Longer isolation for the elderly is not a punishment, it’s common sense

As discussion heats up about how the UK might eventually return to normality, a new row has blown up: what should happen to older people over the age of 70? Is it “arbitrary incarceration” to keep them indoors a while longer?

At the moment, the elderly are living under a strict – if difficult to enforce – instruction to stay at home in isolation. That means no contact at all with the outside world, apart from deliveries of food and essentials, along with necessary medical visits. How long will that continue?

This became the centre of heated debate in the UK’s upper chamber of parliament, the House of Lords, on Wednesday. Lord Blunkett, a former senior member of the Labour governments under Tony Blair, tabled a question asking the government whether it had assessed the impact of the policy and what plans it had to change it.

The response from Lord Bethell, a health minister, was non-committal. The government recognised that, although “shielding is for individuals’ own protection, it is an immense undertaking,” adding that the government will “constantly review all social-distancing measures.” Afterwards, Lord Blunkett told the Guardian: “I was very concerned by the government’s refusal to answer my question. Older people must not be subjected to arbitrary incarceration as well as isolation.”

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A former pensions minister, Baroness Altmann, also expressed concern: “I have real fears that ministers are considering blanket bans to prevent older people leaving their homes during the current crisis... Isolating all older people, if others are allowed out, also risks damaging their physical and mental health.”

Asking over-70s to isolate themselves is not an arbitrary decision. Covid-19 really is much more likely to be a serious illness in older people. For example, a paper published in the Lancet on March 30 examined statistics for China’s outbreak. The paper estimated that, for people aged 60 or over, the infection fatality rate (that is, including those who show very mild or no symptoms) was 3.28 percent. But that rose to 7.8 percent in the over-80s. By contrast, for those under 60, the infection fatality rate was just 0.145 percent. Earlier this month it was reported that 92 percent of deaths in the UK were in the over-60s, with more than half of deaths in the over-80s.

So, the risk of serious illness and death from Covid-19 rises very sharply for older people. Why that should be the case is not entirely clear. Perhaps it is that older people are much more likely to have other health problems and it is those problems that create the vulnerability. It may simply be related to frailty. The fit and active elderly may be at no more risk than many people 10 or 20 years younger. But for now, the correlation between age and risk is a strong one and should be taken seriously.

Society is now in lockdown specifically because Covid-19 is relatively deadly for older people and for those with other specific vulnerabilities – for example, diabetes, morbid obesity and cancer patients with weakened immune systems. For those under the age of 60, the risk from Covid-19 is nowhere near sufficient to justify limiting travel, closing schools and shuttering businesses.

Thus, 'shielding' older people may be essential to allow the rest of society to get back to normal. We minimise the risk of contagion for the most vulnerable, while allowing the rest of us back to work, education, some semblance of socialising, and the rest. It may be true that anyone can die from coronavirus, but in reality that is an official pretence to keep everyone obeying social-distancing guidelines. Our entire strategy should be built around protecting the vulnerable. Part of protecting those people includes releasing the economy to produce the goods and services, and the healthcare, that they are going to need.

That said, complete social isolation for months on end is not going to be sustainable. Older people need to take exercise like anyone else and they are more likely to be faced with the familiar problem that if they don't 'use it', they may well 'lose it' – for good. Many older people have lost their partners already, so extreme loneliness may well be a serious problem, too. So the policy may need to be modified. Perhaps taking exercise once a day while maintaining distance from others, as everyone else in the UK is currently allowed to do, would be wise. Maybe family visits could be allowed in a limited way – such as one person visiting once a week.

Nor should isolation be compulsory. Some older people may well prefer to take their chances and get 'out and about' more than is advised, rather than be kept in complete isolation. There should be a distinction between strong, well-evidenced advice and compulsion. The evidence from the UK so far is that if a policy is explained clearly, the vast majority of people will follow it.

Now is the time for much smarter social-distancing policies. Let's focus on protecting the vulnerable, giving them all the support we can, and start to unwind the lockdown.

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