Editorial | Helping the elderly and isolated in midst of COVID-19
The Government’s restriction on the movement of elderly people, to slow the rate of infection by COVID-19 among Jamaica’s most vulnerable demographic, is logical, but demands more for the strategy to be really efficacious. The Government must now provide specific help to people who must stay at home, but have little family or other social support.
Two things are clear about COVID-19. Without a vaccine to contain the virus, it is growing rapidly. And it is especially hostile to old people, especially those in the 70-plus age range, who have underlying medical conditions, such as diabetes, hypertension and cardiovascular diseases.
Indeed, the early analysis of fatalities from the virus shows that while the vast majority of persons around who are infected will have a mild form of the disease, 15 per cent of 80 and over, who contract the COVID-19, are likely to die. For persons in their 70s, it is eight per cent, and 3.6 per cent among those between 60 and 69. A little over one per cent of the people in their 50s also die, but thereafter the fatality rate declines dramatically, to between 0.2 and 0.4 per cent.
Italy, which, by Tuesday, had more than 6,000 deaths from the virus, or 85 per cent more than China, where COVID-19 first appeared late last year, is a case study of its virulence against the old. More than 42 per cent of Italy’s deaths are people over 80, and 32 per cent are people 70 and over. The average age of people who have died is 78.5. Most had an underlying medical condition.
The profile of COVID-19 in Italy broadly tallies with the country’s demographic. With 64 million people, Italy has the oldest population in Europe, with 23 per cent of its citizens 65 and older. The median age is 47.3.
This demographic is exacerbated by how COVID-19 spreads. People can carry virus long before they show symptoms and, apparently, can spread the disease while asymptomatic. By the time the problem becomes apparent, health systems can be overwhelmed, which appears to have been the case in Italy, with the rapid spread of infections and concomitant fatalities.
In the circumstances, the best way to manage the virus, in the absence of vaccine, is to slow its rate of transmission. The isolation and social-distancing policies, including limiting the operation of enterprise, that have been instituted around the world are good examples of the idea. The strategy also involves protecting the most vulnerable groups.
In that respect, the Government’s directive that people over 75 stay at home, and that those 65 and over should, if possible, work from home, is eminently sensible. Except that, like most of the other social-containment measures announced by the administration, it appears not to have taken into account the circumstances in which many Jamaicans live, or the support they may need to abide by the directives.
Nearly 370,000 Jamaicans are 60 and over, and 106,000 are 75 or older. Many of these people live on their own, with no one to conduct their affairs. Many suffer the anxieties that come with social isolation, which will be exacerbated by this lockdown, its good intention notwithstanding.
Further, up to a third of Jamaica’s population, or around 900,000 people, live in informal or squatter communities, many of them crammed in dilapidated tenements. There are the anecdotes of the people staying until late at night to avoid overcrowding in their living spaces. These make enforcing isolation and social-distancing policies difficult. The Government has to fashion responses to these real constraints.
Solutions to some of these problems, such as providing help to elderly people who live alone, can be dealt with relatively easily. For instance, the Government could mobilise some of the thousands of young people trained by the Jamaica Defence Force (JDF) under the National Service Corps (NSC) programme to help deliver basic services, such as shopping, paying utility bills, collecting medicines, etc., for the elderly who are under lockdown. The NSC graduates would have already been vetted by the JDF and other government agencies. Further, given the structure of the programme, it should be relatively easy, on an ongoing basis, to monitor the health status of this group, to protect themselves and the people they would serve.
Similarly, psychiatrists, psychologists and social workers should be harnessed to design community interventions, delivered, too, if required, by NSC graduates, to help community members remain psychologically healthy in difficult circumstances.