Despite the drastic decline in the number of COVID-19 deaths in the State, Case Fatality Rate (CFR) continues to be the highest in the 90-99 age group.
From 11.4% on November 27, CFR in this group (90-99 years) rose to 11.6% on December 27 and again reduced to 11.4% on January 27. This is the highest CFR among the five age groups of senior citizens - from 60-69 years to above 100 years. However, CFR among senior citizens of two groups, above 60 and above 100 years, has fallen in the State.
In the above 60 age group, CFR that had stood at 5.4% on October 27, reduced to 4% on November 27. This further reduced to 3.7% on December 27. In the centenarians group, it reduced from 5% in November to 4.8% in December and has remained the same this month too.
Over 60% of the 12,207 COVID-19 deaths in the State as of January 27 were that of senior citizens, even as this age group accounts for 16% of the 9.37 lakh cases, indicating that people in this category are highly vulnerable. Senior citizens had accounted for 59.7% of the total 12,062 deaths as on December 27.
Rapid progression
Anoop Amarnath, member of Karnataka’s COVID-19 critical care support unit (CCSU), who heads the department of geriatric medicine at Manipal Hospitals, said one of the potential reasons for the high mortality in the 90-99 age group is the high rate of disease progression.
“What we have seen on the ground is that the rate of decline in the condition of nonagenarians is rapid once they land with moderate/severe COVID-19 infection. The time taken to deteriorate from single-organ dysfunction to multi-organ failure in this age group is very short leaving little time for the treating clinician to intervene,” the doctor said.
He said that early identification and early intervention is vital. Dr. Amarnath said, “We need a very high index of suspicion to identify the disease progression at the initial stage itself in this “very elderly” population.”
“Doctors should look for tell tale signs such as reduction in urine output, early tachycardia (a heart rate of over 100 beats per minute) among other symptoms as chances of recovery are poor if the patient goes into multi-organ failure,” he added.
Advanced comorbidities
C.N. Manjunath, nodal officer for labs and testing in the State’s COVID-19 task force, attributed the high CFR in this age group to multiple age-related advanced comorbidities and geriatric issues. “Many nonagenarians usually have hypertension and diabetes with heart enlargement or hypertension and diabetes with kidney disease. Some may have compromised lung function, would have suffered a stroke or have impaired cognitive function (dementia). All these issues put them at high risk thereby leading to rapid progression of the infection,” he said. “Moreover, some of them can be bedridden too because of which urinary tract infections are common. Such patients need special geriatric and good nursing care,” he added.
