How does SARS-CoV-2 targets the elderly patients? A review on potential mechanisms increasing disease severity
- PMID: 33303345
- PMCID: PMC7703548
- DOI: 10.1016/j.ejim.2020.11.024
How does SARS-CoV-2 targets the elderly patients? A review on potential mechanisms increasing disease severity
Abstract
Importance: Among COVID-19 cases, especially the (frail) elderly show a high number of severe infections, hospital admissions, complications, and death. The highest mortality is found between 80 and 89 years old. Why do these patients have a higher risk of severe COVID-19? In this narrative review we address potential mechanisms regarding viral transmission, physical reserve and the immune system, increasing the severity of this infection in elderly patients.
Observations: First, the spread of COVID-19 may be enhanced in elderly patients. Viral shedding may be increased, and early identification may be complicated due to atypical disease presentation and limited testing capacity. Applying hygiene and quarantine measures, especially in patients with cognitive disorders including dementia, can be challenging. Additionally, elderly patients have a decreased cardiorespiratory reserve and are more likely to have co-morbidity including atherosclerosis, rendering them more susceptible to complications. The aging innate and adaptive immune system is weakened, while there is a pro-inflammatory tendency. The effects of SARS-CoV-2 on the immune system on cytokine production and T-cells, further seem to aggravate this pro-inflammatory tendency, especially in patients with cardiovascular comorbidity, increasing disease severity.
Conclusions and relevance: The combination of all factors mentioned above contribute to the disease severity of COVID-19 in the older patient. While larger studies of COVID-19 in elderly patients are needed, understanding the factors increasing disease severity may improve care and preventative measures to protect the elderly patient at risk for (severe) COVID-19 in the future.
Keywords: COVID19; elderly patients; geriatric care; immunology.
Copyright © 2020. Published by Elsevier B.V.
Conflict of interest statement
The authors declare they have no conflict of interest.
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Comment in
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Loneliness that destroys and upsets: A lesson from and beyond COVID-19.Eur J Intern Med. 2021 Jun;88:125. doi: 10.1016/j.ejim.2021.03.003. Epub 2021 Mar 14. Eur J Intern Med. 2021. PMID: 33775507 Free PMC article. No abstract available.
References
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- Dutch National Institute for Public Health and the Environment. https://www.rivm.nl/coronavirus-covid-19/grafieken, Accessed June 27th 2020.
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