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I'm slightly surprised that the click-bait title "Covid-19 elimination: should we force our young to sacrifice their freedoms so the older generation can live a bit longer?" escaped editorial censure. It should be blindingly apparent that:
1. It is not just old people who fall ill and die from COVID-19. In the ongoing ISARIC study, currently at over 102,000 inpatients[1], the median age was 72 years—in other words, half of admissions were aged under 72. These data also dispel the myth that many of these patients were "about to die anyway". Many would have had ten or more years of life. Examining data for those intubated [2], half were 61 years of age, or younger.
2. Every country has taken a hit, but in some countries, the administration has bungled, arguably mainly due to weak, maladroit leadership (most prominently in the USA). Good science has been ignored. This has led to prolonged spread and ongoing death. In contrast, other countries with zero-COVID policies like Taiwan and New Zealand have ended up with greater freedom, and have not sacrificed older people based on misguided policies that flagrantly ignore commonsense epidemiological principles, principles well-established since the time of John Snow. A focus on short-term compensation for COVID-19 may turn out to be as overtly silly as a short term focus on climate change. What is required is something older people can teach you: fortitude.
3. Similarly, there has been much breast-beating about "the economy" but this is hardly evidence-based. In this context, it should be noted that a wealth of evidence suggests that population health actually improves during times of recession, even deep recession.[3] Human well-being surely trumps the short-term economic targets of politicians and the financial froth of economists. Or does it?
4. It is shameful to sacrifice older people for any reason, but if possible this is even worse where the evidence base for the 'sacrifice' is insubstantial or downright wrong. Repeated failures to control SARS-CoV-2 aggressively in the past have put the world in its current state of escalating deaths and overburdened healthcare services with all the knock-on effects that this implies. Continued failure will exacerbate things. In the worst-case, vaccines will either largely fail to protect the vulnerable, as occurred with vaccines for another coronavirus, feline infectious peritonitis[4], or have unacceptable, generic side-effects (such as demyelinating disease). A dispirited population will then still have to confront the necessity to eliminate COVID-19 through robust lockdowns and good, old-fashioned footslogging epidemiology. We need approaches that have already been shown to work, not hand-waving political speculation and trumpian promises that it will all go away.
If we want to be emotive in our titles, should we not shape them around those—many of them older people—who have not only sacrificed for the common good in the past, but continue to contribute, like Captain Sir Thomas Moore?
It seems wrong to sacrifice millions of lives worldwide so that the young can party.[5]
Re: 'Sacrificing freedom' and COVID-19
Dear Editor
I'm slightly surprised that the click-bait title "Covid-19 elimination: should we force our young to sacrifice their freedoms so the older generation can live a bit longer?" escaped editorial censure. It should be blindingly apparent that:
1. It is not just old people who fall ill and die from COVID-19. In the ongoing ISARIC study, currently at over 102,000 inpatients[1], the median age was 72 years—in other words, half of admissions were aged under 72. These data also dispel the myth that many of these patients were "about to die anyway". Many would have had ten or more years of life. Examining data for those intubated [2], half were 61 years of age, or younger.
2. Every country has taken a hit, but in some countries, the administration has bungled, arguably mainly due to weak, maladroit leadership (most prominently in the USA). Good science has been ignored. This has led to prolonged spread and ongoing death. In contrast, other countries with zero-COVID policies like Taiwan and New Zealand have ended up with greater freedom, and have not sacrificed older people based on misguided policies that flagrantly ignore commonsense epidemiological principles, principles well-established since the time of John Snow. A focus on short-term compensation for COVID-19 may turn out to be as overtly silly as a short term focus on climate change. What is required is something older people can teach you: fortitude.
3. Similarly, there has been much breast-beating about "the economy" but this is hardly evidence-based. In this context, it should be noted that a wealth of evidence suggests that population health actually improves during times of recession, even deep recession.[3] Human well-being surely trumps the short-term economic targets of politicians and the financial froth of economists. Or does it?
4. It is shameful to sacrifice older people for any reason, but if possible this is even worse where the evidence base for the 'sacrifice' is insubstantial or downright wrong. Repeated failures to control SARS-CoV-2 aggressively in the past have put the world in its current state of escalating deaths and overburdened healthcare services with all the knock-on effects that this implies. Continued failure will exacerbate things. In the worst-case, vaccines will either largely fail to protect the vulnerable, as occurred with vaccines for another coronavirus, feline infectious peritonitis[4], or have unacceptable, generic side-effects (such as demyelinating disease). A dispirited population will then still have to confront the necessity to eliminate COVID-19 through robust lockdowns and good, old-fashioned footslogging epidemiology. We need approaches that have already been shown to work, not hand-waving political speculation and trumpian promises that it will all go away.
If we want to be emotive in our titles, should we not shape them around those—many of them older people—who have not only sacrificed for the common good in the past, but continue to contribute, like Captain Sir Thomas Moore?
It seems wrong to sacrifice millions of lives worldwide so that the young can party.[5]
References
[1] ISARIC COVID-19 Clinical Data Report: 4 October 2020. doi: https://doi.org/10.1101/2020.07.17.20155218 (Preprint)
[2] BMJ 2020;369:m1985
[3] Tapia Granados JA, Diez Roux AV. PNAS October 13, 2009 106 (41) 17290-17295; https://doi.org/10.1073/pnas.0904491106
[4] Cloutier M, Nandi M, Ihsan AU, et al. Cytokine. 2020 Dec;136:155256. doi: 10.1016/j.cyto.2020.155256.
[5] https://www.weforum.org/agenda/2020/08/coronavirus-covid-19-who-youth-yo...
Competing interests: No competing interests