Is 50 The New 70?
Six months into the Pandemic it is time for a systematic stocktaking of what we know about Covid-19 and the options for controlling the disease during the winter and into 2021. The aims of this piece are to: (i) consider the position of older people in particular; (ii) warn against a divisive intergenerational framing of Covid-19; (iii) argue for an urgent stocktaking to guide decisions; and (iv) advocate for citizens being more directly involved in decision making as a counter to the over centralised and inept approach of the Prime Minister and his Government to date.
Two recent news items provide entry points to consider age related responses to Coronavirus.
• Proposals to extend annual Flu jabs to over 50s to reduce the incidence of winter Flu and thereby reduce a pressure on the NHS in the face of an anticipated rise in Covid-9 cases. This proposal was press released from HMG Department of Health and Social Care on 24 July.
• The idea of over 50s being assessed for individual Covid-19 risk with a view to imposing shielding type restrictions on social and economic activity was widely covered in the media from 2 August. This idea was attributed to a meeting of the Prime Minister and Chancellor to take stock of options for winter, with restrictions on over 50s characterised in the press as a ‘nuclear’ option. However Government sources described the reports as ‘speculative’ and the idea as ‘not under active consideration’
Both stories raise again the difficulty of applying broad age bands in a piecemeal fashion to define the scope of measures to control the spread of Covid-19 in the population. In essence the line between reasonable proposals based on sound health care principles and alarmist speculation is thin, taking us into the unhealthy world of misinformation and opinion manipulation. The over 50s ‘shielding’ idea is particularly damaging as it was linked to actual Government discussions and also led to knee jerk responses blaming young people for rising infections thereby pitting the generations against each other in the Covid-19 narrative.
From the outset government health advice to older people has been a one-size fits all warning that over 65s are particularly at risk from Covid-19 and should be especially careful to avoid infection. Beyond this broad risk assessment there has been limited attention to older citizens, which is why ‘lock up the over 50s’ type headlines are so disturbing.
What follows is an attempt to broaden the scope of consideration and position older age groups as part of a comprehensive population strategy for winter and beyond,
International Perspectives on Older People and Covid-19
• The United Nations Brief on Covid -19 and older persons of May 2020 sounds a powerful warning of the dangers posed to older people, not only by the virus but by inadequate government policies, and sets out a number of priority areas for national governments. For example: ensuring fairness in medical decision making; preventing neglect and abuse; targeting services at vulnerable older people; taking action to combat loneliness and isolation. This detailed briefing is specific to older people and offers an international benchmark for national planning and performance.
• The World Health Organisation (WHO) advice on use of masks, 5 June 2020 provides important guidance on provision for the over 60s as a vulnerable population. The key message is that medical standard masks should be considered for over 60s provided governments have sufficient supplies to meet medical needs.
Neither source has received much public attention or comment in the UK, yet both are highly relevant to the wellbeing and safety of older citizens. The WHO advice on masks for over 60s is potentially critical for older citizens in the coming winter period yet hardly featured in the acres of print in the UK devoted to the ‘behavioural problems’ around masking. Presumably the UK’s inability to meet demand in the NHS explains why no effort has been made to implement the WHO advice or even publicise it for open discussion.
A number of developments in Scotland/UK are highly relevant when seen in relation to each other and the international sources, but need more attention and response.
• Academy of Medical Sciences July 2020 Report on preparations for winter. This very detailed science based report is a key text to inform discussion. Three points stand out: (i) older people have suffered disproportionally so far; (ii) more should be done to provide comprehensive support for older people and others at increased risk; and (iii) people at risk should be fully involved in decision making about the nature and design of support they need. This later point is especially important in challenging the overly centralised and broad-brush approaches taken by the UK government so far.
• Centre for Ageing Better/Ipsos Mori Survey on experience of the over 50s in England (July 2020). The findings cover health, finances, personnel wellbeing and social relations, showing a mixed pattern of positive and negative experiences. This work evidences a need to support those who have experienced decline and an opportunity to build on the resilience of those who have had a more positive time. The challenge to government is to: (i) promote physical activity and health; (ii) support over 50s to remain in work; (iii) improve poor housing; and (iv) encourage more community involvement.
Turning to the risks of the post lockdown period there is a blunt warning that without action many in this generation face unemployment and a retirement scarred by the impact of the lockdown. Overall the report is a timely counterpoint to the substantial media coverage of the financial and employment predicament of young people and the higher mortality rate among the old. Thereby providing a much more balanced picture of the intergenerational landscape and the range of social, economic and public health responses needed as we move out of lockdown into the longer term effort to manage the pandemic.
• Scottish Parliament Covid-19 Committee. This committee chaired by Murdo Fraser, MSP, provides Parliamentary scrutiny and has produced a substantial portfolio of papers. A letter from Murdo Fraser to John Swinney, MSP and Deputy First Minister (DFM) on 24 June is helpful. The letter deals primarily with the easing of restrictions and highlights the need to develop more tailored messaging to support phased easing of restrictions. Crucially the letter goes on to ask how the Government will go about developing specific guidance for particular social groups including older people.
John Swinney’s reply of 18 July refers to older people and acknowledges some concerns on their part. The main response is to report discussion with “…older people’s stakeholders and those concerned with social isolation and loneliness …”. Whilst it is good to know that older people’s concerns are on the DFM’s agenda, much more detail will be needed to assess how much attention is being directed to understanding and satisfying those concerns.
These items challenge the simplistic but dominant ‘over 60s are more vulnerable to infection’ basis of UK policy so far and demonstrate that much more needs to be done to develop a detailed and varied programme of response for people in the older age groups.
At the moment the issues raised by social and economic hardship allied to the need to get schools, universities and FE colleges back on stream for their normal term times are in the foreground, and there are risky trade offs involved in these efforts. However that should not mean that the position of older citizens is pushed into the background with specific measures underdeveloped as a result. We need a comprehensive approach to meet the needs of all ages and that requires a systematic stocktaking of the situation going into winter and on into 2021.
Proposal: An open and informed stocktaking
It is now time to synthesise the ‘science’ and use it systematically and calmly to decide what to do next as a society. This stocktaking needs to be opened out in a form to replace what Sir Paul Nurse, Nobel Laureate and Director of the Crick Institute, described as the “black box” of centralised decision-making. He went on to say: “Decisions are too often shrouded in secrecy. They need challenge and we need processes to ensure that happens. If they are going to keep the trust of the nation, they need to make those discussions more public.”
The message is clear – open up decision making, access a wider range of information sources, include the views of the population generally and pay more attention to specific groups like older people. Several points will illustrate how this might be done.
• First, identify the state of the ‘science’ at this point, summarise it and publicise it in accessible forms. A recent article in Nature offers a concise basis for such a scientific stock taking by identifying five key questions about Covid-19. These are: (i) why do people respond so differently; (ii) what is the nature of immunity and how long does it last; (iii) has the virus developed any worrying mutations; (iv) how well will a vaccine work; (v) what is the origin of the virus. We need to summarise what is known/ not yet known and consider the implications for managing the spread of the disease.
• Secondly go back to the original Imperial College London Covid-19 Team’s paper on Non Pharmaceutical Measures, which set out a basis for the range of options for control measures. This offers a benchmark for stocktaking the practical measures identified and consider the trade offs between them in the light of experience since the start of the pandemic.
• Thirdly include what expert commentators like Independent SAGE have been saying/proposing. They are notable for holding some of their meetings online so that more people can hear them. And they are openly trying to provide different perspectives to government.
• Finally we need a wider public debate in Scotland since we cannot easily get it from Westminster. We have a Covid-19 scrutiny Committee in the Parliament and we have a Minister for Older People, Christina McKelvie MSP, to provide a critical focus. The Minister can be expected to take a lead in ensuring that older people’s rights and interests are kept to the fore in developing Covid-9 strategy across the full range of ministerial portfolios. However that valuable role can be enhanced by direct ministerial communication with the public and pensioners in particular, in addition to any work with stakeholder groups.
A starting point would be for Scottish Government to establish a direct and open dialogue with pensioners. Pensioners all receive details of Winter Fuel Allowance payments in the autumn so contact details are available. The interests of the 50-65 age group are just as important and health professionals, community groups and the STUC can open up parallel channels for direct communications with their clients and members.
A systematic approach to winter and beyond based on a stocktaking of the state of knowledge offers a much sounder basis for opening up areas such as work, education, healthcare, hospitality, and socialisation, whilst paying more focussed attention to the needs of different age groups. However the overriding strategy needs to include the whole population and avoid divisive conflicts between the young, workers and the old.
The age related frames used to design Covid-19 measures when applied to ‘older people’ have been crude and can tend to ignore citizen’s rights and views. A parallel narrative of blaming the young people for flouting the rules is emerging, which is just as negative.
An urgent public stocktaking is needed to counter the UK government’s centralised approach, which is overly driven by Number 10 and can be characterised as Boris and Dominic treating a public health crisis as if it is a Tory campaigning exercise like Brexit or the 2019 General Election.
A better winter is possible for all of us but it needs a more comprehensive and distinctively Scottish approach than has been shown to date.