2.

    Example temperature traces, showing three patients with either high temperature spikes, high and low temperature spikes or only low temperature spikes.

  • Fig 3.
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    Fig 3.

    Key laboratory parameters across the age range.

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  • What is already known?
    Much speculation has centred on the topic of where COVID-19 cases come from late into lockdown, but little is published to inform this debate. Similarly, while several large patient cohorts have been reported by various countries around the world, little attention has been paid to whether the presentation of COVID-19 may vary in the elderly, who represent the group most likely to be seriously affected.
    What is the question?
    We therefore sought to assess the epidemiological question of where cases continue to come from in weeks 5 and 6 of lockdown, and the diagnostic question of whether presentations of COVID-19 differ in the elderly.
    What was found, and implication for practice now?
    The majority of cases of COVID-19 late in lockdown are epidemiologically linked to contact with health and care services, including carers visiting people at home, which is an important public health consideration for ongoing pandemic planning. COVID-19 can present differently in the elderly, overlapping with many common medical presentations, so focusing testing on those with a cough or fever will miss at least 1 in 3 cases in those over the age of 70.
    • View popup
    Table 1.

    Cohort demographics and epidemiology of infection with coronavirus-19 in weeks 5 and 6 of lockdown in the UK

    CharacteristicWhole cohort (N=115)Under 70(n=40)Aged ≥70 (n=75)
    Baseline demographics
    Median age in years, interquartile range77.5, 51–8657.5, 47–6184, 78–89
    Male66 (57.4)30 (75)36 (48)*
    Epidemiological factors
    Previous hospitalisation within 28 days22 (19.1)4 (10.0)18 (24)
    Admitted from a care home46 (40.0)8 (20.0)38 (50.7)*
    Carers at own home18 (15.7)2 (5)16 (21.3)*
    Works/household works in healthcare6 (5.2)5 (12.5)1 (1.3)*
    One of following applies: recent admission/care home/carers/health work81 (70.4)17 (42.5)64 (85.3)*
    Documented household transmission3 (2.6)3 (5)1 (1.3)
    Working (non-healthcare)4 (3.5)4 (10)0 (0)*
    Community (unidentified source)14 (12.2)16 (35)10 (13.3)*
    Comorbidities
    Hypertension50 (43.5)16 (40)34 (45.3)
    Type 2 diabetes mellitus38 (33.0)14 (35)24 (32)
    Ischaemic heart disease29 (25.2)5 (12.5)24 (32)*
    Dementia28 (24.3)2 (5)26 (34.7)*
    Chronic obstructive pulmonary disease19 (16.5)4 (10)15 (20)
    Chronic kidney disease18 (15.7)3 (7.5)15 (20)
    Stroke or TIA14 (12.2)2 (5)12 (16)
    Cancer11 (9.6)2 (5)9 (12)
    Asthma7 (6.1)3 (7.5)4 (5.3)
    No comorbidities8 (7.0)7 (17.5)1 (1.3)*
    • Values are numbers (percentages) unless stated otherwise.

    • ↵*p <0.05, comparing the <70 and ≥70 groups.

    • View popup
    Table 2.

    Presenting symptoms and signs, along with temperature during hospital admission, in patients diagnosed with COVID-19 in weeks 5 and 6 of lockdown in the UK

    Presenting symptomsWhole cohort (N=115)Under 70(n=40)Aged ≥70 (n=75)
    Fever (or reported chills) or cough82 (71.3)33 (82.5)49 (65.3)
    Cough59 (51.3)27 (67.5)32 (42.7)*
    Fever or reported chills66 (57.4)26 (65)40 (53.3)
    Shortness of breath61 (53.0)24 (60)37 (49.3)
    One of cough, fever or shortness of breath92 (80)36 (90)56 (74.7)
    All of cough, fever and shortness of breath32 (27.8)16 (40)16 (21.3)*
    Chest pain21 (18.3)10 (25)11 (14.7)
    General malaise/off food32 (27.8)11 (27.5)21 (28)
    Nausea/vomiting16 (13.9)6 (15)10 (13.3)
    Diarrhoea19 (16.5)7 (17.5)12 (16)
    Abdominal pain14 (12.2)5 (12.5)9 (12)
    One of diarrhoea/nausea/abdominal pain35 (30.4)17 (42.5)18 (24)*
    Confusion20 (17.4)3 (7.5)17 (22.7)*
    Drowsiness14 (12.2)2 (5)12 (16)*
    Fall22 (19.1)6 (15)16 (21.3)
    Presenting signs
    High fever ≥38.0°C36 (31.3)15 (37.5)21 (28)
    Low grade fever 37.5–37.9°C11 (9.6)6 (15)5 (6.7)
    Normal temperature 36.0–37.4°C52 (45.2)16 (40)36 (48)
    Low temperature ≥35.5°C12 (10.4)1 (2.5)11 (14.7)*
    Average oxygen saturations92%89%93%
    During hospital stay
    ≥38.0°C (high-grade fever)61 (53.0)26 (65)35 (46.7)
    ≥37.5°C (fever)79 (68.7)31 (77.5)48 (64)
    36.0–37.4°C (normal)25 (21.7)3 (7.5)22 (29.3)*
    ≥35.5°C (low temperature)54 (47.0)7 (17.5)47 (62.7)*
    ≥35.5°C and never ≥38.0°C24 (20.9)4 (10)20 (26.7)*
    • Values are numbers (percentages) unless stated otherwise.

    • ↵*p<0.05, comparing the <70 and ≥70 groups.

    • View popup
    Table 3.

    Laboratory investigations at diagnosis and during admission

    Laboratory investigationUnder 70 survivorsUnder 70 diedOver 70 survivorsOver 70 died
    Lymphocyte count on presentation ×109/L
    (NR 1.4–4.8)
    1.0
    (0.73–1.3)
    1.0
    (0.58–1.93)
    0.95
    (0.7–1.3)
    1.0
    (0.78–1.33)
    Lowest lymphocyte count ×109/L0.9
    (0.6–1.3)
    0.7
    (0.5–0.9)
    0.8
    (0.6–1.0)
    0.9
    (0.63–1.13)
    Platelet count on presentation ×109/L
    (NR 150–400)
    244.5
    (180.75–273)
    225.5
    (181–231.25)
    225.0
    (180.5–288.5)
    289*
    (242.5–395.75)
    Lowest platelet count ×109/L235.5
    (173–256.5)
    191
    (145.5 – 226.5)
    197.0
    (147.5–256)
    236.5
    (187–273)
    White cell count on presentation ×109/L
    (NR 4.0–11.0)
    6.25
    (5.28–8.93)
    8.9
    (7.0–12.1)
    8.7
    (6.7–12.35)
    13.1*
    (9.1–15.65)
    Highest white cell count ×109/L7.05
    (5.6–12.3)
    13.15*
    (11.18–17.53)
    9.85
    (7.0–14.38)
    14.05*
    (13.18–19.55)
    CRP on presentation mg/L (NR<5)57.0
    (30.25–133.25)
    126.5*
    (66.25–196.5)
    58.0
    (25.75–101.75)
    49.0
    (30–207)
    Highest CRP mg/L61.5
    (37.25–223.75)
    232.5*
    (115.5–314.0)
    80
    (50.0–214.0)
    96
    (54.25–217.5)
    • Values are median (interquartile range). CRP = C-reactive protein; NR = normal range.

    • ↵*p<0.05, comparing those who survived to those who died within each age-group cohort.

    • View popup
    Table 4.

    Chest X-ray (CXR) appearances along with outcomes

    CharacteristicWhole cohortUnder 70Aged ≥70
    CXR (9 did not have a CXR)
    No consolidation37 (34.9)12 (31.6)25 (36.7)
    Unilateral consolidation23 (21.7)6 (15.7)17 (25.0)
    Bilateral consolidation43 (40.5)20 (52.6)23 (33.8)
    Outcome
    Discharged87 (75.7)31 (77.5)56 (74.7)
    Died28 (24.3)9 (22.5)19 (25.3)
    Died 30–39 (n=3)0
    Died 40–49 (n=9)1 (11.1)
    Died 50–59 (n=13)3 (23.1)
    Died 60–69 (n=15)5 (33.3)
    Died 70–79 (n=22)2 (9.1)
    Died 80–89 (n=35)9 (25.7)
    Died 90–99 (n=18)8 (44.4)
    • Values are numbers (percentages). n represents the total number of patients in each age group. CXR = chest radiograph.

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Coronavirus in the elderly: a late lockdown UK cohort
Andrew D Kerr, Sybil RL Stacpoole
Clinical Medicine Nov 2020, 20 (6) e222-e228; DOI: 10.7861/clinmed.2020-0423

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Coronavirus in the elderly: a late lockdown UK cohort
Andrew D Kerr, Sybil RL Stacpoole
Clinical Medicine Nov 2020, 20 (6) e222-e228; DOI: 10.7861/clinmed.2020-0423
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