This work shed light on the outcomes of elderly patients with COVID-19, with comparison to young individuals in southern China, and analyzed the role of medical resources in the disease prevention and control for the first time. Although the elderly spent more time in hospitalization, the cure rate and the mortality of the elderly seemed to be no worse than that of the young.
A possible reason for these favorable outcomes is early diagnosis, isolation and treatment for all patients , and these strategies need to be supported by sufficient medical resources. In this study, Centers for Disease Control recorded the activity track of all patients, screened and followed up the persons who contacted with them. For every suspected COVID-19 case, testing was performed without any hesitation. The median time from diagnosis to hospitalization is about -1 day, which means that each confirmed patient was isolated and treated in hospital immediately, and high suspected subjects were admitted to hospital before diagnosis. Of note, some patients were asymptomatic and merely with abnormal imaging signs. Such clinical silence could partially undermine the containment of COVID-19, due to missed diagnosis, misdiagnosis and treatment delay. Consequently, it's not a good way to screen patients only through symptoms.
Previous studies show that the mortality in elderly patients varies from 0 to 34.5% in different regions, and is higher in severe epidemic areas [8-11]. In mild epidemic areas, the mortality of the elderly is lower and seems to be no worse than that of the young [9, 10]. These results are consistent with our study in Guangzhou, a mild epidemic area. Regional differences seem to be a risk factor that leads to the increase of mortality. A potential explanation may be the medical resources. Prevention is still the most important strategy , in which the medical resources play a key role. Sufficient medical resources ensure the health of medical staffs and avoid nosocomial infection, and then provide adequate medical services. In our study, no medical staffs were infected, which was helpful for the prevention and control of the epidemic.
Elderly patients were with more comorbidities, severe cases, and more complications, leading to more complex treatment and longer hospitalization. In this study, more elderly patients were admitted to ICU, and received high proportions of nutritional support treatment, mechanical ventilation, CRRT and ECMO. Currently, there is no standard treatment recommended for COVID-19 infections, and as an expedient approach, the treatment strategies follow the guidelines for management of CAP . As such, handling the comorbidities and complications has become a critical part of care. Compared with young patients, elderly patients were more likely to have complications including ARDS, septic shock, acute renal failure, and acute myocardial injury. The overall frailty, multiple comorbidities, undernutrition and declining organ function might have collectively contributed to the higher rate of complications in these elderly patients. Given potentially higher prevalence of comorbidities, undernutrition, organ dysfunction and complications in this age group, elderly patients may be in more need of nutritional support, intensive care, dialysis, and ventilation than average adults. The comprehensive treatment may play a role in the favorable hospitalization outcomes of elderly patients with OVID-19. However, further study is needed to confirm an optimal treatment strategy for patients with COVID-19.
The most commonly used drugs are antibiotics, and the rational use of antibiotics may be helpful for the prognosis. For severe patients, clinical guidelines recommend experiential antibiotics [19, 20]. For others, it remains controversial to decide when to start using antibiotics. Respiratory viruses play crucial roles in triggering bacterial attack, and older individuals are more susceptible to bacterial attack due to low immunity and high risk of aspiration [6, 21]. Therefore, early identification and management of bacterial infections is the key to improving prognosis. According to guidelines for treatment of community-acquired pneumonia guidelines, patients with influenza-positive CAP should be treated with antibiotics as soon as possible ; however, for pneumonia caused by COVID-19, how to identify bacterial infections and when to start antibiotics are yet to be clarified. Given the serious morbidity and mortality of COVID-19, patients with suspected bacterial infection should be prescribed antibiotics after weighing the advantages and disadvantages. Further search is needed to assess the effect of antibiotics in the treatment of COVID-19.
This study showed limitations in several aspects. First, due to retrospective nature of the study, certain clinical data such as body mass index (BMI), smoking history and infection history in the previous year were missing, and this would affect precise interpretation of the study results. Second, with a cross-sectional design, this study did not include a sample size sufficiently large to enable determining the risk factors of mortality in older patients. Third, as an observational study, it is unable to assess the effectiveness of these interventions in this study. Finally, this was a single-center study on COVID-19 patients from southern China. Therefore, our findings should be interpreted with caution and may not be suitable for generalization in a wider population.