US economy will not recover until the elderly feel safe

Policymakers trying to boost the economy during a pandemic need to face a fundamental truth: the U.S. economy will not recover until the most vulnerable among us — the elderly — feel safe.

According to the Federal Reserve, Americans over 70 control 28 percent of the nation’s household wealth. Americans over 65 account for 20 percent of consumer expenditures, according to data from the Bureau of Labor Statistics. They spend that money on health care, travel, dining, and a vast array of other goods and services. 

But according to the most recent CDC data, the death rate without an underlying condition among individuals 70-79 who test positive for the SARS COV-2 stands at 16.7 percent, rising to 28.7 percent among those over 80. For people with common problems like diabetes, hypertension, or cancer, the rates almost double. Even if the numbers continue to decline, as they have been, it will be a while before they reach less appalling levels.

As young people pour out onto the streets and beaches and into bars and clubs, policymakers should realize that much normal consumer spending may stay frozen in the accounts of older Americans, as they make the rational calculation that staying inside is critical to their health and safety. It makes total sense for vulnerable people to remain in lockdown until their chance of getting the virus drops to near zero.

Of course, a highly effective vaccine — say equivalent to those for measles or smallpox — will make us all safe and release the economy for much more rapid recovery. But despite optimistic predictions, there is no guarantee that we’ll have such a vaccine any time soon. And policymakers should also be aware that vaccines have differing efficacy for different demographic groups, so it is vital for our economic futures to find immunizations that are highly effective for the most vulnerable age groups. A vaccine that is 60 percent effective, such as many annual influenza shots, will not do the trick. Does it make sense for a 75-year-old to go out on the town if they’re 60 percent protected against illnesses with a mortality rate as high as one third? Lots of older adults will not like those odds.

What can we do to make it safer for older people while we wait for an effective vaccine? Every state that wants to revive its economy should implement aggressive so-called non-pharmaceutical interventions — wearing masks, careful social distancing, frequent hand washing, widespread testing, contact tracing and isolation of the symptomatic and asymptomatic individuals who test positive for the virus. Many other countries have done this and are reaping the rewards through an economic revival. Even in the U.S., several northeastern states seem in striking distance.

It is true that the mortality rates cited here are for proven COVID cases. Many are asymptomatic or undiagnosed, so the actual chance of dying for an infected elderly person is likely much lower than these CDC numbers. But that overall mortality rate is currently unknown in the United States, and won’t be fully understood until we have much more widespread testing of large representative samples of the population. Until we have those data — another reason for a massive, all-out, national campaign of testing — the only guidance high-risk groups will have is startling mortality rates among the diagnosed. 

In many states that have opened up prematurely in the hopes of reviving the economy, leaders are dealing with angry, resistant populations who want their jobs back now and resent being told to wear masks or restrict their activities. Those leaders should know that opponents of tough non-pharmaceutical interventions are in for a rude surprise. They may be writing the death warrants for their own prosperity as they shed masks and break loose. The key to unlocking a healthy economy may be hiding at home, where their parents and grandparents are still locked in place. When it comes to COVID, only when the weakest are safe will the strong thrive.

David Blumenthal, an academic physician and health care policy expert, is president of The Commonwealth Fund, a national philanthropy engaged in independent research on health and social policy issues.