In case of symptoms (cough, fever), immediately call your primary care physician or the dedicated toll-free number. By Dr. Mustapha Oudrhiri, Specialist in Internal Medicine and Geriatrics, President of AGE Morocco.

All statistics clearly show that our elderly population is the most affected by COVID-19 infection. 80% of deaths occur within this age group.

Through this clinical case, we will demonstrate that delays in diagnosis and treatment are the primary causes of the tragedies we have witnessed since the beginning of this pandemic, especially during this current second wave.

Last Thursday, I saw an 85-year-old patient due to a recent change in behavior (apathy, irritability, and withdrawal). This lady is treated for Type 2 diabetes, hypertension, and recently diagnosed Alzheimer’s disease. She had no fever, no cough, and no digestive issues. The clinical examination showed nothing unusual—no neurological deficits and no anomalies during lung auscultation. Given the current context and knowing that atypical symptoms are the rule in elderly patients, I requested a chest CT scan and blood tests.

I reviewed the results on Saturday: ground-glass opacities estimated at 20% (CO-RADS 5 classification) and a significant inflammatory syndrome with elevated CRP, procalcitonin, and ferritin levels. I immediately started the COVID-19 protocol treatment (excluding hydroxychloroquine). Imagine if this poor lady had to wait until Monday for a PCR test, another 48 hours for results, and then even longer to find a hospital bed. It would have taken at least a week to start treatment—enough time for lung lesions to progress and for the "cytokine storm," responsible for multi-organ failure, to trigger.

The high number of deaths we are seeing is due to this delay in diagnosis and management.

We must absolutely start treatment at the slightest doubt, especially for vulnerable populations such as the elderly or those with chronic illnesses (diabetes, cardiovascular disease, kidney failure, autoimmune diseases, or patients on corticosteroids/immunosuppressants). This is the only way to save lives and relieve our intensive care units.
As a geriatrician, I urge all citizens to be extremely vigilant at the first sign of any unusual symptom in the elderly and to consult a doctor without delay. Atypical symptoms are very frequent. Fever and cough are rare. Pay attention to: Fatigue or loss of appetite. Digestive issues such as diarrhea or abdominal pain. Headaches. Changes in behavior (apathy, drowsiness, irritability, etc.).

A physician will request a chest CT scan at the slightest doubt. While the PCR test is important, it must not be an obstacle to starting treatment if the clinical, biological, and radiological context is suggestive (as tests can be negative in 25% to 30% of cases).

Hydroxychloroquine, part of the national COVID-19 treatment protocol, should be available in pharmacies. We have used this medication for years. While the dose is higher for this protocol, we are aware of the need for an ECG, interpreted by a cardiologist, to rule out contraindications (such as QT interval prolongation).

That said, we cannot repeat it enough: the priority is a rapid diagnosis and starting treatment at the slightest doubt, even if the protocol is adjusted later by introducing hydroxychloroquine.

Let us be very vigilant. Take care of the elderly around us. A child or a young person may carry the virus and feel nothing, but they can be a "time bomb" for the fragile people in their circle.