Protecting workers aged 60–69 years from COVID-19
Authors: Judith R Glynn
Journal: The Lancet Infectious Diseases (2020)

The initial estimates of the case fatality rate of coronavirus disease 2019 (COVID-19) from China and the published modelled estimates both show a very strong age-dependence.1The Novel Coronavirus Pneumonia Emergency Response Epidemiology TeamVital surveillances: the epidemiological characteristics of an outbreak of 2019 novel coronavirus disease (COVID-19)—China, 2020.China CDC Weekly. 2020; 2: 113-122Crossref Scopus (1297) Google Scholar, 2Verity R Okell LC Dorigatti I et al.Estimates of the severity of coronavirus disease 2019: a model-based analysis.Lancet Infect Dis. 2020; (published online March 30.)https://doi.org/10.1016/S1473-3099(20)30243-7Summary Full Text Full Text PDF PubMed Scopus (2273) Google Scholar In the UK, this pattern has been interpreted in public health terms as advice to cocoon (ie, isolate) those older than 70 years and those with underlying health conditions—but is this the right age cutoff? Applying the infection fatality rate ratios from new estimates (which assume a constant attack rate by age) to the age structure of the population of the UK,3Office for National StatisticsNational population projections: 2018-based.https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationprojections/bulletins/nationalpopulationprojections/2018basedDate: Oct 21, 2019Date accessed: March 31, 2020Google Scholar we can see how many deaths we would expect in each age group if there were 1 million infections (table). This shows that 70% of all deaths are in the over-70-years age group, so it is important that they are protected. However, nearly two thirds (64%) of the remaining deaths occur in the 60–69 years age group. This age group is not being particularly protected and includes many who are working on the frontline. Indeed, health-care workers have even been encouraged to come out of retirement to assist.TableEstimated deaths by age group if 1 million people in the UK population are infected with SARS-CoV-2Proportion of UK population (%)Infection fatality ratio (%)Number of deaths if 1 million population infectedProportion of deathsProportion of deaths if over 70s successfully cocooned0–912%0·00161%2<1%<1%10–1911%0·00695%8<1%<1%20–2913%0·0309%41<1%1%30–3913%0·0844%1121%3%40–4913%0·161%2062%6%50–5913%0·595%8038%25%60–6911%1·93%205419%64%70–798%4·28%353533%..80+5%7·80%385336%..Age group given in years. Infection fatality rates from Verity et al,2Verity R Okell LC Dorigatti I et al.Estimates of the severity of coronavirus disease 2019: a model-based analysis.Lancet Infect Dis. 2020; (published online March 30.)https://doi.org/10.1016/S1473-3099(20)30243-7Summary Full Text Full Text PDF PubMed Scopus (2273) Google Scholar and the population structure of the UK in 2018 from the Office for National Statistics.3Office for National StatisticsNational population projections: 2018-based.https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationprojections/bulletins/nationalpopulationprojections/2018basedDate: Oct 21, 2019Date accessed: March 31, 2020Google Scholar SARS-CoV-2=severe acute respiratory syndrome coronavirus 2. Open table in a new tab Age group given in years. Infection fatality rates from Verity et al,2Verity R Okell LC Dorigatti I et al.Estimates of the severity of coronavirus disease 2019: a model-based analysis.Lancet Infect Dis. 2020; (published online March 30.)https://doi.org/10.1016/S1473-3099(20)30243-7Summary Full Text Full Text PDF PubMed Scopus (2273) Google Scholar and the population structure of the UK in 2018 from the Office for National Statistics.3Office for National StatisticsNational population projections: 2018-based.https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationprojections/bulletins/nationalpopulationprojections/2018basedDate: Oct 21, 2019Date accessed: March 31, 2020Google Scholar SARS-CoV-2=severe acute respiratory syndrome coronavirus 2. Based on the Chinese data,1The Novel Coronavirus Pneumonia Emergency Response Epidemiology TeamVital surveillances: the epidemiological characteristics of an outbreak of 2019 novel coronavirus disease (COVID-19)—China, 2020.China CDC Weekly. 2020; 2: 113-122Crossref Scopus (1297) Google Scholar each death corresponds to about two critical cases (needing intensive care) and six people who require hospitalisation. Both for humanitarian reasons and to prevent overload of the health service, shouldn't we be protecting people older than 60 years and ensuring that those in that age group who are currently not working from home are moved to jobs with minimal person contact, whether it is in the health service, schools, government, or the private sector? My partner is older than 60 years and works in the health service. I declare no other competing interests. Estimates of the severity of coronavirus disease 2019: a model-based analysisThese early estimates give an indication of the fatality ratio across the spectrum of COVID-19 disease and show a strong age gradient in risk of death. Full-Text PDF Open Access