Although coronavirus is a new disease, scientific evidence indicates that the older a person is, the more likely they are to die from it. In conjunction with the impact of the coronavirus epidemic on our society and economy, this has led some to suggest that the best course of action may be to have age-based restrictions. So should older people be shielded while the rest of the population go ahead with living their lives as they did before?
Simon Stevens, the Chief Executive of NHS England, has recently commented that such a course of action would amount to an ‘age-based apartheid’. Age UK is in agreement for the following reasons:
1. Age-based restrictions are ageist
There are more than 10 million people aged 65 and older in England, almost 1 in 5 of the population. Not all older people are equally at risk of becoming severely ill with coronavirus, and the reasons for differences in risk are not yet fully understood. Therefore, restricting the freedom of such a large group of people purely because of their age is discriminatory.
2. Age-based restrictions pose a risk to older people’s health
We have already seen that older people’s health has suffered from the restrictions imposed during the first wave of coronavirus. Spending long periods at home may have a debilitating effect on older people’s physical strength and mobility can be reduced. An age-related lockdown would mean that many older people would become increasingly frail – a situation that would be difficult if not impossible to reverse once the epidemic has receded. In addition, we would see a substantial impact on mental health as older people feel locked away, isolated, and as if their role and contributions to society were dispensable.
3. Age-based restrictions are impractical
Many older people have a practical need for daily contact with other people. 2.3 million older people in England need help, from family, friends or formal carers, with day-to-day activities including getting in and out of bed, washing, dressing and eating. In an age-based lockdown these needs would still need to be met. These older people therefore can’t be kept completely shielded from the rest of the population.
In addition to those older people who need daily support from others, there are those that the rest of society depends upon. 1.3 million people aged 65 and older in the UK remain in paid work, whilst many others offer their support to others as carers, volunteer in other ways and provide childcare to their grandchildren. Without these paid and unpaid contributions oiling the wheels of our society our economy would suffer.
So, age-based restrictions won’t work for older people. But could they work for the rest of society? At Age UK we think that the answer is another unequivocal no. We are in agreement with the large majority of scientists that the risks of allowing the virus to run through the community unchecked are too great, and that taking these risks is unnecessary.
4. It’s not only older people who are at greater risk of dying
As coronavirus is a new disease, doctors and scientists haven’t yet been able to identify exactly who is at high risk of the disease and why. Characteristics beyond age – namely being male, being obese, having certain other illnesses, and being of Black or Asian ethnicity – seem to increase the risk of dying. It is not, however, well understood how or why these characteristics put people at greater risk, and it would therefore be impossible to determine who ought to be subject to restrictions alongside older people.
5. There are long-term consequences for coronavirus survivors
The majority of our understanding of risk from coronavirus concentrates on people who end up in hospital, or dying. However, there is growing evidence of long-term health complications for people who are not at high risk of these worst outcomes, what is becoming known as ‘long COVID’.
Scientists have not yet been able to sufficiently study those who are suffering so important questions, including how many of them there are, who they are and how long they suffer for, remain unanswered. Professor Tim Spector, a lead scientist for the COVID Symptom Tracker app, says about 1 in 50 people using the app who have coronavirus still have symptoms 3 months later.
However, this is most likely an underestimate, as people who experience symptoms for many months are less likely to continue reporting them to the app day after day. Until we understand the long-term consequences of having had coronavirus it is irresponsible to expose even those who are unlikely to die to this new virus.
6. This could be the return of 'herd immunity'
Alongside discussion of age-related restrictions often comes mention of ‘herd immunity’. This is the idea that if a large enough proportion of the population were to catch coronavirus, we could reach a situation where enough of the population would be immune to it that there would be no more large outbreaks, even without a vaccine. However, as coronavirus is a new disease we can’t yet answer important questions about how immunity works. Do people become immune, and how long does this immunity last? Without answers to these questions, we cannot know whether herd immunity is even possible.
7. This shouldn't be a choice between the economy and health
The conversation about how to handle the coronavirus epidemic is often presented as a simple choice, that we can either protect health through societal restrictions, or we can release restrictions to protect the economy. But this is a false choice, and it is possible to protect both the economy and our health. Although a vaccine against coronavirus is far from guaranteed, there are promising signs.
In advance of a vaccine we need a functioning system that enables us to test, trace and isolate people with the virus, to limit the spread and enable us to reopen society for the whole population, regardless of their risk from coronavirus. Discussion of age-related restrictions is a distraction from this much more desirable goal.
More articles by Dr Webb
Dr Elizabeth Webb is Head of Research at Age UK. She has an MSc in Epidemiology from the London School of Hygiene and Tropical Medicine and a PhD in Social Epidemiology from University College London.