Well, we are in a mess. We have an ordinary sort of virus (whose closest relative is the common cold), which mostly causes a severe flu, from which most people recover without any complications. Admittedly it has a death rate probably more than twice than the usual flu we have every year, but compared with the plagues of yore (bubonic plague, (Black Death), typhoid, and the 1918 flu epidemic), this is a mild illness. It doesn’t come near AIDS, SARS, MERS, or Ebola,, the most recent really nasty communicable diseases to have threatened us, although they were quickly seen off with new treatments or vaccines. But nothing has caused the amount of fear, economic disruption and devastation of our day to day living, so quickly, as this has.

What is the difference? It seems to be that our civilisation has a moral code – that of wanting to look after the most vulnerable in our society; the elderly, the ill, and the poor, that is extremely admirable. Even countries with hard-wired policies of prioritising the needs of the fittest (the USA, the current British government, and China), have realised that a death rate of up to 18% of our oldest and frailest citizens is going to cause disruption on an immense scale, and that politically it would be unacceptable. The death rate of gay people from AIDS at the beginning of the 90’s, though huge, did not cause this economic upheaval even though many of the victims were economical active and successful, possibly because the target of the virus was a small minority and not as valued by the ordinary (straight) folk of the time. Happily both AIDS and the discrimination has since diminished greatly.

It shows that the elderly, our parents, grandparents, and other older relatives, are really valued, and younger people get really upset when they become ill and die before their time. Doesn’t it?

Yes in part, of course it does. But we also have to take into account that in the last 30 years our society has acquired a very large pool of elderly frail people, with many chronic conditions. This virus is, very cleverly, taking huge advantage of this new susceptible group of hosts.. The Coronavirus, proper name SARS-CoV-2, has mutated to target a particular protein – the ACE2 protein on the surface of cells, in order to get into the cell. This ACE2 protein is one which is found in the cardiovascular and respiratory systems, and when people already have problems in these systems, the virus can kill very easily. It is very clear that once people have severe pneumonia or sepsis with this virus and need ventilation and life support, they can be critically ill for 3 or more weeks and 50% of them may die. This will overwhelm even the most advanced health system such as that in Lombardy, as well as China. We don’t even know what the long term effects are in these people – they may be very debilitating. And It spreads very quickly because there are so many such people in such high concentrations alive today.

We also need to take note of the fact that some of these people, the over 60’s, are amongst the most powerful people on earth. This virus strikes at the heart of economic privilege. OK, we can be sure that the richest in society will be able to jet off to safe havens, and if they do get ill, will have the very best of treatment; but most well-off elderly aren’t able to do this and are facing a situation when health systems, especially those which have grown up to cater almost specifically for this age group, cannot cope. Understandably they are very frightened and upset,

The systems we have for dealing with this situation aren’t working. Testing and quarantine do work – China, Singapore and South Korea have shown this, but even China does not have an exit strategy. When the restrictions are relaxed it is highly likely that the virus will reappear. We need to develop new treatments and most of all a really good vaccine, very quickly, Yet one characteristic of coronaviruses and other upper respiratory tract viruses is that they mutate very quickly (this is why the current flu vaccine has to change every year) and so it will be a real challenge to develop a vaccine which will last more than about six months.

So, is there an answer? Not that I can see. But as a doctor, who practiced over a period of 40 years, I can see that the way society has changed has, very gradually, made this sort of problem inevitable. For instance, In the medical literature and the popular press it is clear that some of the deaths have been in people who were in hospital anyway, being treated for severe illnesses, and after death were found to have tested positive for the coronavirus. Almost any agent could have caused this death. In the old days when I started practising as a doctor, pneumonia was considered to be the “old man’s friend” – a release from suffering after a life lived to the full. Nowadays death is not allowed, it appears, under any circumstances. Ordinary flu kills about eight thousand people a year, again usually people in very poor health. This year these people will die because of coronavirus instead, because it is a more aggressive disease. There will be many excess deaths due entirely to this new virus, but the number of years taken away will not be huge.

I don’t doubt that we will beat this virus, but it has already done a huge amount of damage to the world as a whole. I think it should be a wake up call for health systems throughout the world. Thinking of the 17 old people who died of the virus in one nursing home over a period of 10 days – this terrible toll isn’t likely to be due entirely to bad practices in the home. It is a risk when you have so many frail people, who are on the trajectory which is bound to lead to death in the near future, all together in one place.

I think the answer must lie with us elderly ourselves. I am seventy five, fit and healthy (as far as I know) and enjoying life to the full. But I know I won’t be fit for ever. I have no wish to stay in the anteroom to death in a nursing home for years. There must come a time when we are able to say to our loved ones “I have lived a fulfilling and enjoyable life. I now wish to have the ability to have a big, or small party, or no party at all, and quietly slip off without suffering”. If I became severly ill with Covid-19, I am not sure I would want invasive ventilation and life support for five weeks, with no guarantee I would live or be able to enjoy life afterwards.
And I would wish for the power that now resides with us elderly – the baby-boomers, the ones that have taken most of the resources to ourselves, to be transferred as soon as possible to the younger generations, who should not have to feel they have to prolong the lives of their parents beyond what is reasonable.