Coronavirus often does not announce itself loudly in the elderly, a fact that allowed it to take hold in many nursing homes before anyone knew it was there. Instead of the classic symptoms we were all initially told to look for—fever, cough and shortness of breath—people over 80 often lose their appetites, develop diarrhea, or become confused, agitated or more subdued. Fevers over 99 are rare. Sabine von Preyss Friedman, medical director of 50 facilities in Seattle, including one with an early and large outbreak, has learned to look for very subtle changes. "People look at you sideways and they don't look right, you're doing a test," she said.
Doctors said some patients never have more than mild symptoms. Wright said some can go from no symptoms to death in a few hours. Others develop what appears to be an overreaction of the immune system, or cytokine storm, a few days into the infection. In all age groups, this is a hallmark of very serious illness. Elderly people who get this sick typically do not do well, doctors said.
George Anesi, a pulmonary and critical care doctor at Penn Medicine who sees only hospitalized patients, said that the virus is harder on people the older they are. Those with low blood-oxygen levels and high inflammation levels do the worst. Those whose problems are confined to their lungs fare much better than those with multi-organ failure.
