New Normals
May 11, 2020

Much remains uncertain about the new coronavirus, including its infection rate and its fatality rate. As if the natural uncertainty of such things weren't confusing enough, we're battered with conflicting narratives about the numbers, accusations of "fake news" tossed in every direction.

Thus far, it seems healthy people without any comorbitities aren't especially vulnerable. Some will be sick enough for hospitalization; some will suffer serious illness, but without hospitalization and without being in danger of death; some will suffer almost no symptoms at all. So far, the vast majority of those infected have survived. For the vast majority, it doesn't appear to be a killer virus.

Those claims are controversial, I suppose. But there is consensus about one thing: The elderly are extremely vulnerable, as are those suffering from various chronic conditions (diabetes, obesity, hypertension).

When practicing physicians talk about the pandemic, they often emphasize the need for good general health and building the immune system. When public health officials talk about it, they often emphasize drugs and vaccines. I hope one effect of the pandemic will be to redirect medical care more toward the former.

People over 65, and especially those over 75 are especially vulnerable. According to Worldometer, as of April 14, nearly half of those who died from or with COVID in New York City were over 75, and another quarter were over 65. Only 5% of the dead were under 45.

According to the CDC (data updated on May 8), 21,654 of the 37,308 people who have died from COVID were over seventy-five. That’s 58%. Another 8001 were between 65 and 74. In short, over 79% of COVID deaths occurred among people over 65.

Those numbers aren't perfectly accurate. They don't need to be. It's been clear almost from the start of the epidemic: The old are far, far more vulnerable than anyone else.

It's true, of course, that the elderly are far, far more vulnerable to nearly everything than those who are younger.

According to the CDC, over 2.4 million people died in the United States in 2007 (randomly selected year). Of those, over 1.3 million were over 75 (56%). Another 389,238 died between 65 and 74 (another 16%). Nearly three-quarters of all those who died were in the 65+ age group.

This might be taken as counsel to complacency. My point is the opposite. The COVID epidemic has brought the vulnerability of the old to our attention, but the old were vulnerable before the spring of 2020 and they'll still be vulnerable when the epidemic passes.

Scripture requires that we honor the aged (Leviticus 19:32), and according to Jesus this includes material support for them, particularly for aging parents (Matthew 15:1-11). That has to include attention to their health and safety.

But we've organized society to keep death and dying out of sight and out of mind. The elderly get shunted off to nursing homes. Many die in hospitals, enduring hopeless treatments that, one suspects, are motivated as much by fear of lawsuits as by concern for good of the patient (as a physician admits here).

In his recent Vexed, James Mumford describes the state of the elderly in "normal" times: "When an older person has to go into a home, she is coming to live with strangers - people she has no ties or association with. She has to shed her possessions, those things that made her home a home. And from now on she will typically be a solitary eater." The elderly are marginalized "from a position of authority in wider society" then withdraw "to the stifling circle of the immediate family," and then, if alienated from the family, dispatched into isolation. It all ends with "banishment to care homes."

As Dr. Kimbell Kornu said in his recent Theopolis lecture, we've medicalized death, and so lost the holistic traditional concept of the "good death." "Return to normal" cannot mean returning to forgetfulness of the aged and dying. Here we need a new normal.

Care for the elderly in homes is a huge challenge at present. Once the coronavirus is unleashed in a facility for the aged, it wreaks havoc. How do we care for the vulnerable in a time when they're vulnerable to us?

Public policy has to be designed with their needs preeminent. That doesn't mean we must remain in perpetual lockdown, and I'm not convinced total isolation is optimal even for the vulnerable elderly. It's certainly not a cost-free decision. How many are wasting away in nursing homes because they're alone, confused, unvisited, feeling unloved?

There are no obvious solutions, but we should raise questions about the current policy: Are there safe ways for families and friends to visit? Do seniors themselves have any choice in the matter? Is the isolation of the elderly just another manifestation of a creed that makes perpetuation of physical life the overriding end of medical practice?

The elderly aren't the only vulnerable people in the U.S. Many news outlets have reported that COVID hits African-Americans harder than the rest of the population. According to CNN:

"African Americans make up about 13% of the US population, according to the Census Bureau, but 27% of known Covid-19 deaths. In contrast, about 60% of the US population is white, but make up 49% of known Covid-19 deaths. Hispanics or Latinos are about 18% of the population, and 17% of deaths. Americans of Asian descent make up about 6% of the population and 5% of deaths."

The Guardian reports, quoting Thomas LaVeist of Tulane's school of public health: “'If you look at the health conditions that we know dramatically increase the risk of death if you’re infected with Sars Covid-2, African Americans have much higher prevalence of every one of those conditions. Diabetes, hypertension, heart disease, you name it, African Americans have a higher prevalence."

Perhaps there are unknown genetic factors at work here. But it seems likely that the disparity between African-Americans and other groups is partly the result of a cluster of causes: not only poorer general health, but poorer health care, living conditions, housing, and environment.

The pandemic hits African-Americans hardest because many are already hard-hit. As University of Pittsburgh physician Steven Shapiro put it, "This is a disease of the elderly, sick and poor."

To the extent that African-Americans are at risk because of poverty and associated factors, a "return to normal" is intolerable. We cannot be a society that works only for the strong, rich, and wealthy. Care for the least, the vulnerable, the marginal is the biblical standard of a just society. That must be at the heart of any new normal.

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