COVID-19 has posed an unprecedented global health challenge. World over, including in high-income countries, the pandemic has exposed the non-resilience of health systems. Some countries that already have a part of their elderly population in the workforce are considering increasing the retirement age further, while some others are asking retired healthcare workers to rejoin to meet the looming health crisis. But is this a wise decision?
A recent study in The Lancet Infectious Diseases shows a steep age gradient in deaths from COVID-19. The case fatality rates are nearly four times higher for those over 60 years of age. They are 12 times higher for those above 70 years. With this evidence in hand, and no exceptions being reported, governments across the world have advised isolation for all those aged 60 and above.
Data | COVID-19 is deadliest for the elderly
An unwise decision
Healthcare workers — be it doctors, nurses, paramedical staff, or community health workers — are clearly at an increased risk of contracting COVID-19. In Italy, 20% of healthcare workers have been infected with COVID-19, and hospitals have been the focus for infection. Health workers go back to their homes too. With these facts in mind, it is unwise to engage any health worker above the age of 60 years unless there is no other option. There is a global crisis of medical-grade personal protective equipment (PPE) and so health workers are at an even higher risk. If the PPE crises is not solved, the proportion of health workers affected might be even higher than what has been experienced previously in other countries (which could import supplies from other countries, but that is impossible today).
Elderly healthcare workers are more likely to face serious consequences. Having a colleague succumb very early in the pandemic will hamper the morale of not only the health workforce but also the community. It is evident now that the COVID-19 battle will last for months and not a few weeks as was initially envisaged.
All elderly healthcare workers above 60 years should be ‘benched’ in phase 2 of the transmission and even in early phase 3 and sent home, much like what has been advised to the general public.
Interactive map of confirmed coronavirus cases in India | State-wise tracker for coronavirus cases, deaths and testing rates
Shortage of resources
However, the shortage of human resources for health is a reality that needs to be pragmatically overcome. The elderly health workforce should not be engaged at all in the initial phase, and the focus should rather be on upskilling students, trainees, and younger health workers up the professional ladder. As the crises deepens and when there is a need, the upskilled younger health workers can take up high-risk positions in emergencies, intensive care units, and in areas with community COVID-19 transmission. In contrast, elderly health workers, irrespective of their skill set, can take up low-risk positions.
A time to be humane
When this happens, the priority allocation of medical-grade PPE should be for elderly health workers. When ventilators run out it would mean that elderly people will not be provided one. Elderly healthcare workers should mandatorily be given preference over younger non-health workers. Governments across the world need to declare and enforce these policies and guidelines. This is a moral imperative for the society to protect those who have already done their part all their lives. Whatever way COVID-19 pans out, humans will survive. What we do now would determine if humanity will.
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