Thus far, 2025 has brought us some thirty thousand or more flu deaths, almost 900 measles cases, and 700+ COVID deaths. Gone is the obsessive focus on sequestering the aged or mandating vaccination, even as all three diseases are highly contagious vaccine-responsive, and vaccination rates are waning. Current policy for COVID-type epidemic response, however, again places greater strictures on the aged on the premise that this age group is the most vulnerable. Given that Dr. Jay Bhattacharya, one of the authors of the Great Barrington Declaration, now heads NIH, we should be wary of similar responses going forward. Sadly, any targeted isolation response on the aged is flawed – and its sequelae are ill-conceived.
The predicate for the containment policy of the aged at the inception of COVID (along with draconian lockdowns in nursing homes) was the oft-touted statistic that 80% of all COVID deaths were in the elderly:
“Seniors in general represent 80%of COVID-19 deaths” - Senator Susan Collins.
As a result of this sentiment, harmful draconian lockdowns were enacted, focusing on the aged, including restrictions on visitation in nursing homes, which caused additional or excess deaths, especially in those with dementia. (10,000 excess deaths were reported in the UK in April of 2020 alone.) In defending his Great Barrington Declaration, Bhattacharya argued for “focused protection.”
“The aim of focused protection is to minimize overall mortality from both COVID-19 and other diseases by balancing the need to protect high-risk individuals from COVID-19 while reducing the harm that lockdowns have had on other aspects of medical care and public health.”
Focused protection is poorly defined, based on the misleading statistic that “there is more than a thousand-fold difference in COVID-19 mortality between the oldest and youngest.”
Even New York Governor Cuomo adopted this approach when enacting Matilda’s law:
“to protect New York's most vulnerable populations, including individuals age 70 and older, those with compromised immune systems, and those with underlying illnesses. The measure requires this group of New Yorkers to stay home and limit home visitation to immediate family members or close friends in need of emergency assistance.”
The ensuing harm and discriminatory implementation of this approach has been subsequently acknowledged:
“It is highly likely that mandates and passports have been implemented in ways that discriminate against disadvantaged groups including immigrants, the homeless, isolated elderly people, those with mental illness, specific cultural and religious groups, those in precarious living circumstances, and people with certain political views and values.”
The higher numbers and percentage of COVID deaths among the elderly are surely true. However, two other salient statistics are ignored or go unnoticed. Increasing age, by itself, is a significant driver of mortality. While oldsters die at similar rates from influenza, we don’t ordinarily constrain the movements of our oldsters for fear they will succumb to flu or pneumonia – that response was unique to COVID-19.
The unfortunate policy of locking down the aged was enacted without specifying how that conclusion was reached other than touting the raw numbers of deaths. Nor were deaths in the aged stratified by co-morbidities, a metric more meaningful to an 80-year-old nursing home resident on dialysis. Nor were the risks faced by the elderly compared to those faced by younger cohorts. Once the higher death rates in the elderly were confirmed, researchers backed into justifying their assumption that the elderly were more vulnerable (specifically) to COVID, irrespective of any real experimental or epidemiological assessment.
Some experts claimed,
“It is clear, however, that age alone is by far the most significant risk factor for death due to COVID-19.” [1]
Others discount any specific frailty other than non-age-related co-morbidities.
“[Our] results do not support simple age-based targeting of the older population to prevent severe COVID-19 infections.” [2]
The discord could not be more pronounced
Mixing Mortality Metaphors and Skewing Risky Messages
To construct future policy, these divergent risk assessments must be placed in context.
Aging, by definition, presents the greatest risk of death; it is 100%. Whether it be due to accumulated morbidities or ongoing DNA and immunological disrepair is of little concern in projecting the number of anticipated deaths.
Risks come in various flavors, the most obvious (albeit not necessarily the most useful) being absolute risk - the number of people experiencing an event in relation to the population at risk.
This metric, which underlies the CDC’s and Senator Collins’ policy-setting justifications, does not tell us much about causal mechanisms or why a particular group may suffer more or less than another. For that, we need to compute the relative risk by comparing two groups of people or the same group over time. While the absolute risk of COVID-19 is highest in the elderly, we need to know the relative risks for setting policy.
There are various ways to evaluate this concern, including sophisticated statistics adjusting for age and other confounding variables or simply looking at the most likely causes of death each age group faces. It turns out that it is not the elderly who are most likely to die of COVID, at least compared to other causes; it isn’t even the peri-elderly.
The elderly are far more susceptible to heart disease and cancer (in that order) and only confront COVID-19 as the third leading cause of death. Indeed, in 2021, the elderly were twice as likely to succumb to heart disease as they were to COVID-19.
Not surprisingly, the youngest age group does not expect to die from COVID-19 (although some cases were reported) [3] Perhaps the finding of greatest surprise is that those aged 25-44 (young/ middle age) were most likely to die from COVID-19 compared to any other age group!
As can be seen by the numbers in parenthesis (reflecting the mortality rate of COVID-19 deaths per 100,000 people), COVID-19 does kill many more people in the over-65 category than it does in the 25–44-year-old category. But that’s because fewer people die in the lower age group category overall.
From the view of “informed” consent, young to middle-agers should know that although there are minor risks associated with COVID vaccination, as a group, they are more likely to die of COVID than any other cause, except for unintentional injury – a fact that gets lost in the noise that the elders are the likeliest to die, falsely implying other age groups need not worry.
The elderly are still encouraged to be vaccinated for flu – which now far surpasses COVID deaths. Let’s just hope that should another lethal COVID variant reappear, we don’t start locking up the elderly again while the youngsters go out and spread the disease to those who have the most to fear from it, the 25 to 44-year-olds. Let’s instead urge all groups to vaccinate, including those who may not be most likely to die but most likely to transmit the disease to others.
[1] Why does COVID-19 disproportionately affect older people? Aging DOI: 10.18632/aging.103344
[2] Preexisting Comorbidities Predicting COVID-19 and Mortality in the UK Biobank Community Cohort Journal of Gerontology DOI: 10.1093/gerona/glaa183
[3] Although they were noted to be the group most likely to transmit the disease, suggesting that while they were not likely to get very sick, they were the prime asymptomatic spreaders and should be vaccinated.
