QJM: An International Journal of Medicine, 2021, 157
doi: 10.1093/qjmed/hcab080
ELEMENTS IN THIS MONTH’S ISSUE
Should we ventilate elderly patients with COVID-19?
Seamas C. Donnelly
Editor-in-Chief, QJM
The COVID-19 pandemic has presented significant challenges
to the acute hospital sector and in particular intensive care
resources. The repeated surges of the pandemic have led to
rationing of Intensive Care to those predicted to benefit the
most. It has been suggested that from an economic perspective,
limited resources should target younger COVID patients com-
pared to the older generation.
The Journal has previously highlighted the value of an indi-
vidual to society is not proportional to a single variable—name-
ly their age.1 We have also challenged society, particularly in
the early stages of the pandemic, of whether the protection of
nursing home residents was a national priority.2 We have pub-
lished a series of articles on mental health during this pandemic
and how enforced social isolation exacerbates the mental
health of society but particularly older residents within our
community.3,4
We welcome the paper in the current issue of the Journal
from Dr Raheja and colleagues from Maimonides Medical
Centre, New York in which they analysed the adverse factors
associated with outcome in COVID-19 patients, aged over
75 years admitted to their healthcare facility. They found an
overall mortality in their non-dementia cohort of 52% compared
to 71% in their dementia cohort. In those critically ill patients
requiring intubation, mortality was 95%. It is worthwhile noting
that this is a retrospective study at an early time-point in the
pandemic. Therapeutic strategies have evolved over recent
months with the use of corticosteroids, anti-viral and biological
therapies having been shown to significantly reduce the num-
ber of patients requiring intensive care support and mortality.
However, it does highlight the adverse prognosis of this elderly
population who become critically ill with COVID-19 infection.
The decision to escalate treatment is taken on an individual
basis, taking into account the clinical context and associated
co-morbidities. Would welcome our readerships views on this
important subject.
C The Author(s) 2021. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved.
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Elements in this month’s issue
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Delaying the second vaccine dose during the
pandemic—do not have a problem with
that—maybe not
Certain countries, most notable the United Kingdom, delayed
giving the second dose of the vaccine—the strategy being that
the first dose vaccine exerts a highly significant protective
effect—therefore, we should prioritize giving the first vaccine to
the greatest number of people in the shortest amount of time.
Consequently, the United Kingdom has an impressive percent-
age of its population given the first vaccine dose. Are there any
potential downsides to this strategy? A Commentary piece by
Dr’s Humphreys and Godkin of Cardiff University define the
potential risks of this strategy. In particular, they highlight (i)
not fully vaccinating high-risk subjects in a timely fashion,
leaving them potentially exposed in that 4–12-week window,
(ii) if one dose is ineffectual or suboptimal, it may leave the
individual at risk until the booster is given and (iii) partial
protection may actually facilitate the SARS-CoV-2 virus to
mutate in situ, escaping the weak immune responses and
encourage vaccine-resistant virus variants, which could then
spread.
References
1. Donnelly SM. The elderly and COVID-19: cocooning or cull-
ing—the choice is ours. QJM 2020; 113:453–4.
2. Donnelly SC. Elderly nursing homes residents—are they a pri-
ority in national COVID-19 strategies? QJM 2020; 113:387.
3. Sher L. The impact of the COVID-19 pandemic on suicide rates.
QJM 2020; 113:707–12.
4. Serafini G, Parmigiani B, Amerio A, Aguglia A, Sher L, Amore M,
et al. The psychological impact of COVID-19 on the mental
health in the general population. QJM 2020; 113:531–7.
157
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