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Background: We reported clinical features of elderly COVID-19 patients who were initially asymptomatic or mildly ill, and characterized the clinical features of those requiring hospital transfer.

Methods: Patients with confirmed COVID-19 infection admitted to a community isolation facility (CIF) from May 21 to July 12, 2021 were assessed on demographic data, clinical symptoms, and pulse oximetry. The determinants of hospital transfer in the elderly patients (≥ 65 years) were analyzed. Residual symptoms were followed up among the elderly patients who left the CIF, regardless of hospital transfer or going home.

Results: Of consecutive 408 patients (20 to 91 years old), 67 (16.4%) were older than 65 years old. The proportion of elderly people with hospital transfer was higher, compared to the non-elderly patients (49.3% vs. 15.2%, p < 0.001). Elderly patients were more prone to develop dyspnea and fatigue, but fewer headache, sore throat, and dysosmia, compared to the non-elderly patients (all p < 0.05). Factors determining hospitalization for the elderly patients included dyspnea, low oxygen saturation, and persistent fever. The elderly patients with hospital transfer were more likely to develop sequelae, and fatigue (20.8%) was the most common symptom. Two elderly patients died after hospitalization.

Conclusion: The clinical profiles of the COVID-19 elderly diverged fromthose of the non-elderly. Admission to a CIF for asymptomatic or mildly ill elderly with daily monitoring of clinical presentation to decide hospital transfer is feasible during an outbreak. Early identification of elderly COVID-19 patients at risk of severe disease may deserve early intervention and improve treatment outcomes.