• Andrew D Kerr and Sybil Rl Stacpoole.
• North West Anglia NHS Foundation Trust.
• Clin Med (Lond). 2020 Nov 1; 20 (6): e222e228e222-e228.

ObjectiveTo identify the source of ongoing coronavirus disease 2019 (COVID-19) infections after 4 weeks of lockdown and to characterise the presentation of COVID-19 in the elderly, who represent the highest risk group.DesignRetrospective observational cohort study of 115 patients at one acute district general hospital with a catchment population of approximately 500,000 people, during weeks 5 and 6 of the UK lockdown.ResultsMore than 2 in 3 of the overall cohort had had contacts with the health and social care system prior to diagnosis. This figure rose to 85% in those 70 years and over. In the older cohort, the most common reasons for presentation were shortness of breath or falls, and 1 in 3 had neither cough nor fever.ConclusionCOVID-19 can present differently in the elderly, overlapping with many common presentations, so focusing testing on those with a cough or fever will miss at least 1 in 3 cases in those over the age of 70. A high degree of vigilance, suspicion and repeated testing is required if streaming into high and low risk areas is to succeed, allowing safe restarting of services such as elective surgery and cancer care.© 2020 Royal College of Physicians 2020. All rights reserved.

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