The COVID Grim Reaper

To the Editor:

The articles “COVID-19 in Italy: Ageism and decision making in a pandemic” by Cesari and Proietti¹ and “The geriatrician: The frontline specialist in the treatment of COVID-19 patients - Gemelli against COVID-19 Geriatrics Team” by Landi et al.² clearly discuss the topics to be considered to best manage the care of sick older individuals in COVID-19 outbreaks.

Multimorbidity, frailty, physical disability and cognitive impairment, and alterations of the biological background all may play an additional role in worsening the prognosis and increasing the risk of adverse outcomes more than the mere number of years lived.

Whatever the causes, the mortality rate in older patients is remarkably high: in our hospital located in Brescia, in the region of Lombardy (the area with the highest rate of SARS-CoV-2 infection and death in Italy), in patients older than 80 the mortality rate is 54%, in patients older than 85 the mortality rate is 75%, and in those with severe to terminal dementia [Clinical Dementia Rating (CDR3) to CDR5] the mortality rate is 100%.

The use of cutpoints based on chronological age as guidance of clinical decision of treatment may put most older patients at risk for second-class care, but very old patients in the COVID-19 pandemic have a negligible survival hope; they are “de facto” a doomed population.

A community that abandons their older citizens is a hateful community; if we want to save older lives we must absolutely avoid COVID-19 infection. COVID-19 infection for an aged person is the “Grim Reaper,” and age should therefore be taken into account mainly to incentivize an obligation toward prevention.