He noticed that these patients had a form of oxygen deprivation, which is difficult to detect, called “silent hypoxia,” despite the patients feeling alert and breathing normally ( 19).Īsymptomatic hypoxia (AH) or silent hypoxia is becoming more prevalent in the COVID-19 literature and is associated with extremely poor outcomes ( 20). In April 2020, an emergency room doctor observed COVID-19 patients without visible signs of dyspnea and a SpO 2 below 90%. COVID-19 symptoms may present themselves anywhere from 4–5 to 14 days after exposure, which may be too late for initiating interventions and having positive outcomes ( 18). Atypical presentations of COVID-19 in older adults include a delay in fever and respiratory symptoms. Older adults with COVID-19 do show typical symptoms such as shortness of breath, fever, and cough however, many of them do not ( 17).

Other symptoms, such as coughing, or shortness of breath may be normal for existing chronic conditions such as chronic obstructive pulmonary disease (COPD) or congestive heart failure (CHF). Each of these symptoms may be dismissed as a normal part of aging. COVID-19 symptoms include fatigue, body aches, weakness and an increasing loss of taste and smell ( 17). Atypical presentations could just be a change in cognitive status or mobility. Similar to a fever, older adults lack other usual signs and symptoms of illness onset or exacerbation. Atypical Presentation of COVID-19 in Older Adults Therefore, the objective measure of a temperature and the threshold of 100.4 F as a fever indicator does not provide a sufficient indicator of infection in older adults and may delay the diagnosis and treatment for COVID-19 ( 15, 16). This delay in seeking health care increases their mortality risk ( 14). In other studies, seeking treatment occurred up to 1 week after symptom onset ( 15, 16). One study found older adults ( N = 1,318), presented to the emergency department with influenza 2–5 days after symptom onset ( 14). In fact, upwards of 30% of older adults with serious infections show a mild or no fever ( 7, 13). Lower baseline temperatures may result in overlooking fevers. A study of 2410 hospitalized patients with influenza aged ≥65 years found a lower temperature threshold 99☏ (≥37.2☌) and captured 78% of influenza-positive individuals, while the CDC's threshold for a fever 100☏ (37.8☌) captured only 57% ( 12). In a sample of 18,630 (aged 20–98 years) with a mean age 58.0 years with equal numbers of male/female participants, researchers found an average basal oral body temperature of 97.3☏ (36.2☌) ( 11). In a study of 35,488 participants with a mean age of 52.9 years, the baseline temperatures declined with age (−0.02☌ every decade, p < 0.001) ( 10). Other studies have found that baseline temperatures may be as low as 94☏ (34.4☌) for older adults ( 9). However, studies have found that older adults show a lower core body temperature, described as below 98.6☏ (36.4☌), using the standard definition of a fever is a less useful indicator of infection with older adults ( 7, 8). Of the general population, 98% of the COVID-19 patients was found to have a fever, along with other symptoms ( 6).įever is defined as a temperature of 100.4☏ (38.0☌) or greater ( 4). Thus, the initial objective screening for COVID-19 has been using temperature measurements to diagnose the presence of infection.

The presence of fever is a key clinical indicator of infection and inflammation ( 5). This paper offers suggestions to mitigate these statistics. However, the media's tone has been that this was not alarming but expected due to age and comorbidities. The statistics are staggering, with older adults making up 45–80% of all hospitalizations, 53% of intensive care admissions, and 80% of deaths ( 3, 4). Older adults are another population in which symptom-based screening for COVID-19 should be questioned.Īs the pandemic unfolded, older adults have been hardest hit. However, the efficacy of symptom-based screening (temperature and self-report) for COVID-19 has been called into question in recent studies for both the general population and healthcare workers ( 1, 2).

Prior to testing, screening is conducted, typically consisting of assessing one's temperature and asking questions related to symptoms and exposures. Where available, testing can confirm exposure to COVID-19. Control efforts have included social distancing, hygiene, masks, and lockdowns.

Public health screening for COVID-19 and its mutations are becoming a routine activity, as we assess the safety of resuming interactions with each another.

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