Nathan Stall is a geriatrician at Sinai Health System (SHS) in Toronto and a research fellow at the Institute of Health Policy, Management and Evaluation at the University of Toronto. Samir Sinha is the director of health policy research at the National Institute on Ageing (NIA) at Ryerson University, and the director of geriatrics at SHS and the University Health Network in Toronto.
Two weeks ago, #BoomerRemover – an appalling hashtag highlighting the higher mortality rates being seen among older adults infected with the novel coronavirus – started trending on Twitter. This week, building on the “trade-offs” that President Donald Trump has mused about as the U.S. economy sinks, Texas Lieutenant-Governor Dan Patrick suggested that older people (including himself) would volunteer to die so Americans don’t "lose our whole country.” Thankfully, the abominable hashtag and Mr. Patrick’s comments were roundly dismissed, but both incidents should make all of us consider the intergenerational complacency and ageism that has marred our response to the COVID-19 pandemic.
For weeks, we have known that COVID-19 was a serious global health emergency that would eventually make landfall in North America. Yet even as Canada started to record its first cases, most Canadians did little to change their level of concern or behaviour. Many were reassured by early reports that 80 per cent of individuals infected with COVID-19 experienced only mild symptoms, and that most of the serious infections and deaths occurred among older adults.
Despite increasing warnings from public health agencies, many Canadians still forged ahead with March Break travel plans. Some young Canadians went out to celebrate St. Patrick’s Day, despite the cautions. And in the United States, college students jammed beaches for spring break, with many justifying their actions because they were young.
Tellingly, the turning point in our societal psyche was not Canada’s first COVID-19 death – an older nursing-home resident in North Vancouver – but when high-profile figures such as National Basketball Association star Rudy Gobert, actor Tom Hanks and Sophie Grégoire Trudeau tested positive for COVID-19. New data highlighting that 38 per cent of Americans hospitalized for COVID-19 are under the age of 55, as well as alarming reports of an increasing number of young adults on ventilators, drove this reality home.
In the hours after the World Health Organization (WHO) declared COVID-19 a global pandemic, Canadians jammed stores across the country and started panic-buying, leaving shelves barren for the people who may need supplies most and who tend to buy them in small amounts at a time: frail, older adults.
Even as our level of societal concern and action has escalated over the last week, we are still ignoring many of the needs and concerns of older adults. Increasingly urgent and necessary calls for physical distancing (rather than what the WHO had initially called “social distancing”) have largely neglected the inevitable worsening epidemic of loneliness among this demographic. Visitation to many care homes, and now hospitals, has been restricted, and beyond phone calls from behind windowpanes, there has been little facilitation of needed socialization.
Meanwhile, suggesting that older adults should take it upon themselves to volunteer to die or self-isolate from the rest of us has only further victimized this population.
Many older Canadians are justifiably scared right now. They are scared of contracting a virus where 80 per cent of its deaths are among adults aged 65 years and older. They are fearful of the consequences of necessary physical distancing, including becoming socially isolated from their caregivers, whom many rely upon. And they are scared of having their health care rationed on the basis of age.
In Italy, COVID-19 quickly overran its health-care system, and Italian doctors were forced to judge who received ventilators based on who had the greatest chance of surviving and who had the most years ahead of them. This ethical reasoning, known as “distributive justice,” had to be applied because they were not equipped to treat everyone. Washington state hospitals are reportedly preparing to soon make those same kinds of decisions.
A pandemic gives us a wide lens into the state of our society. So far, our response has not been pretty. When this pandemic ends and humanity survives, how will older adults view the rest of us? Will we be remembered for our callous disregard and self-interest? Or will we be recognized for supporting all Canadians through initiatives such as special hours for older and immunocompromised shoppers, or online groups of volunteers promoting acts of “caremongering?"
The COVID-19 pandemic is just starting to ramp up in Canada. Right now, Canadians not only have the opportunity to flatten the curve of transmission, but also the troubling and heightened intergenerational warfare that has occurred. Let us all be more Canadian, and spread love, not COVID-19.
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