Proportion of patients over 80 years old in Covid ICUs

Brazilian ICUs once again recorded an increase in the prevalence of elderly patients with Covid-19, especially those over 80 years of age, after a period of decline that began in mid-September 2021, when the booster dose of the vaccine was applied.

Unpublished data from the Brazilian ICUs project, which monitors 600 public and private units in the country, shows that, as of the last epidemiological week of December, the proportion of people aged 60 years and over has risen again and has skyrocketed in the last two weeks, reaching 70. % of those admitted to intensive care units. Patients over 80 years old correspond to more than 30%.

Between September and November 2021, this group represented less than 19% of the total number of patients admitted to Covid ICUs. Data from the last few weeks, not yet consolidated, point to an even greater increase.

At HCor, the average age of patients in the Covid ICU today is 79 years old, the highest since the beginning of the pandemic. In 2020 and 2021, the average was 66 years old. At the Albert Einstein hospital, 86% of patients in intensive care are over 60 years old, 45% over 80.

“The proportion of octogenarians in ICUs dropped a lot when they were vaccinated for the first time. [início de 2021]. Then, when the effect of the vaccine is lost due to immunosenescence [envelhecimento do sistema imunológico], it goes back up. With vaccine booster, it falls again, and now it exploded. Maybe it’s time to think about a new booster dose”, says intensive care physician Ederlon Rezende, coordinator of the ICU project.

This immunosenescence may contribute to lower levels of immunity conferred by the vaccine in the elderly, regardless of the type of immunization received.

This was one of the arguments of the city hall of Botucatu (interior of São Paulo) to start last Sunday (6) the application of the fourth dose of the vaccine against Covid in all the elderly aged 70 years or older, who have taken the 3rd dose for at least four months. In the second (7), the group of 60 or more was also included.

In a technical note, the Botucatu Covid-19 monitoring, control, prevention and treatment commission cites the “reduction in the effectiveness of vaccines against Covid-19 over time, from three to four months after their application and more evidently after five months”, the “high transmission with an increase in severe cases, hospitalizations and deaths” caused by the micron and “an aging process of the immune system among the elderly, which can contribute to the levels of immunity reached be minor”.

The Ministry of Health recommended this Wednesday (9) the application of a fourth dose of the Covid-19 vaccine in immunocompromised people over 12 years old. Before, the indication was to reinforce immunization only for adults in this group.

Governor João Doria (PSDB) also announced that the state will apply the fourth dose, regardless of the approval of the Ministry of Health, but did not define when or if there will be priority groups.

According to Miguel Cendoroglo Neto, director-superintendent of medical and hospital services at Einstein, the longer the time since the last dose of the vaccine, the greater the risk of the elderly getting a more severe Covid and needing ICU. “That suggests that maybe we’re going to need a vaccination strategy more often,” he says.

Among those over 70 years old admitted to the Einstein ICU, 56% took the last dose of the vaccine between 90 and 180 days before admission. Another 13% had been vaccinated for more than 180 days.

Fernando Torelly, president of Hcor, says that, in general, the fact that the elderly have more comorbidities also increases the chance of ICU admissions and deaths. Since the beginning of the pandemic, the hospital has recorded 13 deaths of elderly people, with an average age of 88 years. All of them had three or more comorbidities.

According to Einstein’s Cendoroglo Neto, there are three factors related to the profile of patients currently hospitalized in the hospital’s Covid ICU: age, vaccination schedule and how long ago was the last dose.

Einstein sought official information on the patients’ vaccination schedule from the Ministry of Health’s database, with their prior authorization.

Of a total of 92 ICU patients who had Covid as a primary diagnosis, about a quarter (23.9%) are not vaccinated with any dose; 3.3% had the first dose, 17.4% had two doses and 55.4% had had three doses.

At Hcor, of the 81 patients hospitalized on Wednesday, 25% of them were not vaccinated, 43% had an incomplete vaccination schedule, and 32% had all three doses.

“If you consider that we are talking about an average age group of 71 years, and that, in Brazil, the vast majority are vaccinated, the number of unvaccinated hospitalized is very significant”, says Torelly

He reinforces, however, that it is not possible to say that these patients got worse just because they were not vaccinated. “These are patients with many preexisting diseases, with serious clinical conditions. Even among those vaccinated, the Ômicron can generate an imbalance in the clinical picture that can lead them to a more serious situation.”

At Einstein, in about 40% of Covid patients in the ICU or semi-intensive care unit, the disease is secondary. That is, hospitalization occurred more due to the worsening of symptoms related to other underlying diseases, such as decompensated hypertension and asthmatic bronchitis, and not due to Covid itself.

For infectious disease specialist Mirian Dal Ben, from Hospital Sírio-Libanês, among hospitalized patients with Covid, those who are not vaccinated (around 20%) or who have an incomplete vaccination schedule tend to evolve worse in relation to the group of patients with Covid-19. vaccinated.

“They are those who are hospitalized with the characteristics of the pre-vaccine disease, who make that rapid, expressive worsening, on the seventh day of the disease, with respiratory failure and needing intubation. About 5% progress to renal failure. of the vaccinated and unvaccinated patient.”

Among the patients vaccinated with the three doses and who need ICU, says the doctor, in general are the severely immunosuppressed, such as cancer patients and transplant patients. “It’s the group that has a worse response to the vaccine.”

Another data extracted from the base of the Brazilian ICUs project shows that the average length of stay of patients with Covid had a reduction in this new wave caused by the omicron: from 13 days, on average, throughout the pandemic, to 8.7 days since the middle of the pandemic. from December.

“Two things have changed: the virus and the host. In the host, the change has been the vaccine. In the virus, it was the new variant, the omicron, which is much more contagious, but which, in the vast majority of cases, does not cause a disease so serious. Not because of the virus alone, but because the host is now vaccinated.”