In the U.S. and around the world, containment strategies have resulted in many preventable deaths among those at high risk of COVID-19 infection, while they have caused enormous collateral health damage without COVID for all others. With age-wide lockdown measures – including restrictions on school, business and worship activities – we protect low-risk university students and young professionals such as bankers, lawyers, journalists and scientists who can work from home. Meanwhile, older and high-risk members of the working class are exposed to the virus and risking their lives while creating the immunity of the population that will eventually protect us all.
The Great Barrington Declaration advocates a shift to a focused protection strategy that reduces COVID 19 mortality by better protecting the elderly and other high-risk groups. At the same time, low-risk children and adults – for whom lockdown causes more physical and psychological suffering than COVID risk – are encouraged to lead almost normal lives.
The declaration has met with great interest and a positive response worldwide and has so far been signed by more than 600,000 co-signatories. Volunteers have translated it into more than 30 languages, including Cebuano and Faroese. This response makes sense considering the tragic consequences of the ineffective closures, including the hunger of tens of millions of people in developing countries.
In the United States, where the closures have harmed the inner-city working class, nursing home residents and children, the statement has met with considerable resistance from some academics. The main criticism is the difficulty of separating the old from the young. Contrary to this criticism, there are many creative ideas to protect the weak and at the same time enable others to lead a committed and stimulating life. We need to distinguish between different work and life situations.
How can we better protect the residents of nursing homes? This is the most vulnerable population. Key safeguards include frequent testing of nursing home staff who are not yet immune and reducing staff rotation so that each resident interacts with fewer caregivers. Persons infected with COVID-19 should never be sent to nursing homes, and all new residents should be tested before arrival. Separating infected residents from other residents is also critical. At the same time, it is vital for their well-being and mental health to allow residents to spend time with family and friends, and this can be safely achieved by testing all visitors on the same day.
How can we better protect older people living at home? At times when transmission is high, older people should be offered to deliver food and other important items to their homes. At these times it is best to meet family and friends outdoors. We should provide quick tests for visiting relatives. Free N95 masks and instructions on their appropriate use should be provided when potential exposure cannot be avoided.
How can we better protect older people who are still working? People aged 60 years have a moderate risk of mortality from infection and many of them are still working. If they cannot work from home, they should be provided with workplace accommodation by their employer to avoid exposure. Alternatively, social security should provide temporary funding for three to six-month sabbaticals until the risk of illness subsides, with statutory protection against dismissal if older workers are willing to return to work.
How can we better protect older people in multi-generational homes? This is the most formidable challenge, but the key is family-specific solutions. We know that older people who live with adults of working age have a higher COVID 19 risk than older people who live with other older people, while those who live with children have no additional over-risk. If working-age household members can work from home, they can all isolate themselves together. When transmission times are high, another possibility is for an older family member to live temporarily with an older friend or sibling. They can isolate themselves together during the high transmission times in the community. As a last resort, alternative housing options such as empty hotel rooms could be offered for temporary accommodation.
Universities must remain open, as the closure of universities and the economic displacement caused by the lockdown has led millions of young adults to move in with older parents, increasing the regular close exchange between generations. Instead of testing students upon arrival on campus, universities should test students before they go home for Christmas or other holidays.
Although age is the most important predictor for survival of a COVID infection, comorbidities such as diabetes and obesity can slightly reduce survival rates. Younger people with such risk factors should take the same precautions as older people without them. It is important for everyone, young and old, to stay healthy, eat properly and take advantage of opportunities to spend time outdoors, perhaps walking, cycling or doing sports in some other way.
When transmission in the community subsides, older people can resume a normal life with minimal risk. How long this takes depends on the strategy used. If we continue to use unsuccessful age-related containment measures to suppress the disease without having an incredibly safe and effective vaccine, it could take several years before the epidemic ends. It is highly unlikely that the measures available to protect the elderly can be maintained for that long. If targeted protection is used, the pandemic would probably be over in three to six months.
Some have argued that it is impossible to separate older and younger generations. While 100 percent separation is impossible, with the current strategy of containment and contact tracing, we have “successfully” shifted the risk of infection from the professional to the working class. With the targeted protective measures outlined above, it will not be more difficult to shift the risk of infection away from high-risk older people.
Martin Kulldorff is Professor of Medicine at Harvard Medical School. His research focuses on the development of new epidemiological and statistical methods for the early detection and monitoring of outbreaks of infectious diseases and for monitoring the safety of drugs and vaccines after their market launch. Sunetra Gupta is a novelist and Professor of Theoretical Epidemiology at Oxford University with an interest in infectious disease agents responsible for malaria, HIV, influenza and bacterial meningitis. Jay Bhattacharya is Professor of Medicine at Stanford University, Research Fellow at the National Bureau of Economics Research, Senior Fellow at the Stanford Institute for Economic Policy Research and at the Stanford Freeman Spogli Institute.
The views expressed in this article are those of the authors.