Publication of November-December 2020

Objectives. Although the majority of COVID-19-related in-hospital deaths were reported in patients over 75 years of age, this population has been scarcely described so far. This study was aimed at describing the clinical presentation and in-hospital mortality rate of these geriatric patients.

Methods. This retrospective cohort studied the first 50 patients that were affected with COVID-19 and admitted to geriatric wards at Cliniques universitaires Saint-Luc.

Results. Before admission, the patients (median age: 88 years) were vulnerable (16%), mildly/moderately frail (32%), and severely/very severely frail (52%) according to the clinical frailty scale, whilst presenting with geriatric syndromes (cognitive impairment in 54%, recurrent falls in 44%, and malnutrition in 40%). In 36% of patients, the initial COVID-19 presentation was atypical, consisting of delirium-related or digestive symptoms. The in-hospital mortality rate was high (52%), while being not associated with the degree of frailty; the patients’ mortality rate was associated upon diagnosis with older age, lower systolic blood pressure, higher serum lactate dehydrogenase levels, and marked lung infiltrates.

Conclusions. Concerning the first geriatric COVID-19-affected patients, the initial symptom was often misleading, and the in-hospital mortality rate was high (52%),whereas the prognosis factors still need to be better defined, particularly as for the impact of clinical frailty.

Keeping vaccines requires maintaining the cold chain, which commonly exhibits weaknesses, even in more developed countries. However, the exposure of most vaccines to high temperatures results in some degree of degradation. Moreover, the freezing itself can cause an immediate vaccine degradation. In this context, the conservation of vaccines in the refrigerator at a constant temperature between 2 and 8 °C is a required framework for the general practitioner, which is designed to preserve the vaccines’ properties. The main characteristics of suitable refrigerators must combine the maintenance of temperature (between 2 and 8 °C), an equal temperature distribution, the availability of an evaporator that prevents freezing, a very rapid temperature recovery device, as well as forced air circulation. Domestic refrigerators may suffice for storing small volumes of vaccines. They must display the minimum characteristics required for good storage conditions and undergo the adaptations necessary to their proper use. Additionally, regular temperature monitoring and reporting must be performed using an outdoor thermometer with a probe. These easily manageable elements enable vaccines to be stored in good conditions, with the eventual outcome of optimizing vaccine coverage of the population.