Direct and Indirect Impact of COVID-19 In Older Populations

In December 2019, Wuhan city in China, became the center of an outbreak of pneumonia due to a
novel coronavirus SARS-CoV-2, which disease was named coronavirus disease 2019 (COVID19) in
February, 2020, by WHO. The COVID19 is much more dangerous for people over 60 with a death
rate of 3.6% after 60, 8.0% after 70 and 14.8% after 80 -and according to our Italian
colleagues over 20% after 90- against 2.3% in the general population. The elderly patients
exhibits more complications (ARDS, delirium, cardiac and renal insufficiency) needing
intensive care, and often had multiple comorbidities and in particular: cardiovascular
disease (10.5% mortality), diabetes (7.3%), chronic respiratory disease (6.3%) and
hypertension (6%).

Very few data are available the specific burden of Infectious diseases (ID) in older
populations. The large majority of literature is often related to intrahospital or direct
mortality and only recently arise the idea of indirect impact of ID particularly in that
populations. In that meaning, ID may be considered as a trigger of other medical events such
as myocardial infarction, stroke, or other specific outcomes such as functional decline; For
the last 10 years, the Specific interest group " GInGer "( Groupe Infectio-Geriatrique ) a
network of infectiologist and geriatrician SPILF/SFGG) carried out several studies on
different aspects of ID in theses populations and recently demonstrated the indirect and long
term impact of influenza and Clostridioides difficile infections. As an example, In influenza
study, death-rate increases from 12,2 % in hospital related death to 25% at 3 months with
high rate of complications (57%), high rates of rehospitalisation (25%) and functional
decline (35%) leading to high increase in nursing home admission. The cost of these indirect
impact is high and underestimated.

Because of incidence and comorbidities rates, severity of the actual French older COVID
19-infected older populations and because of the potential indirect and long term impact of
COVID19 in these populations, it seems essential to know whether 3 month related death is
largely higher as for influenza, to determine risk factors for intra hospital and long term
death, measure acute and long term complications, and describe the impact of COVID 19 on
specific ageing outcomes such as functional status at Month 3 (M3).