Age has been used both to identify the impact of and shape the response to COVID-19. We have long heard that those who are 65+ are at greater risk; the CDC reports that people in this age group account for 8 of 10 deaths. As frightening as these numbers are, they do not translate into 8 of 10 elders dying, or even 8 of 10 of those infected. Indeed, case mortality rate data from Italy and China give a different view, ranging from 3-4% among those aged 60-69 to 20% for those over age 80. The concentration of elders who were infected and died in congregate settings meant for those in poor health (>1,300 so far in nursing homes in Massachusetts alone) inflates mortality figures. And we are discovering that persons who are younger and are healthy are dying; and deaths not attributed previously to the virus are now seen to be related, such as those from strokes.
Age relations, the systemic inequality between old and younger adults, increase the impact of what might at first seem to be aging per se. The unquestioning response to reports of high mortality rates and imputation of that fragility to age has had dire consequences. In Italy, where resources were stretched, physicians have denied treatment on the basis of old age. In some circles, deaths of old people were touted as sacrifice and tribute to younger generations. Some politicians, such as the Texas lieutenant governor, acknowledged the greater vulnerability of those 65+ but asserted that these elders would be willing to die to bolster the economy for their grandchildren.
Advocates for elders point to the fallacy of treating all those 65+ as a homogenous group. The cohort spans over four decades and includes 51 million people in the U.S. alone. Many are in excellent health; others are not. The likelihood of dying of the virus is much higher for the oldest group than it is for those 60-70. We would not generalize about the impact of their age on all those aged 5-50, or 20-65, but we think nothing of combining all those aged 65 and over.
We must also focus on the inequalities that construct old age as a less-valued status. We must ask: why use age as an indicator in the first place? Just as feminists have urged that we cease focusing on “sex” as biology distinguishable from culture, “because it is rarely specific enough to guide particular investigations, and because it is too easily confused with the more accurate composite phenomenon of sex/gender . . . .” (Springer, et al., 2012) so too is biological “age” confounded with the age relations that treat old age as a problem to be solved,as a threat to health and a cause of death.
The Texas politicians’ remarks were overt, as is the “joking” reference to COVID-19 as the “Boomer remover.” But the ageism that permeates the pandemic runs deeper. Research appearing in the New England Journal of Medicine showed that heart patients with birthdays on either side of 80 received different medical treatment, with those two weeks shy of that birthday being far more likely to receive bypass surgery than those who had just turned 80. In the present context of pandemic lockdown and overwhelmed hospitals, chronological age has become to many people a legitimate basis for denying those over age 65 personhood and adult status. Already seen to be “old” and thus tending toward the doddering, they are assumed not to be able to decide their treatments Colleagues over 65 have reported that their children lecture them on how to behave during the pandemic, explicitly on the basis of their ages, as if they couldn’t figure it out and decide for themselves. Comments about “old” people (judged by their appearance) being out in public abound. Some states have eased nursing home regulations such that these institutions are now granted immunity from liability as long as they are acting “in good faith” during the pandemic.Old people find themselves over-policed, underserved, and undervalued.
The deeper ageism that pervades response to the pandemic becomes clearer when we ask whether we could constrain any other group of adults for their own good. Recent data make clear that men and racial and ethnic minority group members are especially vulnerable to dying from COVID-19 infection. An (appropriate) uproar would ensue if, in response, treatment to these groups was limited or their movements restricted. This pandemic has brought ageism to the center of public policy and debate; SALC scholars have much to contribute to that discussion.