The “elderly” during the covid-19 crisis: a convenient scapegoat or a revelation of social dysfunction?

With the arrival of the coronavirus disease 2019 (covid-19) pandemic, the French society has been deeply shaken in its overall functioning. The proliferation of patients and the increased demand for care, particularly in hospitals and intensive care units, have particularly disrupted the health and social functioning of French society. In this particular context of crisis, the latter played the role of “social analyzer” in the sense given to it by sociologists, that is to say, it shed new light on the social practices instituted normally. We have chosen for this article to examine the way in which a particular category of people “the elderly” had been treated on three registers which appeared to us to be emblematic of the social treatment of these “elderly people” during the covid-19 crisis. First there was the reactivation of what some have called “the struggle of ages” or even the war of generations. Then, this crisis has particularly highlighted the situation of elderly people residing in nursing homes: their increased mortality, their problematic confinement and their priority vaccination. Finally, this crisis raised the question of the relevance of setting up specific confinement according to age. Our conclusion is that crises are conducive to simplistic explanations and the search for scapegoats, but that they are also a formidable indicator of social dysfunctions that predate the crisis. In this sense, the crisis has brought to light an obvious fact in French society of the primacy of “life course inequalities” as a major vector of social exclusion. © 2022 Elsevier Masson SAS Avec l'arrivée de la pandémie de coronavirus disease 2019 (covid-19), la société française a été profondément ébranlée dans son fonctionnement global. La multiplication des malades et l'augmentation de la demandes de soins notamment hospitaliers et en services de réanimation ont particulièrement perturbé le fonctionnement sanitaire et social de la société française. Dans ce contexte particulier de crise, cette dernière a joué le rôle d’ « analyseur social » au sens que lui donnent les sociologues, c'est-à-dire qu'elle a été porteuse d'un éclairage nouveau sur les pratiques sociales instituées en temps normal. Nous avons choisi pour cet article d'examiner la façon dont avait été traitée une catégorie particulière de personnes « les personnes âgées » et ce sur trois registres qui nous sont apparus emblématiques du traitement social de ces « personnes âgées » pendant la crise covid-19. D'abord il y a eu la réactivation de ce que d'aucuns ont appelé « la lutte des âges » ou encore la guerre des générations. Ensuite cette crise a particulièrement mis en lumière la situation des personnes âgées résidant en EHPAD : leur mortalité accrue, leur confinement problématique et leur vaccination prioritaire. Enfin cette crise a posé la question de la pertinence d'une mise en place d'un confinement spécifique en fonction de l’âge. Notre conclusion est que les crises sont propices aux explications simplistes et à la recherche de boucs émissaires, mais qu'elles sont aussi un formidable révélateur des dysfonctionnements sociaux antérieurs à la crise. En ce sens la crise a remis en lumière une évidence, dans la société française, la primauté des « inégalités de parcours de vie » comme vecteur majeur de l'exclusion sociale. © 2022 Elsevier Masson SAS

Les « personnes âgées » pendant la crise du Covid-19: un bouc émissaire commode ou un révélateur des dysfonctionnement sociaux?

Résumé Avec l’arrivée de la pandémie Covid-19, la société française a été profondément ébranlée dans son fonctionnement global. La multiplication des malades et l’augmentation de la demandes de soins notamment hospitaliers et en services de réanimation ont particulièrement perturbé le fonctionnement sanitaire et social de la société française. Dans ce contexte particulier de crise, cette dernière a joué le rôle d’ « analyseur social » au sens que lui donnent les sociologues, c’est-à-dire qu’elle a été porteuse d’un éclairage nouveau sur les pratiques sociales instituées en temps normal. Nous avons choisi pour cet article d’examiner la façon dont avait été traitée une catégorie particulière de personnes « les personnes âgées » et ce sur trois registres qui nous sont apparus emblématiques du traitement social de ces « personnes âgées » pendant la crise Covid-19. D’abord il y a eu la réactivation de ce que d’aucuns ont appelé « la lutte des âges » ou encore la guerre des générations. Ensuite cette crise a particulièrement mis en lumière la situation des personnes âgées résidant en EHPAD : leur mortalité accrue, leur confinement problématique et leur vaccination prioritaire. Enfin cette crise a posé la question de la pertinence d’une mise en place d’un confinement spécifique en fonction de l’âge. Notre conclusion est que les crises sont propices aux explications simplistes et à la recherche de boucs émissaires, mais qu’elles sont aussi un formidable révélateur des dysfonctionnements sociaux antérieurs à la crise. En ce sens la crise a remis en lumière une évidence, dans la société française, la primauté des «  inégalités de parcours de vie » comme vecteur majeur de l’exclusion sociale. Summary With the arrival of the Covid-19 pandemic, French society has been deeply shaken in its overall functioning. The proliferation of patients and the increased demand for care, particularly in hospitals and intensive care units, have particularly disrupted the health and social functioning of French society. In this particular context of crisis, the latter played the role of "social analyzer" in the sense given to it by sociologists, that is to say, it shed new light on the social practices instituted normally. We have chosen for this article to examine the way in which a particular category of people "the elderly" had been treated on three registers which appeared to us to be emblematic of the social treatment of these "elderly people" during the Covid-19 crisis. First there was the reactivation of what some have called “the struggle of ages‿ or even the war of generations. Then, this crisis has particularly highlighted the situation of elderly people residing in nursing homes: their increased mortality, their problematic confinement and their priority vaccination. Finally, this crisis raised the question of the relevance of setting up specific confinement according to age. Our conclusion is that crises are conducive to simplistic explanations and the search for scapegoats, but that they are also a formidable indicator of social dysfunctions that predate the crisis. In this sense, the crisis has brought to light an obvious fact in French society of the primacy of “life course inequalities‿ as a major vector of social exclusion.

Comparison of Mortality Rate and Severity of Pulmonary Involvement in Coronavirus Disease-2019 Adult Patients With and Without Type 2 Diabetes: A Cohort Study.

OBJECTIVES: Patients with diabetes are potentially at higher risk of mortality due to coronavirus disease-2019 (COVID-19). In this study, we aimed to compare the outcomes and severity of pulmonary involvement in COVID-19 patients with and without diabetes. METHODS: In this cohort study, we recruited patients with diabetes who were hospitalized due to COVID-19 during the period from February 2020 to May 2020. Hospitalized individuals without diabetes were enrolled as control subjects. All patients were followed for 90 days and clinical findings and patients' outcomes were reported. RESULTS: Over a period of 4 months, 127 patients with diabetes and 127 individuals without diabetes with a diagnosis of COVID-19 were recruited. Their mean age was 65.70±12.51 years. Mortality was higher in the group with diabetes (22.8% vs 15.0%; p=0.109), although not significantly. More severe pulmonary involvement (p=0.015), extended hospital stay (p<0.001) and greater need for invasive ventilation (p=0.029) were reported in this population. Stepwise logistic regression revealed that diabetes was not independently associated with mortality (p=0.092). Older age (odds ratio [OR], 1.054; p=0.003), aggravated pulmonary involvement on admission (OR, 1.149; p=0.001), presence of comorbidities (OR, 1.290; p=0.020) and hypothyroidism (OR, 6.576; p=0.021) were associated with mortality. Diabetic foot infection had a strong positive correlation with mortality (OR, 49.819; p=0.016), whereas insulin therapy had a negative correlation (OR, 0.242; p=0.045). CONCLUSIONS: The mortality rate due to COVID-19 did not differ significantly between patients with or without diabetes. Older age, macrovascular complications and presence of comorbidities could increase mortality in people with diabetes. Insulin therapy during hospitalization could attenuate the detrimental effects of hyperglycemia and improve prognosis of patients with COVID-19 and diabetes.

Characteristics and outcomes of patients hospitalized for COVID-19 in France: The Critical COVID-19 France (CCF) study.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has led to a public health crisis. Only limited data are available on the characteristics and outcomes of patients hospitalized for COVID-19 in France. AIMS: To investigate the characteristics, cardiovascular complications and outcomes of patients hospitalized for COVID-19 in France. METHODS: The Critical COVID-19 France (CCF) study is a French nationwide study including all consecutive adults with a diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) infection hospitalized in 24 centres between 26 February and 20 April 2020. Patients admitted directly to intensive care were excluded. Clinical, biological and imaging parameters were systematically collected at hospital admission. The primary outcome was in-hospital death. RESULTS: Of 2878 patients included (mean±SD age 66.6±17.0 years, 57.8% men), 360 (12.5%) died in the hospital setting, of which 7 (20.7%) were transferred to intensive care before death. The majority of patients had at least one (72.6%) or two (41.6%) cardiovascular risk factors, mostly hypertension (50.8%), obesity (30.3%), dyslipidaemia (28.0%) and diabetes (23.7%). In multivariable analysis, older age (hazard ratio [HR] 1.05, 95% confidence interval [CI] 1.03-1.06; P<0.001), male sex (HR 1.69, 95% CI 1.11-2.57; P=0.01), diabetes (HR 1.72, 95% CI 1.12-2.63; P=0.01), chronic kidney failure (HR 1.57, 95% CI 1.02-2.41; P=0.04), elevated troponin (HR 1.66, 95% CI 1.11-2.49; P=0.01), elevated B-type natriuretic peptide or N-terminal pro-B-type natriuretic peptide (HR 1.69, 95% CI 1.0004-2.86; P=0.049) and quick Sequential Organ Failure Assessment score ≥2 (HR 1.71, 95% CI 1.12-2.60; P=0.01) were independently associated with in-hospital death. CONCLUSIONS: In this large nationwide cohort of patients hospitalized for COVID-19 in France, cardiovascular comorbidities and risk factors were associated with a substantial morbi-mortality burden.

[Factors associated with the occurrence of acute respiratory distress and death in patients with COVID-19 in Burkina Faso]. / Facteurs associés à la survenue de la détresse respiratoire aiguë et au décès chez des patients atteints de COVID-19 au Burkina Faso.

INTRODUCTION: The development of acute respiratory distress syndrome indicates a serious form of COVID-19. Although there have been several studies on the prognostic factors of its severe form, no such study has been conducted in Burkina Faso. METHODS: This was a retrospective cohort study conducted from March 9 to June 9, 2020 in Ouagadougou, Burkina Faso which involved 456 patients with COVID-19. RESULTS: Nearly a quarter of the patients (23.2%) had presented with acute respiratory distress and 44.3% of them died. Being over 65 years old (HR: 2.7; 95% CI: 1.5-5.1) and having hypertension (HR: 1.9; 95% CI: 1-3.5) were independently associated with the risk of mortality. However, after adjustment, only age over 65 years (HR: 2.3; 95% CI: 1.2-4.3) was a risk factor for death. The survival rate for patients over 65 was 38.5% at 7 days and 30.3% at 15 days. CONCLUSIONS: Acute respiratory distress leading to death is mainly found in older people with COVID-19. Close monitoring of these high-risk patients may reduce the risk of death.