Staying in is hard to do

by Lucia Dore

Staying locked up for days on end is not easy. A day can feel like a week; a week like four. This is especially true for families with children at home, who probably need entertained much of the time. That’s why going outside and undertaking some sort of exercise is so important, be it running, cycling or walking. Certainly, in Britain and New Zealand people can go outside. In Italy, they can’t.

People in troubled relationships may also find it difficult to be cooped up with one another. The rise in domestic violence during this time is significant, according to reports.

There are about 3 billion people all over the world, including 1.3 billion people in India, who are under lockdown. That’s a lot of people.

Is lockdown the best approach? Is it the action of an authoritarian government? Should governments adopt a less draconian approach? Should people take personal responsibility for their health, like that taken in Sweden for example? Do people self-police themselves or does the state need to lay down the law? Does a “controlled approach” and the idea of “herd immunity” work?

Most countries have adopted a more authoritarian approach, which has not necessarily worked. The US, UK, Italy and Spain, in particular, have seen soaring cases of COVID-19 and rising death rates as well. Intervention by the state has often not worked effectively because intervention has been too late.

In almost every country, those over 70 have been told to self-isolate, along with other vulnerable people. This is because people in this age group are more likely to die from COVID-19 than any other. Why are they more vulnerable?

The answer is that their immune system is less robust than younger people and they may also suffer from other complications such as heart disease, diabetes, lung conditions or cancer. As Dr Amir Khan wrote in an article for Al Jazeera: “Elderly individuals are by no means defenceless against viruses, they often do not respond efficiently to new or even previously encountered agents.”.

He also says: “The production of white cells in the bone marrow slows down, and the rate of maturation is also much less robust than that of younger people, leaving them with fewer types of certain white blood cells needed to fight off an infection.”

He adds that there is evidence that older people's immune systems become less able to identify foreign agents. “This may result in something called a "cytokine storm" where the immune system goes into overdrive, not knowing when to shut itself off, thereby attacking healthy cells within the lungs and other parts of the body, making the effects of COVID-19 worse.”

The fact that so many older people live in care homes and nursing homes where highly infectious diseases such as coronavirus spread like wildfire also means there is a higher infection rate there. That has been the case around the world.

But should people who are older be left to die? There’s been debate about this over the past week. The COVID-19 pandemic is forcing senior doctors in Britain’s National Health Service to contemplate the unthinkable: how to ration access to critical care beds and ventilators should resources fall short. In the Daily Mail (dated 30 March) it states that ventilator “rationing” has begun in the UK, with only patients with “reasonable certainty” of survival being put on machines. Are younger people more certain of survival? Some older people may want to die but some may not.

For example, mid-life” women are the population group who are best prepared for emergencies. According to Pat Mitchell (77), celebrity and former CEO of outfits such as CNN Productions and the US’s public broadcasting channel, this is because by the time they are 60, many women have already handled a lot of change (divorce, bereavement, redundancy and menopause) so are more prepared to deal with new situations.

The impact of COVID-19 on the world has meant that many people, young and old, have had time to think about what they want to do in the future, including whether they want to live or to die. We must work as a society to ensure the welfare of older people and to ensure they live.

Photo: by Carole Railton (copyright). "Staying in is hard to do".