"We have spent the last months enacting and debating uniform, universal public-health measures, which treat all citizens equally. But the disease doesn’t treat us all equally. Someone in their 80s faces 180 times the risk of someone in their 30s." (1/x) nymag.com/intelligencer/…
"As we’ve known nearly from the start of this pandemic, but have chosen to downplay in our public messaging and public policy, COVID-19 is brutally lethal for the elderly, considerably less so for the middle-aged, and still less so for the young."
"The disease discriminates by age, in other words, so much so that at least one-third of all deaths from COVID in the U.S. have been nursing-home residents and employees. According to the Kaiser Family Foundation, the figure could be even higher: one-half."
"This is not to say that the young are invulnerable: They are not. Even among the youngest age cohort, COVID-19 is a very scary disease and can be lethal."
"But according to the CDC, almost 60 percent of those who have died from the disease in the U.S. were 75 or older. Almost 80 percent were age 65 or older. Only 7 percent of deaths were those age 54 or younger."
"The data is just as striking elsewhere. In Italy, the case fatality rate, or percentage of those falling ill who ultimately die from the disease, is zero for age groups 0-9, 10-19, and 20-29. It is 0.3 percent for those ages 30-39 and 0.4 percent for those age 40 to 49."
"It is one percent for those ages 50 to 59 and 3.5 percent for those 60 to 69. At 70 to 79, the number jumps to 12.8 percent. At 80-plus, it jumps to 20.2 percent."
"To date, about 200,000 Brits have been hospitalized for COVID-19, and 25,000 have died in hospital; of those, 90 percent of deaths were patients older than 60."
“According to one international aggregation of case fatality rates, by @eladgil, depending on the country, the CFR for patients over 80 years old is 10-55X of CFR of patients in 50s, 30-100X of CFR of patients in 40s, and 60-240X of CFR of patients in 30s.”
"In the U.S., this age skew has become exclusively a talking point of the COVID-skeptical right. But noting that different groups are differently vulnerable is only an argument for throwing up your hands if you only have two options: total lockdown or total indifference."
"Strangely, that has been how the U.S. has chosen to fight this disease, embracing effective quarantines without even attempting to impose, in most parts of the country, less invasive social-distancing measures first..."
"...and without rolling out anywhere in the U.S. anything like the expansive testing programs that have allowed many countries, particularly in Asia, to avoid the need for extended lockdowns."
"And while a number of the reopening plans have suggested different regions could be classified differently, and could implement different levels of caution , there has been much less emphasis on how different groups within each community should be advised..."
"...and how public policy could be shaped to focus most on those most in need."
"Indeed, there has been remarkably little communication directed at individuals beyond 'stay at home' and 'wash your hands'—often the extent of the messaging to the most vulnerable is to say: “If you are over 65 and/or have a preexisting condition, you should be more vigilant.”
"So what would a more targeted public-health approach look like? Let’s take just the age-skew data and rewind to late February, when the first two residents of the Life Care nursing home in Kirkland, Washington, died from COVID-19."
"At that point, a national effort to focus on protecting the health of the country’s elderly could have begun in earnest."
"We could’ve immediately prioritized the supply of PPE to old-age homes, perhaps deploying a sort of national monitoring force of public-health officials to hold these facilities up to standard and ensure that new, coronavirus-specific hygienic protocols were enforced."
"We could’ve done the same for testing materials, requiring residents and staff to be regularly tested, as New York has just now started to do, only months later, after nearly 5,000 have died in nursing homes in the state."
"We could’ve stopped discharging from hospitals elderly patients who were going to return to nursing homes and potentially spread the disease, instead establishing a more centralized quarantine system like those in Hong Kong and Wuhan."
"We could’ve been much more emphatic and explicit in issuing behavioral guidelines for the elderly, their families, and those interacting with them, so that it was much clearer precisely what the risks to the old were and how all of those around them could try to minimize them."
"We could’ve provided additional support for those living alone, or trying to isolate, in part by ramping up meal- and prescription-delivery programs."
"We could’ve deployed the limited resources we had capable of real contact tracing to focus on elderly communities, and as we expanded those resources, we could’ve continued that focus even as the contact tracers expanded their purview to deal with more and more of the pandemic."
"All of this would have presumably required a much more competent federal government, and one much more genuinely focused on the need to protect its citizens, than the one we had or have."
"And yet it is also the case that it would’ve been considerably less costly, and less invasive, than the general-lockdown measures we have taken so far, or than those we are discussing now as a path forward."
"Indeed, all of these options are available to us now — we could secure nursing home and elderly communities around the country today for a fraction of the cost of population-level mass testing. And yet we're not even talking about it. Why not?" (x/x)
