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Wrote an editorial on coronavirus and geriatrics a week ago that hasn't been picked up by any major news outlet; I guess this is what social media is for /1
It is tragic that the case fatality rate for older adults is 10+ % even after adjustments for bias https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30243-7/fulltext /2
But my concern is that we are being blinded by that number and forgetting we have work to do: we will need to care for the ~90% of older adults who will survive this /3
Approximately 1/3 of older adults will develop hospital-associated disability. That means after 10-20 days of bed rest and hospitalization many older patients will newly be unable to shower/bathe/toilet/feed themselves. https://www.ncbi.nlm.nih.gov/pubmed/22028354 /4
Traditionally, these go to assisted living facilities and nursing homes for help. But I estimate if 50% of Americans are affected by COVID, newly disabled older adults will fill every hospital bed and every remaining nursing home bed in the US (plus local shortages) /5
This has very real implications for hospital flow. Italy's death rates may be partly due to poorly thought out discharge planning. https://www.cbc.ca/news/covid-19/italy-covid-19-outbreak-lessons-1.5517520 /6
Post-COVID care is crucial (sensitive to the fact that hopefully you have resources to plan around it now). /7
Testing is CRITICAL. Transmission dynamics for those in recovery is CRITICAL. At what point are patients in recovery no longer contagious? Can community members help COVID patients who have recovered without PPE? This has tremendous implications in structuring care. /8
Health care is a system; post-acute care is an integral part of it (point: home care workers and LTC workers also need PPE). We need to help build this now while we still have 2-3 weeks. /9
