On April 21, 2020, a panel of experts at Charles University in Prague published some thoughts on the Coronavirus pandemic. I recommend the entire article to you; it’s not long. What particularly caught my attention was advice on social distancing for the elderly and other vulnerable populations:
5. ELDERLY CITIZENS NEED SAFE SOCIAL CONTACT, NOT ABSOLUTE QUARANTINE
The stigmatization and imposition of limitations on older people in the “fight against COVID-19” is baseless and unjustified and establishes age discrimination in public sentiment.
As part of the solution to the COVID-19 crisis, the public is being massively persuaded by fear of the extraordinary danger of infection for “older” people and the necessity of implementing identical emergency measures for this very heterogeneous group, including not leaving their apartments or having specific shopping times. At the same time, the public is finding out that it is precisely these seniors affected by COVID-19 that could overwhelm the health care system. Suggestions were even raised to classify patients based only on age. Defining “endangered old age” at 65+ has led to an unprecedented stigmatization of 20% of the population of the republic, including people who are healthy and not particularly endangered. Some became uncertain of themselves or had to suffer the manipulative behavior of their environment. Many of them suffer from exaggerated fear of infection, from reduced contact with families, isolation, loneliness, deprivation of communication, disruption of daily routines with serious psychological consequences, disproportionate to the risk and the potential for reducing it. Several weeks without going outside has endangered fragile people through loss of stability, mobility, and thus self-sufficiency. However, there is no reason for them not to move freely in open spaces while keeping a distance from other people.
It appears that worsening of the COVID-19 prognosis is mainly related to associated illnesses, not age as such. These include nutritional disorders, oncological and cardiovascular diseases, diabetes, possibly some medications. It is not primarily “the elderly” who are affected, but those who are “fragile and severely ill”. In this, COVID-19 is no different from any other stress factor, including disease, as we know from influenza epidemics, heat waves or freezing weather.
Particularly problematic are residential social service facilities (senior residences, assisted living homes) and long-term care facilities. This is an instance of risky concentration of exceptionally fragile people with a number of serious illnesses. Experience from other countries as well as the initial data from the Czech Republic show that these people probably make up the majority of all COVID-19 victims. This shows that one’s health potential (fitness, resilience, adaptability) is a much stronger predictor than age as such. Many frail patients succumbed to this infection as a non-specific stress factor, just as they would have succumbed to the flu or a major injury.On the contrary, even in the Czech Republic, not enough has been done to protect this most endangered group — residents of residential social services facilities. These include the quality of preventive measures, personnel training, quarantine training, sufficient protective and hygiene products, frequent staff testing, the main source of its [the pathogen’s] introduction, testing in case of suspicious symptoms and the immediate transport of infected clients to high-quality quarantine facilities with the necessary care available should difficulties develop, and so on.
Steve Parker, M.D.
PS: Diabetes and obesity are risk factors for severe illness from COVID-19.