Impact of Frailty and Sarcopenia on Post-COVID Recovery

Older adults infected with COVID-19 have a death rate that is 20-40 times higher than young adults, and if they survive their recovery is often protracted and marred by functional decline and disability. Age cutoffs have been proposed for resource allocation though discriminating based on chronological age presents ethical issues and disregards the heterogeneity in health status that could range from vigorous to severely dependent in patients of similar age. Frailty captures this heterogeneity to better support treatment and disposition decisions, and inform post-hospital care needs. We and others have demonstrated that frail patients are 2 to 3 times more likely to suffer deaths, complications, and sequelae of functional decline and poor health-related quality-of-life. These sequelae are pervasive after resolution of the COVID-19 infection and have become known as the post-COVID-19 syndrome. While advanced age has been identified as a risk factor for PCS, this syndrome remains unpredictable and there has surprisingly yet to be a study examining the effects of frailty and sarcopenia (low skeletal muscle mass). A reason for this knowledge gap is the lack of consensus on how to measure frailty in COVID-19 patients since many frailty questionnaires and physical tests are not feasible because of patient acuity, personnel availability, and confinement precautions. One opportunistic approach to gain insights into multiple facets of frailty without extra time or cost (and without extra exposure to COVID-19) is to leverage routinely collected data including imaging and blood tests. While such tests are requested for clinical indications unrelated to frailty, they leave behind a wealth of untapped information about the patient's frailty, body composition, physiological status, and clinical risk.