Covid can also have long-term effects on less vulnerable elderly patients who, after infection, do not need hospitalization for symptoms of the disease. This is the message that comes from an epidemiological study, published in the “Journal of the American Medical Directors Association”, edited by the University of Florence, Careggi University Hospital, Azienda Usl Toscana Centro (Atc) and Istituto Superiore di Sanità.
The researchers, directed by Mauro Di Bari – professor of internal medicine at the Florentine University and director of the Specialization School of Geriatrics – compared, in the period March-November 2020, before the advent of the vaccine, the data on mortality at one year of people over 75 with Covid or other pathologies distinguishing between those who have been hospitalized (in Careggi or in other ATC hospitals) and those who have only accessed the emergency room without then being hospitalized.
The data confirm that Covid-19 increases the risk of death in both hospitalized and non-hospitalized elderly; in both cases, mortality increases with the degree of vulnerability, which is assessed thanks to the Dynamic Silver Code (Cad), a four-level classification developed by the same group of researchers.
In particular, according to the findings of the research, in non-hospitalized patients the excess mortality due to Covid-19 is greater, in relative terms, in the less vulnerable subjects than in the more vulnerable subjects. In fact, in the elderly included in class 1 Cad (less vulnerable) the mortality was 14.2% in the presence of Covid and 2.9% in the absence of the disease, almost 5 times higher. On the contrary, in the elderly belonging to the highest risk group (Cad vulnerability class 4) mortality was 46.7% in the presence of Covid and 26% in its absence, therefore with a ratio of 2: 1.
Furthermore, while in hospitalized subjects the mortality rate is higher in the first month of treatment of the disease and stabilizes in the following months, in non-hospitalized subjects the risk remains relevant for a longer period.
“Since the beginning of the pandemic, the mortality associated with Covid-19 has been much higher in patients defined as fragile or, more appropriately, vulnerable, but the studies conducted so far – explains Di Bari, underlining the novelty of the research – had taken considering only hospitalized subjects, they were limited to hospital mortality and did not allow comparison with patients without Covid-19 “.
“The study – comments Di Bari – suggests the opportunity for greater and more protracted vigilance towards less vulnerable elderly subjects affected by Covid-19, even though their initial conditions and mild symptoms do not require hospitalization: the risk of complications, including serious and late ones, should not be overlooked. In light of this analysis, conducted as mentioned in the period preceding the appearance of the vaccine – concludes Di Bari -, we can affirm that it was absolutely appropriate to extend vaccination to all categories of elderly regardless of the degree of vulnerability, because the vaccine is the main tool for preventing the serious effects of Covid-19 “