A prolonged course of COVID-19 in a person with dementia

The course of COVID-19 may be particularly long-lasting in elderly patients. Caring for patients with dementia suffering from COVID-19 is challenging due to unclear symptom presentation, delirium, and maintaining isolation procedures.

A man in his sixties with dementia, hospitalised in a psychogeriatric ward, presented with mild upper respiratory tract symptoms and recovered within 24 hours. Ten days later he developed more severe symptoms. PCR test for SARS-CoV-2 was positive. Over the following two months his clinical state fluctuated, from almost symptom-free days to being bedridden and assessed as potentially terminal. After the initial positive test, he had three consecutive negative tests, before he again tested positive for SARS-CoV-2. Uncertainty as to whether the patient remained contagious resulted in isolation of the patient for over two months.

PCR testing of SARS-CoV-2 does not differentiate between intact virus and remnants thereof, and patients may test positive for a long time. This along with a fluctuating clinical course makes it difficult for clinicians to decide when to end isolation of COVID-19 patients.