Betrayal of Trust? The Impact of the COVID-19 Global Pandemic on Older Persons

In a 2001 book review of Laurie Garrett’s “Betrayal of Trust: The Collapse of Global Public Health,” Dr Amir Attaran, the then Director of International Health Research at Harvard, referred to the content as the “stuff of nightmares” (Attaran, 2001). In her book, Garrett warns of profound vulnerabilities across the network of public health arrangements, medical institutions, and political infrastructure that could lead to the rapid spread of a future nefarious virus with devastating consequences (Garrett, 2000). Now, some two decades later, many of those forewarnings have come to pass as countries around the world attempt to control the spread of the novel coronavirus (COVID-19). In the devastating 3 months since first reports of people presenting with symptoms in China to the devastating events unraveling in places such as Bergamo (Italy) and New York City (USA), the COVID-19 pandemic has, as of April 6, 2020, spread to more than 200 countries, infected more than 2.7 million people, and taken more than 187,000 lives (World Health Organization [WHO], 2020). The complete landscape of COVID-19’s clinical presentation is emerging, but not yet fully understood. Similar to other pathogens within the coronavirus family, COVID-19 targets the respiratory system (Rothan & Byrareddy, 2020). New evidence is emerging, to suggest that COVID-19 may also affect the nervous and cardiac systems thereby obscuring how to effectively manage the disease process (Guo et al., 2020; Wu et al., 2020). The Centers for Disease Control and Prevention (CDC, 2020) report that after a 2to 14-day incubation period, symptomatic infected persons generally present with cough, fever, myalgia, and shortness of breath. Once infected, a person can experience a range of disease severity, from someone being fully asymptomatic through to someone fighting for their lives in a high acuity setting on a ventilator. According to the WHO-Europe, 95% of COVID-19 deaths are among people older than 60 years, and further, 50% of all deaths are among people 80 years and older (Lardieri, 2020; WHO Regional Office for Europe, 2020). Using an Italian and Chinese sample, Onder and colleagues (2020) reported an overall case fatality rate of 7.2%, with fatality rates between 0.3% and 0.4% for the 30to 49-year group, between 1.0% and 3.5% for the 50to 69-year group, and between 12.8% and 20.2% for those aged 70 years and above. While others have reported lower aggregated case fatality rates (Mahase, 2020; Porcheddu et al., 2020; Singhal, 2020), they all consistently report a concerning trend toward higher fatality rates among older age groups. The CDC report on their website that “Older adults and people who have severe underlying medical conditions like heart or lung disease or diabetes seem to be at higher risk for developing more serious complications from COVID-19 illness” (CDC, 2020). Overall, it has become rather clear that older persons, especially those who have underlying chronic health conditions, are at greater risk of contracting and experiencing serious illness with COVID-19 (Zhou et al., 2020). Not all older persons will contract COVID-19 thereby creating, for the purposes of our argument and for simplicity, two possible theoretical groups. First, a group of older persons who will acquire the virus and will struggle through the disease trajectory and second, a group who will not acquire the disease, but who will spend the next number of months under crushing isolation and under a great deal of stress and uncertainty. While the trajectory for each group differs, each could have rather monumental consequential outcomes, all of which could largely be mediated with appropriate early supportive interventions. First, consider the group of older persons who will acquire the disease. Based on global trends, they are very likely to require resource-intensive medical interventions, once infected. The challenge is that there may not be sufficient 924131 JAGXXX10.1177/0733464820924131Journal of Applied GerontologyLandry et al. article-commentary2020