Do you want to live a longer life in good health? I have myself written quite a few articles on ageing (such as “Age doesn’t come by itself”) in this blog, so when I read about this on a popular website recently, my interest was piqued by such a question. Who doesn’t want to live longer in good health (or even otherwise)? Only those who are so ill that they see no future, or people with incurable depression, perhaps. But anyone enjoying good health and a satisfying life usually wants to live a longer life in good health, if it is possible.
In fact the item in question was, as you might expect, a fulsome exposition of wondrous scientific advances just around the corner that are going to lead to breakthroughs which will extend people’s lifespans considerably with no downsides. On looking at the detail of these, you can see that they are all tiny steps forward in understanding the ageing process, such as in gene therapy, plasmid delivery, faecal microbiota transplantation, regrowing the thymus gland and many others.They may all be genuine attempts to prolong life but the main emphasis seemed to be on getting private finance to support these initiatives, and it is unlikely that the true timescales of doing this will be communicated to those willing to part with their cash.
A better way of trying to improve the way we age would be to use drugs which have been in use for some time, and so don’t need large amounts of money to develop, and see if they will work. There are two examples which are being looked at. The first is a very old drug; one so old that GPs like myself were using it back in the 70’s. It is called metformin, and is still in use today as a very important treatment for type 2 diabetes as well as several other conditions. Researchers found that diabetic people who had been using it for decades had lower death rates overall (all-cause mortality) than their counterparts who had never used it, (1) despite their diabetes which usually increases death rates from various causes. They had fewer cancer diagnoses, and a lower rate of cardiovascular diseases than diabetics who did not take metformin. So the authors of this article considered that metformin could be extending lifespans and healths by acting as a geroprotective agent, suppressing the inflammation caused by senescent cells which are dying.
Another newer drug, rapamycin, an immunosuppressant, can increase lifespan in mice by about 10%, and this is thought to be because it inhibits a pathway called mTOR which is known to be involved with the ageing process, and has an effect on things like liver and heart degeneration(2). It has been shown to slow the progression of Alzheimer’s and Huntingdon’s disease, and in older people can dramatically improve immune function and vaccination responses – something which might be very useful right now, in the middle of a pandemic which is actively going to reduce human life expectancy by at least a year, it is said.
So perhaps we shouldn’t be looking at extending life just now, and our priority has to be to deal with the very pressing needs of this most serious health to human health in a century.
Fortunately the full extent of science to tackle these challenges has been exceptional, with the rapid development of several successful vaccines, some very helpful treatments, and an enhanced understanding of the importance of good public health systems all over the world. What has been amazing is how much scientists have discovered about this novel illness in such a short time. It now appears that that it is possible to work out who is most likely to suffer badly from this disease, and in what way, separating out the many who are not going to have anything more than a minor self-limiting illness. Firstly, looking the initial few days of the illness, it is found that the more distinct symptoms you have, the more likely you are to go on to get serious disease, and so should seek medical help early. The details are on the ZOE website (3), which Prof Tim Specter is running with great success. Some of the most distressing stories of early deaths from covid-19 have been how so many, often younger people, were admitted too late in their illness to be saved. This appeared sometimes to be the result of the algorithms used by the emergency 111 service, which told people to stay at home even though they were actually suffering from lung failure, because it was not realised that people could be suffering from very low oxygen levels without becoming breathless. (The symptom of breathlessness is actually more dependent on carbon dioxide levels being high than oxygen levels being low.) The use of pulse oximeters, which measure your oxygen saturation levels, at home would have allowed these people to survive by encouraging early admission to hospital. So if a patient early in the illness develops multiple symptoms they should contact a doctor and request a pulse oximeter so that they can check on their oxygen levels at home.
Algorithms and prediction models such as ISARIC4C (4) are also being developed from huge amounts of data collected by health systems which will predict the risk of a person already in hospital with Covid going on to develop serious disease. This would also help hospitals cope with the surge of patients. In addition, scientists are now able to tell from blood tests at the beginning of the illness whether a person’s immune system is likely to go into overdrive and so cause serious disease. (5) So, again, early medical intervention might be able to stop the process happening. The death toll in the near future might come down quite markedly.
So, looking ahead to a period when most people either have been immunised, or have had the disease with few ill effects, what can we say about how life will have been changed? Will it be enough to get us back to the position when we can genuinely look forward to living longer and more productive lives far into the future? Well, no. This pandemic has changed our lives forever…
Firstly it is plain that covid-19 will not have gone away. It will still be there, mutating regularly, but perhaps not so frequently because there will be less of it, circulating at a low level in the background, but still capable of causing severe spikes at times, especially in the winter. The particular problem with this virus is that it manages to infect other people while the infecting person is still going about his business, unaware that he is infected. This is unusual, and means it is no disadvantage to the survival of the virus if its hosts are ultimately killed, as the virus has already spread. So it is less likely that the virus will mutate to cause less serious illness, as other coronaviruses have done.
And how much will the at-risk elderly change their lifestyles? The latest guidance is that those who are very vulnerable will still have to self-isolate, even when immunised, far into the future. Only when it is clear that immunization totally prevents severe illness and death can we really say the risk is small enough to go out in freedom. Most older people will probably decide to get slowly back to normal and accept the extra risk. But I know many people in their seventies and older who will have effectively stayed in their homes for over a year when this is all over, and they may find it hard to go out without worry. They have often been able to occupy their time with solitary pastimes such as gardening, and reading, and to socialize
only on Zoom and the telephone, and some may no longer want to go back to the old times of mindless socialising and materialism (they think).
Likewise, younger people working from home may prefer this if the alternative is to go back to those dreadful long commutes, although for many women this has resulted in far more work and responsibilities within the home. It would be nice to think that workplaces will be flexible in making the better use of the change in work patterns for a better outcome for the worker.
The best news would be if working age people could get back to powering the economy so that some of the poverty and stress that the disadvantaged have suffered can be alleviated. We look forward to people mixing again with our social and cultural activities like music, drama, and hospitality getting back to normal.
We can be sure that all societies will be changed for ever by this pandemic. What is now clear is that we are not all in this together. The inequality that has developed in the last 30 or so years of the current models of socioeconomic development has ensured that much of the older generation – the wealthy property-owning retired – are enabled to better survive and thrive as they have the means to self-protect, while the people they depend on for their everyday needs – the key workers in power supply industries, water, food production, sanitation as well as healthcare – are the ones who are more at risk of death. Often there is a racial element, in that these workers are disproportionately from immigrant BAME or other disadvantaged backgrounds. One can envisage a situation that will exacerbate the generation divide, so that the overall standard of living of the young will decline quite rapidly, while the older cohorts will continue to be sustained by their arguably unfair economic advantages.
On the wider conclusions that may be drawn, health systems and social care need to be re-designed. Transport systems hopefully can be largely renovated and re-designed to fit our new patterns, and similarly hospitality, catering, and hotels, will change location to where people have moved to, out of city centres, and open spaces will be developed further now that we have come to understand the need for them.
These are changes we could easily make if the will is there. But what about the bigger ecological questions of sustainable living, which haven’t gone away? Are we better able to understand that the way of life we had is quickly going to lead to a severe breakdown in our climate and alter our way of life for ever?
This pandemic is actually well overdue. Scientists have been warning of serious pandemics for over twenty years, and the successful overcoming of the MERS and SARS-1 threats was only a taster. There are other diseases too that are being watched. One, called NIPAH, has a death rate above 40%, and that would really put everything in jeopardy.(6) Fruit bats are the natural host of this coronavirus and there is no treatment.
The number of humans on this planet now, compared with two centuries ago, shows exponential growth, and this is something that we are perhaps better able to understand, thanks to our being confronted with the exponential growth of this virus. Exponential growth is the hallmark of plagues, and we can now see that humanity is getting to the peak of its growth. We are likely to encounter more plagues after this one, because we are destabilising the ecology, the life support we need from other plants and animals, and the very fabric of our planet. There will undoubtedly be more pandemics. Scientists are particularly concerned with those that arise from bats, as did SARS-CoV-2 which causes Covid-19. Bats are known to harbour many coronaviruses, and in tropical regions such as in Asia the viruses flourish. Further population growth and encroachment of people into these previously secluded places increases the risk that viruses will cross over into people. It isn’t the fault of the bats; left alone, everything would be fine. We need to curb the population growth and accompanying indefinite (and impossible) consumption increases that are causing this problem.
It was interesting to see in the lecture that prompted this article (on prolonging life) that overpopulation was dismissed out of hand. They pointed to the fact that the world’s population is correcting itself as the birth rate falls in most developed countries. While this is of course something to be welcomed, it does not solve the problem as these people are already on the planet and enjoying a long lifespan, which could result in the ecology going over the tipping point, with extinctions of plants and animals continuing inexorably; and we shall pollute the land, the oceans and our atmospheres; a terrible legacy for our children and grandchildren.
The effects of a pandemic on overall population will depend on what age group the pandemic targets. The well known Black Death pandemics in the 14th century killed so many young workers (up to 60% of the population died) that eventually the remaining ones were enabled to put an end to feudalism. This ultimately led to a much improved life for generations to come, but that was very unusual. During pandemics, availability of contraception is often reduced so that, especially with this one where young childbearing people are not affected very much, there may be a considerable rise in population even as life expectancy falls. And after pandemics, the birth rate often rises, as optimism returns and people feel safe enough to reproduce, so the net result is that the exponential rise continues unchecked after a brief blip.
So the idea that humanity can look forward to living a longer life in good health is a pipe dream. Once the worst of this pandemic is over, we ought not to try to get back to where we were. That was a path that threatened destruction. And it would be even more destructive if we thought that science could engineer yet more years of healthy living for the few extremely wealthy elderly who could afford to finance it. This may not happen this time if the downsides of overpopulation come upon us quickly, but even so we need to be on our guard. The economic system we have now is similar to a giant Ponzi scheme, in which a growing population consumes more and more at the expense of future ecologies to the eventual point of collapse. There may be authoritarian leaders who do not want the population to fall, as that would reduce their power in their terms and leave them with a lowered capacity for wealth generation to the benefit of their small class of collaborators. I hope more people will understand the risks we are taking with our world, and finally act to ensure everyone’s chance of a longer life is taken into account.
1. https://pubmed.ncbi.nlm.nih.gov/28802803/
2. https://pubmed.ncbi.nlm.nih.gov/19587680/
3. ZOE website https://covid.joinzoe.com-19
4. ISARIC4C *https://www.doctors.net.uk/blog/opinions/2021/01/25/big-data-can-help-doctors-predict-which-covid-patients-will-become-seriously-ill/
5. Blood tests high CRP and ferritin levels may be correlated with more severe illness;https://www.bbc.com/future/article/20200505-cytokine-storms-when-the-body-attacks-itself
Elen Samuel, doctor and writer 