Intended for healthcare professionals


Covid-19: Isolating older people would be “age based apartheid,” says NHS boss

BMJ 2020; 370 doi: (Published 29 September 2020) Cite this as: BMJ 2020;370:m3788

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  1. Gareth Iacobucci
  1. The BMJ

Segmenting and shielding the oldest and most vulnerable groups of people from covid-19 rather than imposing local or national lockdowns would represent “age based apartheid” and should be rejected, the chief executive of NHS England has said.

Simon Stevens said such a policy, being advocated by some sections of the medical profession,1 was “implausible,” because while it was sensible for older people to take extra precautions they often received help from working age people. He also cited the negative effects of social isolation on older people as a reason not to pursue such a measure.

Speaking at an online conference hosted by Spectator magazine, Stevens pointed to the pattern of infections spreading in northwest England over the past few weeks, which began with young people but were now “beginning to ripple up the age curve.”

He said, “The idea that you could completely separate the fifth of the population who are aged over 65 [for example] is, I think, implausible, not least because some of the most vulnerable will be getting help from working age adults, some of whom will be younger and some of whom will be living in households with younger people, and so forth.

“And in any event, there would be legitimate concern about the social isolation that is giving rise to this very understandable discussion of how much visiting you can do in care homes, for example. So I think, in a nutshell, that extra precautions for those at greatest risk is clearly a sensible part of the mix. But, by itself, we’re not going to have age based apartheid across this country.”

Stevens was also asked what the UK’s biggest failure had been during the pandemic. He identified the failure to grasp the level of infections in February and March. “Fundamentally, the reason we will have ended up with the deaths that we have had is because we had much more coronavirus circulating in the community in February and March than was known about at the time,” he said.

“That in part is because of the absence of testing, [and] it is partly the case definition that originally attributed coronavirus type symptoms to being coronavirus if you had a travel history from Wuhan or China when actually … much more of it came from France and Italy.”

Stevens highlighted Office for National Statistics figures showing that 70% of working age adults who died from coronavirus had been infected before early March and therefore before the country went into national lockdown on 23 March.

“That will turn out to have been a crucial period,” he said.