Abstract
COVID-19, the illness caused by the SARS-CoV-2 virus, has reached pandemic proportions. Although the virus can cause disease in anyone, it is particularly dangerous for those with various “co-morbidities” such as heart disease, hypertension, diabetes, obesity and others. Furthermore, advancing age (from about 60 on), even in those older persons without any accompanying illnesses, is a strong and independent risk factor for pneumonia, need for an ICU bed and death from the virus. It is therefore essential to find ways to protect all at-risk persons (old or young) from the virus but at the same time not harming, more than absolutely necessary their essential freedoms as well as taking into account their social/psychological needs. Compared with other OECD countries, Israel’s population is still relatively young, with only 11.5% being over 65+ with a smaller proportion of older persons in long-term institutions than that found in most other comparable jurisdictions. These factors might explain a part of the country’s (so far) relatively low rates of serious disease and mortality compared to those seen in other developed countries. However there are still over a million older citizens at risk and the numbers of infected, hospitalized and seriously ill persons are rising once again. This is no time for complacency.An analysis of the effect of age on the disease as seen through the principles of medical ethics is followed by a proposal as to how best to balance these sometimes conflicting goals. This paper relates mainly to older persons in the community since the Ministry of Health early on in the pandemic initiated an effective program (Magen Avot) meant to protect those older persons in long-term care institutions. Recommendations include the Ministry of Health publishing clear guidelines as to risk factors and offering sensible advice on how to practice physical (not “social”) distancing without exacerbating an older person’s sense of social isolation. In order to reduce the incidence of influenza (which can clinically be confused with COVID-19) and the potentially disastrous consequences of a “double pandemic” this coming winter, a robust flu vaccination program needs immediate implementation. Persons at all ages (but especially those 60+) should be encouraged and assisted to sign advance directives, especially those who do not wish to undergo invasive therapy. An individual older person’s wish to “make way” for younger people should be respected as an expression of his/her autonomy. As we enter the second wave, triage mechanisms and protocols need to be circulated in readiness for and well before a situation in which an acute imbalance develops between the availability for acute resources and the population’s need for them. The Ministry of Health, in cooperation with other relevant ministries and NGOs, should take the lead in developing plans, ensuring that they are carried out in an orderly, timely and transparent manner. The blanket is indeed not large enough but we must place it as judiciously as possible in order as much as possible to protect, cover and keep warm the body politic.
Highlights
The SARS-CoV-2 virus can effect anyone at any age
This means that a person at risk at any age must be free to make an individual decision as to whether he/ she is willing to go back out into society, take the risk of falling ill with COVID-19 and accept the consequences, dire they may be. This claim, in contrast to the one re the older airplane pilot falling ill and endangering all passengers, assumes that older persons are only endangering themselves were they end up needing hospitalization or an ICU bed. Should this second wave respond to steps being taken and wane quickly and Israel be assured that we have enough ICU beds to manage any surge, this claim will be valid and the older person or anyone with other risk factors must be free to take their chances
Closer to the elder pilot argument is the dire effect that too many people simultaneously falling ill with COVID-19 would have on hospital services but not exclusively ICU/ventilator beds
Summary
The SARS-CoV-2 virus can effect anyone at any age. As it continues to spread throughout the world it will clearly be with us for the foreseeable future. Chronological age (even when controlling for other characteristics) is clearly one of the most significant risk factors for COVID-19 pneumonia, the need for ventilator support and above all for death (ref [6]).
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