Comparison of COVID-19 disease between young and elderly patients: Hidden viral shedding of COVID-19
Mori H, Obinata H, Murakami W, Tatsuya K, Sasaki H, Miyake Y, Taniguchi Y, Ota S, Yamaga M, Suyama Y, Tamura K. Comparison of COVID-19 disease between young and elderly patients: Hidden viral shedding of COVID-19. J Infect Chemother. doi: 10.1016/j.jiac.2020.09.003. Epub 2020 Sep 6. PMID: 32950393; PMCID: PMC7474868.
I chose to do my article discussion based on my third H&P, which was about my patient who came in with shortness of breath and weakness, and was found to have a right upper lobe pneumonia. Even though COVID was ruled out in our patient, it still brough to light the current pandemic we are in, and how that should always be in our differentials for patients coming in with viral symptoms. I was also very interested to see how the symptomatic presentation and the spread/viral shedding differs between young and elderly patients.
COVID-19 is a wide spread viral disease that affected over 4 million people world wide by May 2020, a number which has since been rising due to the various variants. It can lead to severe acute respiratory distress syndrome and the symptoms can vary from person to person, especially in the different age groups. Minor symptoms include headache, fever, fatigue, cough and seemed to improve without any treatment. Where as, severe symptoms include dyspnea, hypoxia and need for ICU admission and intubation. There are also asymptomatic carriers, who have radiological abnormalities but no symptoms, and can lead to increased transmission. This study looked at how the duration and clinical manifestation of this disease differed in elderly and young patients.
This is a retrospective study done on 187 patients who were diagnosed with COVID via a PCR test and admitted to the hospital from Feb 11th to April 30th. This group was divided into the elderly group of 87 patients (over age of 60) and the young group of 100 patients (below 60). The median age of the elderly group was 72 and the young group was 41. Common comorbidities in the elderly group included HTN, Diabetes and CVD. The PCR was done on patients who either had symptoms themselves, or knew of close contacts that had the disease. The PCR test was performed every 2 days, and the discharge criteria included 2 consecutive negative tests. Each patient had lab results and chest CT that was evaluated within 48 hours after admission, and clinical data was collected retrospectively by 2 doctors who were bling to the information and study. Data that was extracted included clinical info, symptoms and lab findings. Statistical analysis was performed to assess the correlation between the age and number of admission days/ disease duration.
They found that the number of asymptomatic cases was higher in the elderly group (35.6%) vs the younger group (10%), along with the number of severe cases (28.7% vs 8%) The most common symptom in the younger group was fever. CT findings showed no significant difference in the younger group vs the older group. The also found that the days of admission of the symptomatic patients in the elderly were longer then the younger group, and the disease duration and days of admission of asymptomatic elder patients was longer then the younger ones.
This study found that elderly patients were likely to have severe symptoms, but were more often shown to be asymptomatic and afebrile. They also found that there was no difference in the CT results of abnormal or asymptomatic cases between the two groups. Finally, they found that duration of the disease had a direct positive correlation with the age of the patient. The elder group was also found to have severe cases while being asymptomatic, which was referred as “ silent pneumonia.” Also, since there was no difference in the LDH and CRP levels of the group it shows that despite the varying clinical manifestations, the lung damage was similar. They also found that elderly patients are more likely to e asymptomatic carriers with a higher viral load and shedding potential.
