A enigma is emerging from the data on hospitalizations and deaths for COVID-19 in recent weeks, specifically concerning those over 90. “The data indicate that over 80% of the deceased are over 90 years old, but at the same time they show that in therapies intensive there are almost no patients of that age,” he observes Francis Broccolivirologist at the University of Salento, commenting on the weekly monitoring of the Istituto Superiore di Sanità and the Ministry from the Health.
An anomaly in the data: high mortality but low presence in intensive care
Monitoring shows that hospitalization and mortality rates for Covid-19 are higher in the older age groups, reaching 116 deaths per million inhabitants among the over-90s. However, it is surprising that, in this same age group, the rate of hospitalization in intensive care units has been just 1 per million inhabitants since the first July last, while between the 6th May and on June 24 it was zero. Over the same period, the death rate among those over 90 increased significantly: from 1 death per million inhabitants on May 6, to 11 on July 8, up to 29 per million on August 5.
“There are almost no over-90s in intensive care, but they do not die at home, considering that there are many people in this age group hospitalized in ordinary wards,” Broccolo emphasizes. In fact, the hospitalizations of the ultra-ninety year olds in the ordinary departments they have increased significantlygoing from 13 per million inhabitants to May 6thor at 110 theJuly 8thuntil reaching a peak of 173 on July 29, then dropping to 116 on August 6.
The key to the enigma: mild course but fatal outcome
Why, then, do these patients not end up in intensive care? “The course of the disease in these patients is often mild, characterized by shapes moderate ones that do not raise critical parameters such as saturation oxygen or markers related to thromboembolism,” explains Broccolo. “Many of these patients do not therefore manifest acute events or serious clinical symptoms that justify admission to intensive care. Howeverthis does not mean that they are not at risk of an unfavorable evolution of the disease.”
The Solution: Predictive Testing to Improve Clinical Management
According to Broccolo, it is possible to predict the risk of a severe course using tests based on biomarkers specific to Covid-19, such as onPar. “These tests, although available, are not currently used in clinical practice. Yet, through this now well-validated biomarker, it would be possible to predict critical cases measuring the activation level of the answer immune system already at the time of admission,” says the virologist. “This strategy could significantly improve clinical management, further reducing mortality among the most vulnerable patients vulnerable“.
The phenomenon observed among the over 90s highlights the need for greater attention in the clinical management of elderly patients affected by COVID-19. Although they do not frequently end up in intensive care, the risk of a lethal outcome remains high. The use of tools diagnostic advanced vaccines could provide an answer to this puzzle, improving the prediction of critical cases and, consequently, reducing mortality in this extremely vulnerable age group.
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