For the elderly in particular, Covid can be in disguise


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“We’re not necessarily surprised by this,” said Dr. Maria Carney, a geriatrician and author of the Northwell study. “Older adults are not always around like other adults. They may not have a fever. Their metabolisms are different.”

Dr. Carney explained that young diabetics, for example, may sweat and have heart palpitations if their blood sugar drops. An elderly person with low blood sugar can faint without warning. Older adults who are depressed may experience a loss of appetite or insomnia but not necessarily feel sad.

In May of 2020, Dr. Carney heard from a daughter worried about her mother, who was in her 80s and suddenly became weaker. “She didn’t have a fever or a cough, but it wasn’t the same,” Dr. Carney recalls. The daughter reported that doctors at the local emergency room diagnosed a urinary tract infection and prescribed antibiotics. But after five days, her mother’s condition worsened. “She needs a Covid test,” Dr Carney advised.

Diagnosing COVID-19 quickly in older patients can make a big difference. “We have things to show now that we didn’t have in the first wave,” said Dr. Eleftherios Milionakis, chair of the division of infectious diseases at the Warren Albert School of Medicine at Brown University, who led the Providence nursing home study. “We have a better understanding, more treatments, and better support.”

Among the improvements: the use of anticoagulant drugs to prevent clotting and the use of monoclonal antibodies (treatment that former President Trump received at Walter Reed Hospital) that strengthen the immune system. But, Dr. Milionakis added, “It is critical that you start any kind of treatment early.”

Understanding that something as mysterious as weakness, confusion or loss of appetite may indicate a Covid infection can also help protect friends and family, who can then self-isolate and get tested. Not only does it help the individual, but it can also contain the spread of the virus,” said Dr. Milionakis.

A diagnosis of Covid can also avoid unnecessary tests and procedures. “We can avoid unnecessary tests, puncture and induction, and CT scans,” said Dr. Carney. CT scans are expensive, cumbersome, and take time to schedule and analyze; Nasal swab for Covid is quick, relatively cheap, and now widely available.


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