Should we limit events to protect the elderly?

Would this protect communities where the coronavirus hasn't yet established?...
05 March 2020

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Question

How can elderly people be better protected in our communities where the virus has not yet become established? Do we need much greater preventative efforts by limiting mass attendance events, like my local Cheltenham Festival?

Answer

Listener Ken got in touch with this question - Chris Smith provided a virologist's perspective...

Chris S - Right. First of all, are elderly people at greater risk? And the answer is that they're at greater risk of complications from this. They're not at greater risk of catching it than anybody else. Everyone's at risk of catching it because no one has immunity and depending upon how sociable you want to be, your risk is going to go up.

Phil - But Ken's point is that these are the people that are most concerned. These are the people that are most vulnerable.

Chris S - Yeah. And so what one has to consider is: I know what my risk is. Therefore, if I'm older, I'm at a higher risk. If I'm younger, I'm at a lower risk and I can make a judgement about whether or not I want to do anything about that. If I decided I want to do something about that, there are some simple practical things you can do. If you live on your own, or you know, just with a partner, then it may be possible to adjust your lifestyle. I was talking to one person the other day who said that what she and her husband have taken to doing because he's at higher risk, is that they will go and do their weekly shop in the evening when they know the shop has fewer people in it, so they're going to bump into fewer members of the public who might be incubating this. That's one thing. Two, you can tell your relatives and your friends to please let you know that they've got a cold or a cough or something before they come over, and in that way you can choose whether or not you want to socialize with people who might be able to infect you with something. And if everyone begins to use their common sense like this: don't go and see each other, don't take the grandchildren over when you've got some symptoms, because it's a fact that with any kind of infectious disease, the more symptomatic you are, the more infectious you are.

Phil - But is there not any argument for containment by limiting these huge events so that it doesn't get into, for example, the town of Cheltenham where Ken might live.

Chris S - There is an argument for doing that, and that's what Italy is trying to do as a huge experiment at the moment. Their approach has been to say, we're going to shut schools for 10 days, we're going to shut universities for 10 days. They've chosen those groups because they've got large groups of individuals who are young individuals who fall into this category, of potentially getting infected but not actually knowing they potentially are infected with this virus, and therefore being able to pass it onto other people. Those children also amounted to a large group who could pass it into their parents who could take it into the workplace, for example. So by reducing activity in those areas of society, they're doing the experiment to see, right, what's that gonna do to the spread of this thing? Is it going to slow it down? At the same time, they're effectively putting a huge chunk of their country into quarantine again to stop movements, and slow down the rate at which this trickles across the population because there's no going back. Now, there's no way we're going to stop this. We all accept that it is going to spread and it's going to basically spread to everybody eventually, but it's the rate at which it does that that matters, and if you can slow down the rate at which it's going across the country and through a population, you can smooth out the spikes because the danger here is, if you get lots of people who get infected all at once, the small minority that will have a problem if there are no healthcare services available because there are so many of them coming all at once. There's a danger that you then get a knock on effect on the health service and then you also get a secondary knock on effect, because, say, if the ambulance is not available for someone with a heart attack, because they're dealing with all these people with say a coronavirus infection, then people start dying of heart attacks. So that's what people are trying to do by doing these sorts of manoeuvers. But we've never been in this position so we just don't know. So it's very hard to say this is the way to deal with this because at the moment we're learning.

Phil - So if it were up to you, what would you say? Keep the Cheltenham festival? Maybe try and call it off, or too early to say?

Chris S - For now, too early to say, because we don't know what the numbers are going to be. We don't know what the level of circulation in the population is at the moment or henceforth. And therefore because we don't know the trajectory, we don't know how many of these measures we're going to have to resort to, to try and slow this thing down.#

Phil - Chris Rogers?

Chris R - Is there a risk that the negative effects of, for example, quarantining a huge number of people, can actually cause significant harm as well?

Chris S - Yeah, because if you've got, say an older person, who's dependent on a group of people caring for them, and those people then eschew that care provision because they're worried about either infecting the older person or getting infected themselves by going out and getting shopping and so on, that other person's going to have a care problem and that could have knock on consequences. Things may be missed, that person may fall over and hurt themselves and not be able to get up and they may go longer before someone comes and helps them. So there will almost certainly be consequences in that respect. And then there's the whole psychological aspect of this. If you talk to people who are on the boat Diamond Princess in Yokohama, they are going stir crazy. I mean it puts a whole new spin on the phrase cabin fever, I know, because you've got these people with coronavirus confined to barracks for two weeks, but they were finding it very tough indeed to be stuck in something resembling their wardrobe. Some of those cabinets didn't even have a window for two weeks and it sounds like a holiday. But believe me talking to those people, they said it absolutely wasn't. And I think that's a very real prospect that we're also going to get social isolation. You're going to get people with mental illness for example, who rely on contact with other people to help them stay well and stay ahead of say addictive problems and things like that. It could have all kinds of far reaching consequences. So we do have to be proportionate and sensible and not unleash the floodgates too quickly on these measures because there is a danger. But then people get complacent. People don't want to comply anymore because they're bored and then it comes roaring back. So that's what we want to try and avoid.

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