They were the most fragile and the coronavirus preyed on them in the first wave. The elderly who contracted COVID-19 and ended up admitted to the hospital numbered in the thousands during the peak of the pandemic in March and April. Sadly, many of them passed away. Now, after a few months with a much lower number of cases among the most susceptible population, a new perception is permeating in the ER: more and more elderly patients that arrive infected at their services.

The path of Covid leads once again to nursing homes: “It always comes from the outside in”

After the harshness of the first months, the strict confinement applied during the state of alarm took effect: many hospitals barely treated cases of coronavirus in June. Later, the de-escalation, mobility, social life and summer brought with them a new profile of the COVID patient. The positives among the elderly fell in the summer season and were young people, with no or very mild symptoms, those most affected by the disease.

“During the first phase of this second wave, the people who arrived were under 60 years old. As time went by age has been rising and we have re-entered older people. In the ICU right now there will be no one under 60, “explains Pascual Piñera, head of the Emergency Service at the Reina Sofía University General Hospital in Murcia, who details that two or three weeks ago they began to detect this situation.

“Over the weeks the age has risen and we have re-admitted older people. Right now there will be no one under 60 in the ICU”

It is the same impression that César Carballo, assistant to the Emergency Service of the Ramón y Cajal Hospital in Madrid, has. “We are beginning to see older patients. 15 or 20 days ago practically only young people were admitted, with little comorbidity and who were easier to discharge. For a week the profile seems to have changed, and they are 60, 70, 80 years old, “he says, and stresses that it will be necessary to check whether the trend is indeed consolidating.

“It is true that, probably, in the summer months we had fewer elderly people. Since the beginning of September, we not only see asymptomatic and young patients, but people with symptoms, with severe pneumonia, who take young people as well as people aged 40 and 50 and over 65 to the ICU, “says Dr. Virginia Fraile, an intensivist at the ICU at the Río Hortega Hospital in Valladolid.

Risk of saturating the healthcare system

The director of the Center for the Coordination of Health Alerts and Emergencies (CCAES), Fernando Simón.
Simon warns of the rise in cases among those over 60: “The risk of overloading the hospital system increases”

Earlier this week, the director of the Center for the Coordination of Health Alerts and Emergencies (CCAES), Fernando Simón, already warned of the increase in COVID-19 cases among people over 60 years old. A month and a half ago, positives in this age group represented 15% of total patients, while now have increased to 20%. And he was very clear about the dangers of this trend: “Obviously it increases the risk of hospitalization and, therefore, of overload the system even more of which we are seeing to date. “A perspective in which the two emergency physicians agree.

“Fundamentally what is admitted is what has increased age, what is worse,” says Piñera, who is also the second vice president of the Spanish Society of Emergency Medicine and Emergencies (SEMES). Along these lines, Carballo deepens: “The elderly patient has a greater chance of being admitted and that it goes wrong, that is, having complications, going to the ICU and dyingAnd it is then, as the number of this type of patients increases, when the threat of overloading the health system appears by lengthening stays and delaying discharges.

The problem, the doctor of the Reina Sofía de Murcia affects, is going to be generated above all in the Intensive Care Units, where admissions are longer – between two and four weeks, on average – and this can lead to space problems. “ICUs are finite, and ours is currently full of COVID,” he says. And Carballo pronounces himself in the same sense: “Older patients have more comorbidity, more associated pathologies, with which discharge is delayed and there is no time for the hospital to empty. If we are seeing more positives in people over 60, the The risk we run is that the system is saturated. “

“Older patients are more likely to be admitted and to go wrong, that is, to have complications, to go to the ICU and to die”

However, Piñera is optimistic and considers that “by now It is difficult for the emergencies to be saturated as in the previous peak. “In addition, Fraile, who is a member of the board of directors of the Spanish Society of Intensive, Critical Medicine and Coronary Units (Semicyuc) abounds, many patients now” arrive at the hospital earlier and will be able to recover faster “, thus reducing the stay.

Contagion in the family environment

As for the area in which these infections in the elderly have taken place, both emergency physicians agree and point to the family circle. The Ramón y Cajal doctor is even more precise and points out to the little ones: “When the course began, we knew that the children, who are most asymptomatic, were going to go home and were going to stay with their grandparents. caution a bit. This was an expected effect of the opening of schools“, he says.

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The vice president of SEMES is not so forceful, who does not see the origin in the schools, because in his hospital they began to detect this trend of increasing age before the start of the course: “We suspect that the elderly took themselves seriously from the beginning This situation and the infections now more than in the field of work occur in the family, but I don’t think they come from school because it started earlier “, he emphasizes.

Fraile agrees with the latter: “Most infections are occurring in the family, social gatherings …”. And before this circumstance and the arrival of winter, take the opportunity to emphasize the importance of vaccination against influenza and pneumococci among the elderly, with the aim of reducing admissions for non-COVID respiratory diseases and the overload of hospitals.