For Seniors Especially, Covid Can Be Stealthy

“We’re not necessarily surprised by this,” said Dr. Maria Carney, a geriatrician and an author of the Northwell study. “Older adults don’t always present like other adults. They may not mount a fever. Their metabolisms are different.”

Younger diabetics, for instance, may become sweaty and experience palpitations if their blood sugar falls, Dr. Carney explained. An older person with low blood sugar could faint without warning. Older people who suffer from depression may have appetite loss or insomnia but not necessarily feel sad.

In May of 2020, Dr. Carney heard from a daughter worried about her mother, who was in her 80s and had suddenly grown weaker. “She didn’t have fever or a cough, but she was just not herself,” Dr. Carney recalled. Doctors at a local emergency room had diagnosed a urinary tract infection and prescribed antibiotics, the daughter reported. But five days later, her mother’s condition was worsening. “She needs a Covid test,” Dr. Carney advised.

Diagnosing Covid quickly in older patients can make a world of difference. “We have things to offer now that we didn’t have in the first wave,” said Dr. Eleftherios Mylonakis, chief of infectious diseases at Warren Alpert Medical School of Brown University, who led the Providence nursing home study. “We have better understanding, more treatments, better support.”

Among the improvements: using anticoagulant drugs to prevent clotting and using monoclonal antibodies (the treatment that former President Trump received at Walter Reed Hospital) that strengthen the immune system. But, Dr. Mylonakis added, “It’s paramount to start any kind of treatment early.”

Understanding that something as vague as weakness, confusion or appetite loss might signal a Covid infection can also help protect friends and family, who can then isolate and get tested themselves. “It not only helps the individual, but also can contain the spread of the virus,” Dr. Mylonakis said.

A Covid diagnosis can also ward off needless tests and procedures. “We can avoid unnecessary testing, poking and prodding, CT scans,” Dr. Carney said. CT scans are expensive, burdensome and take time to schedule and analyze; a nasal swab for Covid is quick, relatively cheap and now widely available.