Discussion
We present the first UK clinical data of 71 cases of COVID-19 patients
admitted to one clinical centre. The majority of patients (70 patients)
were white British and one patient was Asian. Our cohort of patients of
mean (SD) age of 70.7 (16.6) years, with 75% are ≥65 years, appears
older than the published Chinese cohort {median age was only 46.0 years
and the proportion of older patients (> 60 years) was
44.1%}, we had slightly more men (58% v 51.6%) but the comorbidities
were similar. 8 Around 10% of our patients presented
with gastrointestinal symptoms such as diarrhoea compared to only 3.8%
in a Chinese study. 9 Although in another Chinese
study by Wang et al, 10% of patients initially presented with nausea
and diarrhoea 1-2 days before the onset of fever and dyspnoea.4 Laboratory systemic abnormalities particularly
lymphopenia and elevated CRP and chest imaging findings are consistent
with previously published literature. 10 The majority
of our patients (55%) had normal chest x-ray in comparison to only
around 18% in a Chinese report. 9 Our case fatality
rate of 14% was similar to 8% for those aged 70-79 and 14.8% for
those ≥80 years that was reported from China. 8 Also,
previously, older age has been reported as an important independent
predictor of mortality in SARS and MERS. 11, 12 Older
people are more susceptible to infection likely due to associated
comorbidities and attenuation of the innate immunity.13 The ageing immune system is characterized by a low
grade and chronic systemic inflammatory state or “InflammAgeing” and
is associated with an increased susceptibility to infection.14 One important finding in this case series, which
has not been reported yet in the literature, is the emergence of frailty
as a detrimental significant factor for poor outcome in patients with
COVID-19. Frailty is a syndrome that is characterised by multisystem
dysregulation that leads to reduced physiologic reserve and increased
risk of adverse health outcomes. Dysregulation in the innate and
adaptive immunity also leads to chronic inflammation, with increase in
inflammatory markers, and increased susceptibility to severe infections.
Increased inflammatory markers have been shown in patients with viral
pneumonia. 13 Although frailty was not formally
assessed in the COVID-19 studies, the fact that old age is associated
with comorbidities and was associated with an increased risk of COVID-19
infection and worse outcomes may suggest underlying frailty was common
in these old patients. The strength of this case series is its
prospective design which allowed follow up of cases as well as the use
of electronic record which allowed accurate documentation of results.
However, this study has few limitations which include first, the small
number included so far and the incomplete conclusion of outcomes of the
patients who are still under treatment in hospital however, this series
is in a continuous follow up and successive publications will follow as
more information are gathered. Second, we were not able to record the
incubation period for the current infection as this was not clearly
re-called by the patients. Third, we are not able to report efficacy of
any specific antiviral therapy as per our hospital protocol, this has
not been used.