One day in March 2020, Rosemary Bily got so tired she could barely get out of bed.
“He slept a lot,” said his son-in-law Rich Lamanno.
“She was exhausted for almost a whole month.”
Lamanno and his in-laws, Rosemary and Eugene Bily, contracted COVID-19 in March 2020 after attending a family party. Photo Gregg Vigliotti / The New York Times.
Bily, now 86, also featured nausea and diarrhea, along with a mild cough, and largely got on with Tylenol and Gatorade.
Days later, her husband, Eugene Bily, 90, started coughing and also became lethargic.
If it had not been for a family reunion days before, the Bily children would not have suspected the new coronavirus.
They could have blamed the flu, or just advancing age.
“What we heard on TV was ‘high fever and shortness of breath’, but they didn’t have none of those symptoms“Recalls Lamanno.
However, a dozen guests had gathered at a restaurant in Rockville Center, Long Island, earlier that month to celebrate a niece’s birthday, and one by one most of them fell ill of COVID, including Lamanno and his wife.
When symptoms spread, doctors told the concerned family that the Bils most likely had COVID-19.
As tests were rare at the time, neither of them underwent them; the family also feared taking them to local hospitals, which were overflowing.
However, subsequent antibody tests confirmed that Eugene and Rosemary Bily, who live in Oceanside, New York, had contracted and survived the virus.
Rich Lamanno in front of his in-laws’ house in Oceanside, New York. Photo Gregg Vigliotti / The New York Times.
The population over 65, most vulnerable to the effects of the virus, was vaccinated early against COVID-19 and has the highest rate in the country:
more than 80 percent are fully vaccinated.
However, with the new increase in infections, as well as the increase in hospitalizations among older adults, a new large-scale study published in Journals of Gerontology provides a timely warning:
COVID may look different in older patients.
“People expect fever, cough and shortness of breath,” says Allison Marziliano, lead author of the study.
She is a health and social psychologist at the Feinstein Institutes for Medical Research, which is part of the larger Northwell Health system in New York State.
But when researchers tracked the electronic health records of nearly 5,000 people, all over the age of 65, who were hospitalized for COVID at a dozen Northwell hospitals in March and April 2020, they found that a third had arrived with other unexpected symptoms.
Searching through the records using language software, the team found that about a quarter of older patients reported a functional impairment.
“It was about falls, fatigue, weakness, difficulty walking or getting out of bed,” explained Marziliano.
Eleven percent experienced altered mental status: “confusion, agitation, forgetfulness, lethargy ”added. About half of the group with atypical symptoms also suffered from at least one of the classic COVID-19 problems:
fever, trouble breathing, cough.
“Doctors should know, older adults should know, their caregivers should know:
If certain atypical symptoms are observed, it could be COVID, ”warned Marziliano.
The rate of atypical symptoms it increased significantly with age, affecting about 31 percent of people 65 to 74 years old, but more than 44 percent of those older than 85 years.
Those symptoms were more common in women, in black patients (but not in Hispanics) and in those with other chronic diseases, particularly diabetes or dementia.
Since people in the atypical group were less likely to experience respiratory problems and require ventilation, they were less likely to need intensive care.
But both groups spent almost 10 days in the hospital, and about a third of each group died.
“These people were in the hospital the same time,” said Marziliano.
“His death rate was just as high. So this should not be ruled out. “
The research mirrors the findings of other smaller studies of older people conducted at the beginning of the pandemic in the United States and Europe.
During a COVID outbreak at a Providence, Rhode Island nursing home, for example, a Brown University study found that the most common symptom was loss of appetite, followed by lethargy, diarrhea, and fatigue.
“We’re not necessarily surprised by this,” said Maria Carney, a geriatrician and author of the Northwell study.
“Older adults don’t always present themselves like other adults. They may not have a fever. Their metabolisms are different”.
Younger diabetics, for example, can sweat and experience palpitations if their blood sugar drops, Carney explained.
An older person with a drop in blood sugar may pass out without warning.
Older people with depression may have a loss of appetite or insomnia, but not necessarily feel sad.
In May 2020, Carney received news of a daughter who was concerned about her mother, who was in her 80s and suddenly weakened.
“She didn’t have a fever or a cough, but she wasn’t herself,” Carney recalled.
Doctors at a local emergency room diagnosed her with a urinary tract infection and prescribed antibiotics, the daughter reported.
However, five days later, her mother’s condition it got worse.
“You need a COVID test,” Carney advised.
Quickly diagnose COVID-19 in older patients can make a big difference.
“We now have things to offer that we didn’t have in the first wave,” said Eleftherios Mylonakis, chief of infectious diseases at Brown University’s Warren Alpert School of Medicine, who led the Providence nursing home study.
“We have a better understanding, more treatments and better support ”.
Among the improvements: the use of anticoagulant drugs to prevent clotting and the use of monoclonal antibodies (the treatment that former President Donald Trump received at Walter Reed Hospital in Bethesda, Maryland) that boost the immune system.
However, Mylonakis added, “It is essential to start any type of treatment early.”
With the widespread use of vaccination, the symptoms of COVID-19 in older adults can be even more subtle.
Fever is easy to measure, and shortness of breath will send anyone to an emergency department, Carney noted, while “we don’t necessarily notice if someone has stopped eating.”
His advice, to older patients and their caregivers and doctors, is to watch for changes that occur in a rush, in a matter of days.
“When there is a change in behavior, physical or cognitiveIt may not seem like an infection, but you have to keep COVID at the top of the list, ”he recommended.
The woman with the worried daughter had indeed contracted the virus; died in a hospital.
But the Bils recovered and continue to live in their two-story Oceanside home.
Eugene Bily had many health problems even before the pandemic.
In the past eighteen months, he underwent two hip operations and several other hospitalizations.
In June, he began receiving hospice care at home.
However, Rosemary Bily made a full recovery from the virus.
At 86 years old, she drives to the supermarket and the pharmacy, visits her hairdresser every week, keeps in touch with her family via iPad and cell phone, and helps take care of her granddaughters.
“He’s doing well,” Lamanno said.
“He has resumed his normal life.”
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