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dc.contributor.author
Esteban, Ignacio
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Bergero, Georgina
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Alves, Camila
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Bronstein, Micaela
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Ziegler, Valeria
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Wood, Cristian
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Caballero, Mauricio Tomás
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Wappner, Diego
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Libster, Romina Paula
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Perez Marc, Gonzalo
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Polack, Fernando Pedro
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dc.date.available
2022-02-02T12:01:02Z
dc.date.issued
2021-08
dc.identifier.citation
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
dc.identifier.issn
2572-4754
dc.identifier.uri
http://hdl.handle.net/11336/151159
dc.description.abstract
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.
dc.format
application/pdf
dc.language.iso
eng
dc.publisher
Bill & Melinda Gates Foundation
dc.rights
info:eu-repo/semantics/openAccess
dc.rights.uri
https://creativecommons.org/licenses/by-nc-sa/2.5/ar/
dc.subject
SARS COV2
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COVID-19
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DEMENTIA
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Epidemiología
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Ciencias de la Salud
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CIENCIAS MÉDICAS Y DE LA SALUD
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dc.title
Asymptomatic COVID-19 in the elderly: dementia and viral clearance as risk factors for disease progression
dc.type
info:eu-repo/semantics/article
dc.type
info:ar-repo/semantics/artículo
dc.type
info:eu-repo/semantics/publishedVersion
dc.date.updated
2022-02-01T17:41:13Z
dc.journal.volume
5
dc.journal.pagination
1-8
dc.journal.pais
Estados Unidos
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dc.description.fil
Fil: Esteban, Ignacio. Fundación para la Investigación en Infectología Infantil; Argentina
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Fil: Bergero, Georgina. Fundación para la Investigación en Infectología Infantil; Argentina
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Fil: Alves, Camila. Fundación para la Investigación en Infectología Infantil; Argentina
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Fil: Bronstein, Micaela. Fundación para la Investigación en Infectología Infantil; Argentina
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Fil: Ziegler, Valeria. Fundación para la Investigación en Infectología Infantil; Argentina
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Fil: Wood, Cristian. Ministerio de Defensa. Ejército Argentino. Hospital Militar Central Cirujano Mayor "Dr. Cosme Argerich"; Argentina
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Fil: Caballero, Mauricio Tomás. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Fundación para la Investigación en Infectología Infantil; Argentina
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Fil: Wappner, Diego. No especifíca;
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Fil: Libster, Romina Paula. Fundación para la Investigación en Infectología Infantil; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina
dc.description.fil
Fil: Perez Marc, Gonzalo. Ministerio de Defensa. Ejército Argentino. Hospital Militar Central Cirujano Mayor "Dr. Cosme Argerich"; Argentina
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Fil: Polack, Fernando Pedro. Fundación para la Investigación en Infectología Infantil; Argentina
dc.journal.title
Gates Open Research
dc.relation.alternativeid
info:eu-repo/semantics/altIdentifier/url/https://gatesopenresearch.org/articles/5-143/v1
dc.relation.alternativeid
info:eu-repo/semantics/altIdentifier/doi/http://dx.doi.org/10.12688/gatesopenres.13357.1
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