There is currently a discussion, relayed by media such as the Sun and MailOnline and circulated on social media, about the way Covid-19 predominantly impacts older people and those who have pre-existing health conditions. Some are advocating that those who are healthy and aged under 60 should not be subject to restrictions. There are several flaws in this narrative, from practical as well as ethical perspectives.
It is correct that 388 people aged under 60 with no pre-existing health conditions have died from Covid in England. Similarly, “only” 1,591 Covid-related deaths have occurred in people without pre-existing health conditions who are aged 60 or older. The majority of deaths – 45,770 – have occurred in people with pre-existing health issues (3,210 of them in people below the age of 60).
But what is meant by “pre-existing condition”? Included are things such as having had treatment for a mental health condition, having autism or other learning difficulties, asthma, chronic kidney disease, chronic neurological disorders, chronic lung disease, dementia, diabetes, rheumatological disorders (types of arthritis and other joint conditions), and ischaemic heart disease (angina and heart attacks). I have asthma, along with about 7% of the population in England. Should I happen to die from Covid (which is unlikely), I will be classified as having a pre-existing condition.
What’s more, health – and therefore the distribution of “pre-existing conditions” in society – is inextricably linked to wealth. Being poor means you are at increased risk of health conditions such as asthma and diabetes. Being poor decreases your life expectancy. The recently published Build Back Fairer: The Covid-19 Marmot Review highlights the link between deprivation and mortality from Covid-19 and other health conditions – the more deprived the local authority in which you live, the higher the mortality.
The best explanation of this I have seen is from Dr Mike Ryan, an executive director at the World Health Organization: “It is not just Covid-19 that is killing people, it is under-privilege, it is lack of access [to healthcare], it is years of living with health conditions that haven’t been properly managed because of the colour of your skin, or your ethnicity, or your social group.”
Suggesting that the young and the healthy should be able to live their lives unhindered by restrictions reduces social responsibility for Britain’s health inequality and draws a distinction between “them” (the poor and the at-risk) and “us”. We have little chance of eradicating Covid-19 (or many other infectious diseases) or preventing the next pandemic unless we take the issue of health inequality seriously.
The argument often made, citing mortality statistics for those without underlying health conditions, is that the economy will be ruined unless some are free to return to “normal”. It is not that simple. Society is interconnected, and our individual actions have an impact on others. Going to a pub or a restaurant requires people to serve the food and drink; others to supply the goods we consume; cleaners; and a host of other roles, many of which are occupations at increased risk of mortality from Covid.
The concept of “focused protection” is not new and was proposed by the authors of the highly criticised Great Barrington declaration. They suggested: “The most compassionate approach that balances the risks and benefits of reaching herd immunity, is to allow those who are at minimal risk of death to live their lives normally to build up immunity to the virus through natural infection, while better protecting those who are at highest risk.” The problem is, even if we accept this idea (I don’t), it is not feasible.
How do we keep about 15 million people (the estimated number of people in England with a chronic health condition) away from the virus, look after them in a Covid-safe manner, and keep society running? It would be near-impossible. Would they need to live separately from their families? Who would ensure they were fed and cared for during their isolation? Chris Whitty was correct to describe this approach as “flawed and operationally impractical”.
Accepting that we cannot protect millions of at-risk people from Covid, any virus circulating in the low-risk groups will rapidly transfer to those who will require healthcare when sick. If a health system (this is not an NHS-specific issue, as was seen in New York) becomes overwhelmed, it cannot provide healthcare for anyone. Reducing the transmission of the virus protects us all, whether we have pre-existing health conditions or not. If there is less Covid, the health system is more able to treat non-Covid illnesses to which we are all susceptible.
Death is not the only Covid outcome that matters, to individuals or the economy. The Office for National Statistics estimates that there are currently about 186,000 people living in households in England with symptoms relating to Covid that have persisted for five to 12 weeks: one in 10 people has symptoms 12 weeks after infection. Although preliminary, the data also hints that patients who were hospitalised with Covid may have increased rates of new diagnoses of serious cardiac, kidney and lung conditions, as well as diabetes. We still have much to learn about this new disease.
In the end, either everyone’s health matters or no one matters. Where do we draw the line? The narrative of “them” and “us” is a dangerous one, and the idea that Covid-19 will not impact us all is foolish.