Public Health England updates guidance to highlight delirium as a COVID symptom in frail, older people

Public Health England has updated its COVID-19 guidance for elderly people presenting with delirium, based on research from the COVID Symptom Study app. We speak to lead researcher, Dr Claire Steves, to find out more.

New results from the COVID Symptom Study show that delirium - a state of sudden confusion - is a key symptom of COVID-19 in older people. Public Health England has now updated its guidance, advising doctors to test for elderly people presenting with acute confusion for COVID-19.

This will enable quicker diagnosis and earlier treatment of COVID-19 in older, vulnerable people, helping to save lives and prevent the spread of the virus.

It’s a powerful demonstration of the value of the COVID Symptom Study app, and it has only been possible because of our millions of users taking a minute every day to log their health. Every single one of you is really helping to make a difference, so thank you.

We spoke to consultant geriatrician and lead researcher on the delirium study, Dr Claire Steves from King’s College London, to find out more.

What is delirium?

Back in May, data from our COVID Symptom Study app users identified a third key symptom of the disease - loss of smell (anosmia) - leading to a change in the official guidelines.

Now, data from the COVID Symptom Study app has been used to identify an additional sign in frail, elderly people: delirium.

Delirium is a state of acute confusion that starts suddenly and can occur during any illness. The exact trigger may not always be clear, but delirium can be associated with low oxygen levels or the effects of the underlying illness on the brain. It is generally more common in older people who need help with daily life - for example due mobility problems, poor eyesight, hearing problems or existing memory issues such as dementia.

Although COVID-19 is caused by a virus that affects the airways, Claire and her fellow clinicians quickly realised that it was also having an effect on the brain.“Early in the pandemic, we noticed that many frail, older patients with COVID were suffering from delirium, but there was very little data to support our experiences,” she says. “So when we devised the COVID Symptom Study app, we made sure that it asked questions about confusion, disorientation and drowsiness, which are the core symptoms of delirium, so that we could gather some information.”

Another important step was updating the app to allow people to log health reports on behalf of other people, such as elderly relatives who may not be able to use the app themselves. This significantly increased the amount of data available from older people, making the results more reliable.

COVID Symptom Study app data confirms that delirium is a key symptom of COVID-19 in older people

Data from the app quickly showed an association between COVID and symptoms of delirium in elderly, frail individuals.

To confirm the link, Claire and her collaborators also assessed older patients with COVID-19 at St Thomas’ hospital in London for signs of delirium.

“Both sets of data showed that delirium is associated with a positive COVID test in older individuals, particularly if they are frail,” says Claire.

They also saw that a third of the people who tested positive for COVID and reported signs of delirium through the app did not have a fever or a cough, while one in five hospitalised patients with COVID-19 did not have any other classic symptoms of the disease.  

The results highlight the fact doctors and carers should be aware that older people with delirium may have COVID-19, even in the absence of other key symptoms.

“Everyone who cares for older people should be aware that acute confusion may be the only sign of a COVID infection, so they can get tested, identify the problem early on, and stop the virus from spreading,” says Claire, who highlights that older people suffering from delirium may be unable to report other symptoms such as anosmia.

As a result of the publication of the research in the journal Age and Ageing on September 28th, Public Health England quickly updated their guidance, advising clinicians to obtain a COVID-19 test for elderly people presenting with delirium, even in the absence of other symptoms. The new guidelines were published on October 2nd.

Your data is improving the response to COVID-19

The updates to the guidance from Public Health England highlight the importance of the data provided by our millions of participants using the COVID Symptom Study app on a daily basis to log their health.

Without you, none of this would be possible. So we want to say a huge thank you for helping to make a difference.

“Whilst we knew from our anecdotal experiences early in the pandemic that older people with COVID were suffering from delirium, it takes data and peer-reviewed publications for this link to be reflected in updated guidance from Public Health England,” says Claire.  

“We are very proud of the contribution the COVID Symptom Study has made to their change in guidance, and much of it is thanks to our citizen scientists.”

“The COVID symptom study app has made a difference to national policy that will help frail, older people in many care settings,” says Claire.

Our work is far from over. We still need as many people as possible to download the app and spend just a minute every day logging their health so we can continue to track the disease, uncover key insights, and help public health authorities and the NHS respond.

“We are all in this together,” Claire says. “We urge you to keep logging, and keep tracking for your elderly relatives, so we can understand how COVID-19 affects all people and help keep everyone safe.”

Find out more:

• Probable delirium is a presenting symptom of COVID-19 in frail, older adults: a cohort study of 322 hospitalized and 535 community-based older adults – Age and Ageing
• COVID-19: investigation and initial clinical management of possible cases – Public Health England
• How does coronavirus affect the brain? – COVID Symptom Study
• Delirium is a key sign of COVID-19 in frail, older people – COVID Symptom Study