Back to Normal from Covid-19

There has been much discussion of how to manage Covid-19 virus infections during the return to normal life.  There are many issues, but one in particular stands out for comment.

That issue comes from the much-noted age dependence of the virus death rate.  By now we’ve had plenty of experience of how this works.  For people under 50, the Covid-19 risk is similar to normal flu.  50-60 means more risk but still relatively small.  Over 60 it starts getting significantly worse, with the death rate more or less doubling for each ten years of age.  Pre-existing conditions make matters worse, but the age effect is still huge.  (There may be other categories of people worthy of attention, but that’s beyond the scope here.)

Overall reducing the death rate is primarily a matter of reducing the death rate for older people.  However, as a practical matter, focusing on the elderly is quite a big job.   If we’re going to protect the elderly from the virus at the very least we need to:  find them all, deliver food and other goods for them, assure fully-competent staff and daily testing at nursing homes.   No one is currently doing that.  On the contrary, death rates at nursing homes are scandalous, and individuals are largely left to manage themselves.  In Massachusetts as of this writing 610 of 1245 deaths were from nursing homes. Our extra hour of food shopping reserved for people over 60 is hardly a solution.

For the first bout with Covid-19 there has been neither the time nor the testing capability for such a strategy.  The countries that originally opted for “herd immunity”—with whatever they could do to protect the elderly—had to back off because of deaths.  The only alternative to catastrophe was to limit the spread of the virus in the population as a whole.  (There is a whole subculture of right-wing columnists claiming there was never a reason for the shutdowns, because it’s just a “simple” problem of isolating the elderly—without any proposals at all for how to do it.  For people who don’t go for that, there’s a different subculture dedicated to the proposition that the Covid-19 virus was never a problem to begin with!)

The point of this note is to recognize that the situation is different for the return to normality.  A focus on the elderly is both an obligation and an opportunity.  The obligation is that we just have to start doing a better job of protecting them.  It may be a logistical nightmare (only 5% of people aged 65+ are in nursing homes), but it’s a well-defined problem to be addressed with time, money, and commitment.  Testing is getting better.  It might even take the National Guard.  But we can certainly make things better if we start now.  We can call the right-wing’s bluff and spend the money to do it.

The opportunity of course is that reducing the elderly death rate will help ride through the ups and downs in new Covid-19 cases as people come back into the workforce.  People will still be getting sick, but children can go to school and parents can go to restaurants without risking anyone’s lives.  Whatever money is spent will be earned back in transition time.

This has to happen, it has to be fully-funded, and it has to start now.  “Flattening the curve” was essential to surviving the first onslaught of the virus.  For the return to normality, it’s “protecting the elderly” that will keep a difficult process going.

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