The Tip of the Iceberg?
COVID-19 has taken a toll on all members of the population across the globe. The SARS COV-2 virus has been identified as a respiratory virus displaying a myriad of signs and symptoms. For many, an infection may lead to only mild symptoms or go entirely unnoticed. However, a significant proportion of infected individuals experience severe and debilitating consequences.
Now over a year since the pandemic was declared, we can establish that COVID-19 is far more than just an illness with respiratory impact. I believe, based on available research and my personal experiences, that COVID-19 is a multi-system illness, with profound effects on several bodily systems. To further complicate this, disease manifestation with COVID-19 varies among differing age groups from extremes like paediatric multisystem inflammatory syndrome (PIMS) seen in the younger population to thromboembolic events and multiorgan system failure in adults. In this reflective piece, I aim to delve deeper into how this novel ailment impacts the older person both in the secondary healthcare setting and society.
To best manage any disorder or disease, I have learnt that it is key to identify how the illness manifests in particular age groups. This includes recognising deviations from typical presentations and the impact of comorbidities and existing drug treatment on disease progression. Whilst on my care of the elderly rotation at Queen’s Hospital, Romford I observed some crucial differences in presentation of patients infected with COVID-19. Several older patients had presented with delirium (namely the hypoactive subtype) and falls and did not necessarily exhibit the common symptoms of fever, cough, dyspnoea, or anosmia. Furthermore, patients complaining of arthralgia and myalgia would not necessarily have a fever beyond 38 degrees, thus indicating the need to lower the threshold for diagnosing fever. The lack of consistent data on this novel outbreak in conjunction with atypical presentations has made it a challenge to recognise and manage the disease efficiently.
Furthermore, increasing age is a known risk factor for developing severe illness with COVID-19. The reasons behind this are multifactorial. Firstly, increasing age increases the likelihood of suffering from dysfunction and disease. Secondly, as individuals become inflicted with illness, they simultaneously accumulate more and more medications, with the side effects of medications requiring further drugs to be taken to counteract those complications. This troubling cycle has led to the development of the START and STOPP criteria to tackle polypharmacy in our comorbid, ageing population.
Owing to this, I have seen healthcare professionals face challenges surrounding management of the initial COVID attack but also the aftereffects of the infection on the body. For example, at Queen’s Hospital a patient with existing heart failure and cardiovascular risk factors had encountered a severe COVID infection for which he required non-invasive ventilation. Several months later, he presented to the hospital again with difficulty breathing. Hence, I believe that life after the pandemic will involve management of such patients whose bodily systems have not fully recovered from the impact of the virus or alternatively have had their pre-existing ailments worsened.
The social impact of the pandemic has been equally significant. The social circumstances of an older person have added to their vulnerability to contracting the virus. If family are unable to provide extensive support, the older individual may require a daily package of care up to four times a day for assistance with household chores, cooking, and personal hygiene or alternatively choose to live in a residential care home. Although essential, interaction with carers and social workers in such a scenario puts our older population at increased risk of contracting the virus.
By virtue of this, we have heard of discrepancies in supplying personal protective equipment to care home staff leading to an unreasonable number of cases and subsequently deaths in this environment. Additionally, avoidance of interpersonal interaction has placed countless difficulties on more vulnerable, dependent members of our society to perform basic activities such as shopping, cooking meals and cleaning. Unfortunately, this has given rise to further problems such as increasing isolation and depression. Poor management of household cleanliness and hygiene has also led to an increased likelihood of falls from trip hazards as well as non-COVID infections. This brings to light the enormity of the effects of the pandemic on our older population where infection with COVID is seen to merely be the tip of the iceberg.
To conclude, the novel coronavirus outbreak has had significant implications on healthcare and livelihoods. Its economic, political, health, and educational impact has been profound with aftereffects expected to be felt for years to come. My own experiences have highlighted to me the variation in disease presentation between differing age groups and the dire need for research to bring consistency and efficiency to the health and welfare of all members of the population.
