Clinical Observations in Very Elderly Patients with COVID-19 in Wuhan

Background: In December 2019, the outbreak of coronavirus disease 2019 (COVID-19) started in Wuhan, and is now causing a worldwide pandemic. However, the experience in very elderly patients is very limited, which has important implications for the investigation of hospital infection in medical and health institutions.

Methods: Seven patients with confirmed COVID-19 infection in the Department of Geriatrics at Zhongnan Hospital of Wuhan University were included. Clinical data were retrospectively collected and analyzed. Laboratory tests and chest computed tomography (CT) images from the patients before and after the COVID-19 infection were compared.

Results: The median age of patients was 91 years old (87-96). Six patients had pneumonia in the last 6 months. Dyspnea occurred in one patient 64 h after the onset of the disease. In the other six patients, minor fatigue with low fever were the only other manifestations of the disease. Lymphopenia and a significant reduction in plasma globulin level was observed compared with levels before the onset of the disease. None had typical chest CT phenotypes during the early stage, except the critically ill patient mentioned who had developed "white lung" and then died. One patient even showed absorption of inflammation compared with previous hypostatic pneumonia.

Conclusions: The ratio of fatal cases in very elderly patients with COVID-19 is no higher than that reported in non-elderly patients was, and probably due to a low immune response. However, the elderly patients manifested minor clinical symptoms and atypical changes in chest CT images, which usually lead to misdiagnosis or delayed diagnosis. Geriatr Gerontol Int 2020; 20: 709-714.