Asymptomatic COVID-19 in the elderly: dementia and viral clearance as risk factors for disease progression

Autores
Esteban, Ignacio; Bergero, Georgina; Alves, Camila; Bronstein, Micaela; Ziegler, Valeria; Wood, Cristian; Caballero, Mauricio Tomás; Wappner, Diego; Libster, Romina Paula; Perez Marc, Gonzalo; Polack, Fernando Pedro
Año de publicación
2021
Idioma
inglés
Tipo de recurso
artículo
Estado
versión publicada
Descripción
Background:SARS-CoV-2 infected individuals ≥60 years old have the highest hospitalization rates and represent >80% fatalities. Within this population, those in long-term facilities represent >50% of the total COVID-19 related deaths per country. Among those without symptoms, the rate of pre-symptomatic illness is unclear, and potential predictors of progression for symptom development are unknown.Our objective was to delineate the natural evolution of asymptomatic SARS-CoV-2 infection in elders and identify determinants of progression.Methods:We established a medical surveillance team monitoring 63 geriatric institutions. When an index COVID-19 case emerged, we tested all other eligible asymptomatic elders ≥75 or >60 years old with at least 1 comorbidity. SARS-CoV-2 infected elders were followed for 28 days. Disease was diagnosed when any COVID-19 manifestation occurred. SARS-CoV-2 load at enrollment, shedding on day 15, and antibody responses were also studied.Results:After 28 days of follow-up, 74/113(65%) SARS-CoV-2-infected elders remained asymptomatic. 21/39(54%) pre-symptomatic patients developed hypoxemia and ten pre-symptomatic patients died(median day 13.5,IQR 12).Dementia was the only clinical risk factor associated with disease(OR 2.41(95%CI=1.08, 5.39). In a multivariable logistic regression model, dementia remained as a risk factor for COVID-19 severe disease. Furthermore, dementia status showed a statistically significant different trend when assessing the cumulative probability of developing COVID-19 symptoms(log-rank p=0.027).On day 15, SARS-CoV-2 was detectable in 30% of the asymptomatic group while in 61% of the pre-symptomatic(p=0.012).No differences were observed among groups in RT-PCR mean cycle threshold at enrollment(p=0.391) and in the rates of antibody seropositivity(IgM and IgG against SARS-CoV-2 nucleocapsid protein).Conclusions:In summary, 2/3 of our cohort of SARS-CoV-2 infected elders from vulnerable communities in Argentina remained asymptomatic after 28 days of follow-up with high mortality among those developing symptoms. Dementia and persistent SARS-CoV-2 shedding were associated with progression from asymptomatic to symptomatic infection.
Fil: Esteban, Ignacio. Fundación para la Investigación en Infectología Infantil; Argentina
Fil: Bergero, Georgina. Fundación para la Investigación en Infectología Infantil; Argentina
Fil: Alves, Camila. Fundación para la Investigación en Infectología Infantil; Argentina
Fil: Bronstein, Micaela. Fundación para la Investigación en Infectología Infantil; Argentina
Fil: Ziegler, Valeria. Fundación para la Investigación en Infectología Infantil; Argentina
Fil: Wood, Cristian. Ministerio de Defensa. Ejército Argentino. Hospital Militar Central Cirujano Mayor "Dr. Cosme Argerich"; Argentina
Fil: Caballero, Mauricio Tomás. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Fundación para la Investigación en Infectología Infantil; Argentina
Fil: Wappner, Diego. No especifíca;
Fil: Libster, Romina Paula. Fundación para la Investigación en Infectología Infantil; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina
Fil: Perez Marc, Gonzalo. Ministerio de Defensa. Ejército Argentino. Hospital Militar Central Cirujano Mayor "Dr. Cosme Argerich"; Argentina
Fil: Polack, Fernando Pedro. Fundación para la Investigación en Infectología Infantil; Argentina
Materia
SARS COV2
COVID-19
DEMENTIA
Nivel de accesibilidad
acceso abierto
Condiciones de uso
https://creativecommons.org/licenses/by-nc-sa/2.5/ar/
Repositorio
CONICET Digital (CONICET)
Institución
Consejo Nacional de Investigaciones Científicas y Técnicas
OAI Identificador
oai:ri.conicet.gov.ar:11336/151159
Acceder
id CONICETDig_c4a3bd9876dd9ceaca99a0596feee0d8
oai_identifier_str oai:ri.conicet.gov.ar:11336/151159
network_acronym_str CONICETDig
repository_id_str 3498
network_name_str CONICET Digital (CONICET)
spelling Asymptomatic COVID-19 in the elderly: dementia and viral clearance as risk factors for disease progressionEsteban, IgnacioBergero, GeorginaAlves, CamilaBronstein, MicaelaZiegler, ValeriaWood, CristianCaballero, Mauricio TomásWappner, DiegoLibster, Romina PaulaPerez Marc, GonzaloPolack, Fernando PedroSARS COV2COVID-19DEMENTIAhttps://purl.org/becyt/ford/3.3https://purl.org/becyt/ford/3Background:SARS-CoV-2 infected individuals ≥60 years old have the highest hospitalization rates and represent >80% fatalities. Within this population, those in long-term facilities represent >50% of the total COVID-19 related deaths per country. Among those without symptoms, the rate of pre-symptomatic illness is unclear, and potential predictors of progression for symptom development are unknown.Our objective was to delineate the natural evolution of asymptomatic SARS-CoV-2 infection in elders and identify determinants of progression.Methods:We established a medical surveillance team monitoring 63 geriatric institutions. When an index COVID-19 case emerged, we tested all other eligible asymptomatic elders ≥75 or >60 years old with at least 1 comorbidity. SARS-CoV-2 infected elders were followed for 28 days. Disease was diagnosed when any COVID-19 manifestation occurred. SARS-CoV-2 load at enrollment, shedding on day 15, and antibody responses were also studied.Results:After 28 days of follow-up, 74/113(65%) SARS-CoV-2-infected elders remained asymptomatic. 21/39(54%) pre-symptomatic patients developed hypoxemia and ten pre-symptomatic patients died(median day 13.5,IQR 12).Dementia was the only clinical risk factor associated with disease(OR 2.41(95%CI=1.08, 5.39). In a multivariable logistic regression model, dementia remained as a risk factor for COVID-19 severe disease. Furthermore, dementia status showed a statistically significant different trend when assessing the cumulative probability of developing COVID-19 symptoms(log-rank p=0.027).On day 15, SARS-CoV-2 was detectable in 30% of the asymptomatic group while in 61% of the pre-symptomatic(p=0.012).No differences were observed among groups in RT-PCR mean cycle threshold at enrollment(p=0.391) and in the rates of antibody seropositivity(IgM and IgG against SARS-CoV-2 nucleocapsid protein).Conclusions:In summary, 2/3 of our cohort of SARS-CoV-2 infected elders from vulnerable communities in Argentina remained asymptomatic after 28 days of follow-up with high mortality among those developing symptoms. Dementia and persistent SARS-CoV-2 shedding were associated with progression from asymptomatic to symptomatic infection.Fil: Esteban, Ignacio. Fundación para la Investigación en Infectología Infantil; ArgentinaFil: Bergero, Georgina. Fundación para la Investigación en Infectología Infantil; ArgentinaFil: Alves, Camila. Fundación para la Investigación en Infectología Infantil; ArgentinaFil: Bronstein, Micaela. Fundación para la Investigación en Infectología Infantil; ArgentinaFil: Ziegler, Valeria. Fundación para la Investigación en Infectología Infantil; ArgentinaFil: Wood, Cristian. Ministerio de Defensa. Ejército Argentino. Hospital Militar Central Cirujano Mayor "Dr. Cosme Argerich"; ArgentinaFil: Caballero, Mauricio Tomás. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Fundación para la Investigación en Infectología Infantil; ArgentinaFil: Wappner, Diego. No especifíca;Fil: Libster, Romina Paula. Fundación para la Investigación en Infectología Infantil; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Perez Marc, Gonzalo. Ministerio de Defensa. Ejército Argentino. Hospital Militar Central Cirujano Mayor "Dr. Cosme Argerich"; ArgentinaFil: Polack, Fernando Pedro. Fundación para la Investigación en Infectología Infantil; ArgentinaBill & Melinda Gates Foundation2021-08info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttp://purl.org/coar/resource_type/c_6501info:ar-repo/semantics/articuloapplication/pdfapplication/pdfhttp://hdl.handle.net/11336/151159Esteban, Ignacio; Bergero, Georgina; Alves, Camila; Bronstein, Micaela; Ziegler, Valeria; et al.; Asymptomatic COVID-19 in the elderly: dementia and viral clearance as risk factors for disease progression; Bill & Melinda Gates Foundation; Gates Open Research; 5; 8-2021; 1-82572-4754CONICET DigitalCONICETenginfo:eu-repo/semantics/altIdentifier/url/https://gatesopenresearch.org/articles/5-143/v1info:eu-repo/semantics/altIdentifier/doi/10.12688/gatesopenres.13357.1info:eu-repo/semantics/openAccesshttps://creativecommons.org/licenses/by-nc-sa/2.5/ar/reponame:CONICET Digital (CONICET)instname:Consejo Nacional de Investigaciones Científicas y Técnicas2025-09-03T10:00:01Zoai:ri.conicet.gov.ar:11336/151159instacron:CONICETInstitucionalhttp://ri.conicet.gov.ar/Organismo científico-tecnológicoNo correspondehttp://ri.conicet.gov.ar/oai/requestdasensio@conicet.gov.ar; lcarlino@conicet.gov.arArgentinaNo correspondeNo correspondeNo correspondeopendoar:34982025-09-03 10:00:01.841CONICET Digital (CONICET) - Consejo Nacional de Investigaciones Científicas y Técnicasfalse
dc.title.none.fl_str_mv Asymptomatic COVID-19 in the elderly: dementia and viral clearance as risk factors for disease progression
title Asymptomatic COVID-19 in the elderly: dementia and viral clearance as risk factors for disease progression
spellingShingle Asymptomatic COVID-19 in the elderly: dementia and viral clearance as risk factors for disease progression
Esteban, Ignacio
SARS COV2
COVID-19
DEMENTIA
title_short Asymptomatic COVID-19 in the elderly: dementia and viral clearance as risk factors for disease progression
title_full Asymptomatic COVID-19 in the elderly: dementia and viral clearance as risk factors for disease progression
title_fullStr Asymptomatic COVID-19 in the elderly: dementia and viral clearance as risk factors for disease progression
title_full_unstemmed Asymptomatic COVID-19 in the elderly: dementia and viral clearance as risk factors for disease progression
title_sort Asymptomatic COVID-19 in the elderly: dementia and viral clearance as risk factors for disease progression
dc.creator.none.fl_str_mv Esteban, Ignacio
Bergero, Georgina
Alves, Camila
Bronstein, Micaela
Ziegler, Valeria
Wood, Cristian
Caballero, Mauricio Tomás
Wappner, Diego
Libster, Romina Paula
Perez Marc, Gonzalo
Polack, Fernando Pedro
author Esteban, Ignacio
author_facet Esteban, Ignacio
Bergero, Georgina
Alves, Camila
Bronstein, Micaela
Ziegler, Valeria
Wood, Cristian
Caballero, Mauricio Tomás
Wappner, Diego
Libster, Romina Paula
Perez Marc, Gonzalo
Polack, Fernando Pedro
author_role author
author2 Bergero, Georgina
Alves, Camila
Bronstein, Micaela
Ziegler, Valeria
Wood, Cristian
Caballero, Mauricio Tomás
Wappner, Diego
Libster, Romina Paula
Perez Marc, Gonzalo
Polack, Fernando Pedro
author2_role author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv SARS COV2
COVID-19
DEMENTIA
topic SARS COV2
COVID-19
DEMENTIA
purl_subject.fl_str_mv https://purl.org/becyt/ford/3.3
https://purl.org/becyt/ford/3
dc.description.none.fl_txt_mv Background:SARS-CoV-2 infected individuals ≥60 years old have the highest hospitalization rates and represent >80% fatalities. Within this population, those in long-term facilities represent >50% of the total COVID-19 related deaths per country. Among those without symptoms, the rate of pre-symptomatic illness is unclear, and potential predictors of progression for symptom development are unknown.Our objective was to delineate the natural evolution of asymptomatic SARS-CoV-2 infection in elders and identify determinants of progression.Methods:We established a medical surveillance team monitoring 63 geriatric institutions. When an index COVID-19 case emerged, we tested all other eligible asymptomatic elders ≥75 or >60 years old with at least 1 comorbidity. SARS-CoV-2 infected elders were followed for 28 days. Disease was diagnosed when any COVID-19 manifestation occurred. SARS-CoV-2 load at enrollment, shedding on day 15, and antibody responses were also studied.Results:After 28 days of follow-up, 74/113(65%) SARS-CoV-2-infected elders remained asymptomatic. 21/39(54%) pre-symptomatic patients developed hypoxemia and ten pre-symptomatic patients died(median day 13.5,IQR 12).Dementia was the only clinical risk factor associated with disease(OR 2.41(95%CI=1.08, 5.39). In a multivariable logistic regression model, dementia remained as a risk factor for COVID-19 severe disease. Furthermore, dementia status showed a statistically significant different trend when assessing the cumulative probability of developing COVID-19 symptoms(log-rank p=0.027).On day 15, SARS-CoV-2 was detectable in 30% of the asymptomatic group while in 61% of the pre-symptomatic(p=0.012).No differences were observed among groups in RT-PCR mean cycle threshold at enrollment(p=0.391) and in the rates of antibody seropositivity(IgM and IgG against SARS-CoV-2 nucleocapsid protein).Conclusions:In summary, 2/3 of our cohort of SARS-CoV-2 infected elders from vulnerable communities in Argentina remained asymptomatic after 28 days of follow-up with high mortality among those developing symptoms. Dementia and persistent SARS-CoV-2 shedding were associated with progression from asymptomatic to symptomatic infection.
Fil: Esteban, Ignacio. Fundación para la Investigación en Infectología Infantil; Argentina
Fil: Bergero, Georgina. Fundación para la Investigación en Infectología Infantil; Argentina
Fil: Alves, Camila. Fundación para la Investigación en Infectología Infantil; Argentina
Fil: Bronstein, Micaela. Fundación para la Investigación en Infectología Infantil; Argentina
Fil: Ziegler, Valeria. Fundación para la Investigación en Infectología Infantil; Argentina
Fil: Wood, Cristian. Ministerio de Defensa. Ejército Argentino. Hospital Militar Central Cirujano Mayor "Dr. Cosme Argerich"; Argentina
Fil: Caballero, Mauricio Tomás. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Fundación para la Investigación en Infectología Infantil; Argentina
Fil: Wappner, Diego. No especifíca;
Fil: Libster, Romina Paula. Fundación para la Investigación en Infectología Infantil; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina
Fil: Perez Marc, Gonzalo. Ministerio de Defensa. Ejército Argentino. Hospital Militar Central Cirujano Mayor "Dr. Cosme Argerich"; Argentina
Fil: Polack, Fernando Pedro. Fundación para la Investigación en Infectología Infantil; Argentina
description Background:SARS-CoV-2 infected individuals ≥60 years old have the highest hospitalization rates and represent >80% fatalities. Within this population, those in long-term facilities represent >50% of the total COVID-19 related deaths per country. Among those without symptoms, the rate of pre-symptomatic illness is unclear, and potential predictors of progression for symptom development are unknown.Our objective was to delineate the natural evolution of asymptomatic SARS-CoV-2 infection in elders and identify determinants of progression.Methods:We established a medical surveillance team monitoring 63 geriatric institutions. When an index COVID-19 case emerged, we tested all other eligible asymptomatic elders ≥75 or >60 years old with at least 1 comorbidity. SARS-CoV-2 infected elders were followed for 28 days. Disease was diagnosed when any COVID-19 manifestation occurred. SARS-CoV-2 load at enrollment, shedding on day 15, and antibody responses were also studied.Results:After 28 days of follow-up, 74/113(65%) SARS-CoV-2-infected elders remained asymptomatic. 21/39(54%) pre-symptomatic patients developed hypoxemia and ten pre-symptomatic patients died(median day 13.5,IQR 12).Dementia was the only clinical risk factor associated with disease(OR 2.41(95%CI=1.08, 5.39). In a multivariable logistic regression model, dementia remained as a risk factor for COVID-19 severe disease. Furthermore, dementia status showed a statistically significant different trend when assessing the cumulative probability of developing COVID-19 symptoms(log-rank p=0.027).On day 15, SARS-CoV-2 was detectable in 30% of the asymptomatic group while in 61% of the pre-symptomatic(p=0.012).No differences were observed among groups in RT-PCR mean cycle threshold at enrollment(p=0.391) and in the rates of antibody seropositivity(IgM and IgG against SARS-CoV-2 nucleocapsid protein).Conclusions:In summary, 2/3 of our cohort of SARS-CoV-2 infected elders from vulnerable communities in Argentina remained asymptomatic after 28 days of follow-up with high mortality among those developing symptoms. Dementia and persistent SARS-CoV-2 shedding were associated with progression from asymptomatic to symptomatic infection.
publishDate 2021
dc.date.none.fl_str_mv 2021-08
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
http://purl.org/coar/resource_type/c_6501
info:ar-repo/semantics/articulo
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv http://hdl.handle.net/11336/151159
Esteban, Ignacio; Bergero, Georgina; Alves, Camila; Bronstein, Micaela; Ziegler, Valeria; et al.; Asymptomatic COVID-19 in the elderly: dementia and viral clearance as risk factors for disease progression; Bill & Melinda Gates Foundation; Gates Open Research; 5; 8-2021; 1-8
2572-4754
CONICET Digital
CONICET
url http://hdl.handle.net/11336/151159
identifier_str_mv Esteban, Ignacio; Bergero, Georgina; Alves, Camila; Bronstein, Micaela; Ziegler, Valeria; et al.; Asymptomatic COVID-19 in the elderly: dementia and viral clearance as risk factors for disease progression; Bill & Melinda Gates Foundation; Gates Open Research; 5; 8-2021; 1-8
2572-4754
CONICET Digital
CONICET
dc.language.none.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv info:eu-repo/semantics/altIdentifier/url/https://gatesopenresearch.org/articles/5-143/v1
info:eu-repo/semantics/altIdentifier/doi/10.12688/gatesopenres.13357.1
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
https://creativecommons.org/licenses/by-nc-sa/2.5/ar/
eu_rights_str_mv openAccess
rights_invalid_str_mv https://creativecommons.org/licenses/by-nc-sa/2.5/ar/
dc.format.none.fl_str_mv application/pdf
application/pdf
dc.publisher.none.fl_str_mv Bill & Melinda Gates Foundation
publisher.none.fl_str_mv Bill & Melinda Gates Foundation
dc.source.none.fl_str_mv reponame:CONICET Digital (CONICET)
instname:Consejo Nacional de Investigaciones Científicas y Técnicas
reponame_str CONICET Digital (CONICET)
collection CONICET Digital (CONICET)
instname_str Consejo Nacional de Investigaciones Científicas y Técnicas
repository.name.fl_str_mv CONICET Digital (CONICET) - Consejo Nacional de Investigaciones Científicas y Técnicas
repository.mail.fl_str_mv dasensio@conicet.gov.ar; lcarlino@conicet.gov.ar
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score 13.13397

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