Covid-19 and Those Other Health Needs
By Michael Hodin
As the world continues its Covid-19 economic shutdown, we are beginning to understand the truly profound connection between health and economics. Indeed, as the debate about when and how to reopen the economy evolves, “public health vs. economic health” is emerging as a false choice. In fact, many who have focused on the 21st century miracle of longevity — what Lynda Gratton and Andrew Scott called The Hundred Year Life — have already understood this immutable connection between our health and economic lives in matters of culture, public policy, and daily life.
This connection is only growing more important as our populations continue to age. That’s why Bank of America and Aegon, two global financial institutions with headquarters on two separate continents, have spent the last decade or so advancing our understanding of the health-wealth link. These financial services companies have spearheaded research on health topics like healthier and more active aging, cognitive decline, NCDs, and elder caregiving. As a result, they have a perspective that is now invaluable for the Covid-19 world, balancing both health and economic priorities. As Lorna Sabbia, Head of Retirement & Personal Wealth Solutions at Bank of America, said at the Global Coalition on Aging Silver Economy Forum last July, “According to Bank of America research, of clients’ 7 life priorities, the number one concern is health…will I have enough money to cover costs [as I age].” What was true in July of 2019 is even more so for today’s coronavirus.
The intertwined health and economic impacts of Covid-19 are especially critical in light of the age-related health conditions that are often now being neglected. If we let diagnosis, care, and treatment lapse, these follow-on consequences will rapidly multiply. Therefore, as we focus on “getting back to work,” and while we continue to be vigilant about Covid-19, we should also begin working towards solutions for these conditions. Three areas where we might start:
· Fragility fractures and osteoporosis. In a must-read by Grace Marie Turner, who heads the Gallen Institute think tank, Dr. Andrea Singer of MedStar Georgetown University Hospital estimates that up to 75% of her patients will have trouble getting their next dose of needed injectable osteoporosis treatment — placing them at increased risk for fragility fractures. Even before Covid-19, as reflected in this important piece in the British Geriatrics Society’s Age and Ageing, treatment and rehabilitation for fragility fractures was already at a crisis, as 1-in-3 women and 1-in-5 men over 50 experience a fracture — totaling 9 million each year worldwide and growing as our population ages. Equally as troubling, among those who present with a fracture, usually from a first fall in emergency care, a full 80% do not receive adequate treatment or rehabilitation.
Now, these risks — and the resulting costs and economic impact — are elevated even more for older adults from Tokyo to New York, Shanghai to London, and the results threaten to cascade across workforces, businesses, and economies. Roughly one-quarter of workers with osteoporosis have had to leave the workforce, change their job, or reduce their working hours. In the EU alone, fragility fractures cause more than 7.6 million sick days. And these totals don’t even account for the impact on family caregivers.
· Age-related macular degeneration (AMD) and vision loss. Covid-19 is disrupting treatment for the estimated 196 million people who suffer from AMD worldwide — the leading cause of vision loss among older adults in developed countries. Even before Covid-19’s impacts, the total cost of visual impairment due to AMD alone was already projected to be around $392 billion, with productivity losses of $36 billion. Just imagine the likely disease trajectory, cost curves, and declining quality of life after months, if not longer, of foregone treatment as an unintended result of Covid-19.
· Loneliness and frailty. Social isolation and related health deterioration were already a significant challenge for older adults, and this risk is now heightened in a world of “stay-at-home” orders and social distancing. These are of a piece with the growing recognition that isolation and loneliness — together with falls and vision loss — are leading to increases in frailty. As conceptualized by Dr. Linda Fried, Dean of the Mailman School of Public Health, in a decade-old report to the WHO: “Moments of Risk Matter,” Covid-19 has produced a “moment of risk” for exponential increases in frailty that intersects with existing, if dramatically extended conditions, like osteoporosis and vision loss.
Much like the imperative to find a balance between reopening the economy and curtailing the pandemic, we must find ways to address Covid-19 and enable a healthier and more active aging precisely for our older citizens most at risk of Covid-19. We must ensure that their survival does not leave them, and us, with equally bad conditions in such obvious areas as fragility fractures, AMD vision deterioration, isolation, and overall frailty itself. Three steps are key to achieving this — both during the Covid-19 lockdown and beyond:
1. All governments should relax regulations to facilitate treatment and payment of injectable and infusion medicines. With care and sensitivity, we can get it right.
2. Utilize, leverage, and expand telehealth and telemedicine and remote patient care to support treatments, even as we learn to use this technology for better monitoring, earlier detection, and diagnosis.
3. Empower all of us through effective public health communication to recognize the signs in our parents, grandparents, and older neighbors who are suffering from the unintended emotional consequences of lockdown.
As we launch the Decade of Healthy Ageing this year, unexpectedly coinciding with Covid-19 pandemic, it is worth recalling the wisdom from Aegon’s Chairman Alex Wyaendts at last years’ Silver Economy Forum when he called for a New Social Contract born out of the global aging mega-trend. How much more prescient in light of Covid-19.
