Covid-19, Older Adults and the Ageing Society

Suhita Chopra Chatterjee, Debolina Chatterjee

• Publisher: Routledge
• Year: 2022
• ISBN:
  9781000582741
• Edition: 1
• Topic: Medicine
• Subtopic: Health Care Delivery

COVID-19 has brought unprecedented challenges in the care of older adults. During the first surge of the pandemic, governments all over the world struggled with high disease severity and increased mortality among older adults.

This work documents the impact of the pandemic by collating information from different countries and by synthesizing inputs from several knowledge domains—Sociology, Gerontology, Geriatrics, Medicine and Public Health. The impact on older adults is examined primarily with respect to three main issues—pervasive ageism, spread of infections in care homes worldwide, and the unintended harm of public health measures on geriatric population in different care settings. The complex tensions between epidemic control and the need to respond to social and economic imperatives are investigated with respect to disadvantaged and vulnerable older adults. The book also critically examines international ageing policies with the intention of identifying gaps in pandemic response in particular, and approaches to older adult care in general. In the light of the evidence presented, lessons are drawn which might improve aged care and strengthen emergency preparedness. Finally, considering the evolving nature of the pandemic, new international responses to older adult care and pandemic management are presented as an epilogue.

It is anticipated that the book would help nourish critical thinking and implement new solutions to older care during and beyond the pandemic

1Introduction

DOI: 10.4324/​9781003286936-1

“Please do not leave the house. Ask your domestic aide to bring groceries for you and leave them outside the door. If possible, shop online.” It was March 2020. The young man seemed overtly anxious on the phone call from Seattle, where the first case of COVID-19 in the United States of America (USA) was diagnosed on 20 January 2020 in neighbouring Snohomish County. On 28 February 2020, a skilled senior living facility near Seattle reported its first positive COVID-19 test result from a resident, and by 18 March 2020, a total of 167 confirmed cases affecting 101 residents, 50 healthcare personnel, and 16 visitors were found to be epidemiologically linked to the facility. 34 residents and 1 visitor died.¹ “I wish you had picked up the know-how for online shopping the last time I visited you,” he expressed concern while talking to his mother in India. “The coronavirus is sparing the young but killing older people. Unfortunately, all my loved ones are over 60 with comorbidities–diabetes, asthma, hypertension, lung and heart disease, cancer. All of you are at risk.”

Early pandemic trends in coronavirus fatalities indicated that age was the strongest predictor of an infected person's risk of dying. Reliable estimates of the infection fatality ratio (IFR) or the probability of dying once infected, based on data from mainland China, revealed that the virus was more lethal among older adults.² Also, those with chronic conditions suffered from health deterioration and death from COVID-19. As per an initial report of the World Health Organization (WHO)-China Joint Mission submitted on 28 February 2020, among those who died globally, 13.2% had cardiovascular problems, 9.2% diabetes, 8.0% chronic respiratory disease, 8.4% hypertension and 7.6% cancer.³ Evidence to this effect started pouring in from different countries. The USA-Center for Disease Control and Prevention (CDC) reported that 38% of the 7,162 patients with COVID-19 had an underlying health condition. Among those admitted to Intensive Care Units (ICUs), 78% had comorbidities; and among patients hospitalized but not admitted to an ICU, it was 71%. An Italian study published in March 2020 reported that of hospitalized patients with COVID-19 infections, 98.5% had a pre-existing condition, and almost 50% of them had multiple morbidities. In the United Kingdom (UK), among people who died of COVID-19 in March and April 2020, 90% had at least one pre-existing condition.⁴

Before the boy hung up, he warned his mother again, “Self-preservation, not altruism! You need not worry for me, though,” he said, as he drew her attention once more to differences in immune responses among people of different age groups. “The infection appears to be mild in younger people. There is an evolutionary advantage for the young. However, in older people it leads to serious consequences.” He pleaded again after a pause, “If you fall sick, I am not sure how I will travel to India. And even if I do, I am not sure how I will return to the States again.”

Travel restrictions were still not in place and the WHO had not yet declared the outbreak a pandemic. Between 10 and 12 January 2020, it published a comprehensive package of guidance documents for countries, covering topics related to outbreak management of the new disease. This included guidelines on infection prevention and control, laboratory testing, national capacities review tool and risk communication. There were also advisories on community engagement, surveillance and travel among other issues. On 11 and 12 February 2020, a Global Research and Innovation Forum on the novel coronavirus was convened by WHO and was attended in person by more than 300 experts and funders from 48 countries, and by 150, virtually. Participants came together to assess the level of knowledge, identify gaps and accelerate and fund priority research equitably. Topics covered by the Forum included the origin of the virus, natural history, transmission and diagnosis. Epidemiological studies, clinical characterization and management, infection prevention and control were discussed. Research and development for candidate therapeutics and vaccines, ethical considerations for research and integration of Social Sciences into the outbreak response were also part of the deliberations. The global community was cautioned as to the need for high-quality, non-pharmaceutical public health measures, such as case detection and isolation, contact tracing and monitoring/quarantining and community engagement.⁵ The WHO, on 7 March 2020, issued a consolidated package of guidance covering preparedness, readiness and response actions for four different transmission scenarios: no cases, sporadic cases, cluster of cases and community transmissions. On 11 March 2020, the outbreak was officially declared as a pandemic. Soon countries locked their borders and subsequently clamped shutdowns and lockdowns within their national territories to combat the COVID-19 pandemic.⁶

The first surge of the pandemic in many countries of the world occurred in the winter and spring of 2020. This wave substantially ebbed during the summer, followed by an emergence of a second wave in the fall of the same year. Many international organizations involved in tracking the trajectory of the disease used the end of June 2020 as cut-off for the first wave.⁷ Initially, governments, despite being aware of the existence of the virus in other countries, failed to anticipate the risks in their own national boundaries. As a result, sporadic and cluster of cases gave way to community transmission. With gradual cognizance of the growing infections, governments had to impose national lockdowns and travel restrictions. By April 2020, about half of the world's population with more than 3.9 million people across more than 90 countries was under some form of lockdown, directed to stay at home by their governments.⁸ Research evidence demonstrated that lockdowns were effective at reducing the spread of COVID-19 and related mortalities.^9,10,11,12

COVID-19: The Making of a Pandemic

In late December 2019, a cluster of pneumonia cases of unknown origin shook Wuhan in China. On 31st of the month, when an alert was issued by the Wuhan Municipal Health Commission, a rapid response team was sent there by the Chinese-CDC and WHO was notified. Epidemiological investigation suggested that the virus might have originated in Wuhan's Huanan seafood wholesale market. Accordingly, it was shut down and disinfected, and active case detection and tracing started. On 7 January 2020, the causative pathogen was identified as a novel coronavirus, and genomic characterization and test method development ensued. Under an electron microscope, it seemed to have a crown-like surface and was responsible for two outbreaks of new diseases in recent history—Severe Acute Respiratory Syndrome (SARS) in 2003 (that resulted in around 1,000 deaths) and Middle East Respiratory Syndrome (MERS) in 2012–2013 (that resulted in 862 deaths), although not considered a pandemic.¹³ The virus was found to be distinct from both (SARS-CoV and MERS-CoV) coronavirus, yet closely related. Early cases suggested that COVID-19 (the new name for disease caused by the novel coronavirus) was less severe than SARS and MERS. However, the rapid onset of illness and mounting evidence of human-to-human transmission suggested that this virus was more contagious than the earlier ones.¹⁴

Globally, as on 30 June 2020, WHO received data pertaining to 10,185,374 cases and 503,862 deaths from national authorities. Region wise, Africa reported 297,290 cases and 6,010 deaths; Americas reported 5,136,705 cases and 247,129 deaths; Eastern Mediterranean countries reported 1,058,055 cases and 24,423 deaths; Europe reported 2,692,086 cases and 197,254 deaths; South-East Asia reported 784,931 cases and 21,593 deaths and Western Pacific reported 215,566 cases and 7,440 deaths. There were also 163,865 new confirmed cases and 3,946 new deaths in the last 24 hours of the reported date.¹⁵ By 31 July 2020, the figures had increased to 17,106,007 total confirmed cases and 668,910 deaths. Americas were badly affected and the number of cases stood at 9,152,173 with a death toll of 351,121. USA had 4,388,566 total confirmed cases and 150,054 deaths with an average of 60,000 cases being recorded per day. Europe fared no better. There were 3,333,300 confirmed cases of COVID-19 across the whole of Europe since the first confirmed cases in France on January 25. Russia and UK were worst hit with 839,981 and 302,305 cases, respectively. Fatality rates were however higher in UK with 45,999 deaths. Italy, which was once the epicentre of the virus, was overtaken by Spain during July with 285,430 cases and 28,443 deaths. Among Eastern Mediterranean countries, Iran had 301,530 confirmed cases and 16,569 deaths, while India, among South-East Asian countries, recorded 1,638,870 cases and 35,747 deaths. The Western Pacific Region appeared better, with Singapore having 51,809 cases and 27 deaths, Japan having 34,372 cases and 1,006 deaths and China reporting 87,956 total cases and 4,666 deaths. The situation in some countries was much better. New Zealand had 1,210 confirmed cases and 22 deaths, while Vietnam had 510 cases and no deaths at all.¹⁶

The pandemic revived traumatic memories of past outbreaks–Swine flu (2009–2010), Hong Kong flu (1968–1969), Asian flu (1957–1958) and the Spanish flu (1918–1920). The Spanish flu was the most severe pandemic in recent history, although a comparison of excess deaths in New York City during the beginning of the COVID-19 outbreak with excess deaths from the peak of the influenza outbreak found COVID-19 mortality rates to be higher.¹⁷ Caused by an H1N1 virus with genes of avian origin, not much is known of how and where Spanish flu originated. According to estimates, about 500 million people or one-third of the world's population became infected with this virus and 50 million died worldwide.^18,19 A unique feature of the Spanish flu was that the mortality was high in young and healthy people in the age group of 20–40 years.²⁰ But it was not clear what made the 1918 H1N1 so devastating. In the absence of vaccines and antibiotics to treat infections, control measures were restricted to non-pharmaceutical interventions (NPIs) such as isolation, quarantine, good personal hygiene, use of disinfectants and limitations of public gatherings.²¹ This is understandable since medical science was in a nascent stage. The first antibiotics and flu vaccine were developed in 1928 and 1940, respectively, i.e., many years after the deadly flu. Lockdown, social distancing and masks saved the world then. It was seen that closure of public places like churches, schools and theatres significantly re...

Table of contents

• Cover Page
• Half-Title Page
• Title Page
• Copyright Page
• Contents
• 1 Introduction
• 2 Rearing Its Ugly Head: Ageism and COVID
• 3 Care Homes: The Neglected Cinderella Sector
• 4 Geriatric Harm of Public Health Measures
• 5 Revisiting the Ageing Carescape
• 6 First Surge COVID Lessons for an Ageing World
• 7 Older Adults Amidst a Persisting Pandemic: An Epilogue
• Index