Jacquelyn Martin/AP Photo
Hospital worker Amanda Perkins, second from left, with family members, visits Rock Creek Park in Washington, D.C., March 17, 2020. People within the same household may be categorized at different risk levels for COVID-19 based on their age and resistance to the novel coronavirus.
Governments today are necessarily calling for social distancing of people of all ages and a shutdown of public events and activities that increase the risks of spreading the coronavirus. The primary objective is to “flatten the curve” of the COVID-19 epidemic to avoid overwhelming health care systems with a spike of cases in the next few months. But economies cannot shut down indefinitely, and some industries—like health care itself—cannot shut down at all.
As we have learned from China and elsewhere, the risks of severe illness and death are distributed very unevenly. The aged and those with chronic illnesses are at much higher risk than young, middle-aged, and healthy people. In addition, people who have survived the infection will likely have acquired some immunity, although it’s not yet known whether reinfection is possible and how long any immunity will last. (Chinese data suggest that if there is reinfection, it is uncommon.)
As more detailed knowledge develops, public health authorities will be able to define different tiers of risk more precisely. At the low end will be people who have survived the infection and developed antibodies against it, as well as children and those under the age of 30. At the high end will be people over the age of 60 and those with comorbid conditions. Universally available testing for both the virus and the antibodies will be vital in giving individuals guidance about their risks.
Instead of the blanket policies being adopted now, we could move to policies that distinguish a stay-at-home population from a safe-to-work population. But that kind of division raises an obvious objection: What would happen to the stay-at-homers when those who are interacting more freely with others at work and school come home?
Since the coronavirus circulates within households, there are two possibilities. One is to distinguish people at low risk who live in households with others at low risk—for example, families that have all survived the infection or who are young and healthy. The other is to encourage individuals at low risk to live together—for example, in now-empty college dormitories and hotels. Making such facilities available ought to be a priority.
Societies will now be asking the young to take on urgent work that the old cannot do. They ought to value young adults accordingly and provide them the new deal they deserve.
Some kind of policy along these lines could apply in the period between the current shutdown and the point when a vaccine or effective treatments become available. But it might also apply immediately to workers in vital occupations—like first responders—who are going to be exposed to increasing risk in the coming weeks. For example, people who have had COVID-19 and recovered from it, or never gotten sick from the coronavirus when infected, ought to be recruited and trained on an emergency basis for vital services that would put others, if they performed those services, at high risk.
Since many of the young, middle-aged, and healthy who were asked to return to work would not be at zero risk, there would be some increase in COVID-19 and some deaths resulting from this policy. The key thing would be to proceed step-by-step, with the lowest-risk groups returning to work first, and only slowly expanding the return of others later.
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In societies where the worst-case scenarios unfold and deaths reach into the hundreds of thousands and even millions, there is going to be an enormous generational upheaval. Demographically, it will be the reverse of wars in which the primary casualties have been young men. This time, the casualties will be chiefly among older men and women.
But there is a similarity to wartime. Societies will now be asking the young to take on urgent work that the old cannot do. They ought to value young adults accordingly and provide them the new deal they deserve—for their education, for buying homes, and for care of their children. Amid all the grief of the terrible period we are facing, we ought to look ahead to a rebirth of social solidarity, a renewed sense of reciprocity between the old and the young.
