SARS-CoV-2 and COVID-19 in older adults: what we may expect regarding pathogenesis, immune responses, and outcomes

Geroscience. 2020 Apr;42(2):505-514. doi: 10.1007/s11357-020-00186-0. Epub 2020 Apr 10.


SARS-CoV-2 virus, the causative agent of the coronavirus infectious disease-19 (COVID-19), is taking the globe by storm, approaching 500,000 confirmed cases and over 21,000 deaths as of March 25, 2020. While under control in some affected Asian countries (Taiwan, Singapore, Vietnam), the virus demonstrated an exponential phase of infectivity in several large countries (China in late January and February and many European countries and the USA in March), with cases exploding by 30-50,000/day in the third and fourth weeks of March, 2020. SARS-CoV-2 has proven to be particularly deadly to older adults and those with certain underlying medical conditions, many of whom are of advanced age. Here, we briefly review the virus, its structure and evolution, epidemiology and pathogenesis, immunogenicity and immune, and clinical response in older adults, using available knowledge on SARS-CoV-2 and its highly pathogenic relatives MERS-CoV and SARS-CoV-1. We conclude by discussing clinical and basic science approaches to protect older adults against this disease.

Keywords: COVID-19; Care; Immunity; Older adults; Pathogenesis; SARS-CoV-2.

Publication types

  • Review

MeSH terms

  • Aged
  • Angiotensin-Converting Enzyme 2
  • Animals
  • Antibodies, Viral / immunology
  • Betacoronavirus / genetics
  • Betacoronavirus / pathogenicity
  • COVID-19
  • Chemokines / immunology
  • Coronavirus Infections / immunology*
  • Coronavirus Infections / pathology*
  • Cytokines / immunology
  • Fever / diagnosis
  • Fever / virology
  • Geriatrics
  • Humans
  • Immunosenescence
  • Middle East Respiratory Syndrome Coronavirus
  • Pandemics
  • Peptidyl-Dipeptidase A / genetics
  • Pneumonia, Viral / immunology*
  • Pneumonia, Viral / pathology*
  • SARS Virus
  • SARS-CoV-2
  • Spike Glycoprotein, Coronavirus / genetics


  • Antibodies, Viral
  • Chemokines
  • Cytokines
  • Spike Glycoprotein, Coronavirus
  • spike protein, SARS-CoV-2
  • Peptidyl-Dipeptidase A
  • ACE2 protein, human
  • Angiotensin-Converting Enzyme 2