THE DEATH TOLL AMONG THE ELDERLY IS NOT JUST A MEDICAL FACT. IT IS ALSO A RESULT OF BIGOTRY.
BY RICHARD GOLDSTEIN
Young people are becoming infected with the coronavirus at an alarming rate, but the disease it causes remains primarily a killer of the aged. Eighty percent of the deaths from Covid-19 have occurred in people over 65. Every decision about preventing and treating this virus is fateful for the old. The narrative that “we’re all in this together” ignores the elevated risk for minorities and those with underlying health problems, but the greatest predictor of who will die is age. Even among people of color, most of those who perish in this pandemic are old.
Yet, there is a striking reluctance to focus attention on the elderly, a tendency to mention their vulnerability in passing, as one of many tragedies the virus has produced. This indifference to old people underlies the widespread refusal to wear masks. Their deaths are often regarded as natural, and therefore regretable, but acceptable. In fact, there is nothing natural about the catastrophic scale of this crisis. It is, to a great extent, the product of decisions that have placed the old in danger. Everything from the condition of nursing homes to the premature opening of businesses and the toleration of maskless gatherings has worked against their vital interests. Policy after haphazard policy has made it more difficult for them to avoid infection. The pattern in all these choices is hard to see, but its result is brutally clear.
If present trends continue, researchers predict that, by February, over 450,000 Americans will be casualties of Covid-19. Think of it — 360,000 elders gone before the buds sprout on trees. We may never know how many of these deaths could have been avoided with an effective national response, but, by reliable estimates, tens of thousands might have been saved. No one wanted so many people to perish, but their survival was not worth the necessary effort. In many red states, productivity and pleasure were deemed more important; in some liberal cities, leaders failed to act soon enough to prevent the worst from happening. These decisions were ultimately political, and they reflect longstanding beliefs that some people are expendable. Race and class are central in this calculus. So is age.
Just as AIDS revealed that certain groups were subject to a silence which equaled death, this pandemic has exposed another relationship between stigma and risk. It has lifted a rock on the nation, revealing all the maggots wriggling beneath. Agism is one of them. It is a bias often hidden behind acts of kindness and gestures of respect. Yet, it shapes the quality of life for nearly all old people, and in this emergency, it is a killer.
The coronavirus could not have found a more suitable petri dish than nursing homes in America. Residents and workers at those facilities comprise more than a third of deaths from Covid-19 in the U.S. That should be no surprise, since many nursing homes — around 43 percent, according to a Pro Publica investigation — lacked a legally mandated emergency plan when the pandemic hit. Lax regulation created little impetus to focus on disease prevention, and the chaos was compounded by new guidelines that allowed less rigorous training of staff. Some care homes failed to inform family members that their parents were ill. Others hid the extent of viral spread. But legal action has been stymied by the exemption of nursing homes in many states from wrongful-death suits. Wrenching images of residents being carted off to the hospital or the morgue cannot convey the systemic nature of this failure. It is nothing less than a culling of the old, and it stems from a disregard that belies the pretense of concern. So pervasive — and yet, undetectable — is this attitude that it rarely seems like a prejudice. The honorific senior citizen is deeply ironic, given what has transpired not just in America, but across the Western world.
In some European countries, nursing homes were excluded from planning for the pandemic, and their residents were missing from statistical models that guided the response. In Belgium, an untold number of those over 65 who fell ill from the virus were denied admission to hospitals, though there were enough beds to accommodate them. A New York Times report found that this was true even when the sick were likely to benefit from intensive care. Instead, these patients were sent back to their nursing homes, where they were treated with morphine and, as one physician put it, “comforted to death.” In Sweden, protocols advised the same course of treatment: morphine instead of oxygen. In Spain, more than 4500 investigations have been opened after the bodies of residents in care homes were found abandoned in their beds.
Covid-19 has exposed the truth about how old people who cannot afford private attendants — that is, most old people — are cared for. But they have also been placed at risk by government responses that enabled the virus to spread. Refusing to lock down the Swedish population led to one of the world’s highest per-capita death rates, and by some estimates, 90 percent of those fatalities were in people over 70. When Britain decided to open restaurants and pubs, 88 out of every 100 deaths from Covid-19 were in those older than 65. This is not just poor planning; it is criminal negligence. These states blurred the line between euthanasia and murder.
In America, death is only part of the suffering inflicted on the elderly during the pandemic. Though recessions generally affect newly hired young workers, in this crisis older workers have suffered more. Their jobless rate is now the highest it has been since 1948, as strapped companies dismiss them rather than pay higher insurance costs and mandated raises. Age discrimination is illegal, but such cases are notoriously difficult to prove. Nor is it easy for unemployed seniors to find new jobs. We may soon see millions of people too young to retire and too old to work. That is not just a fact of medical or economic life; it is also the result of bigotry.
Yet, despite glaring proof to the contrary, most old people in America don’t think of themselves as victims of a bias. Their ranks span the categories of race and class, making it hard for them to identify with the oppressed, and the beneficial effects of Social Security and Medicare strengthen their sense of being valued. The culture colludes in this image of contentment. Drug ads show the elderly frolicking with puppies and grandchildren. In the sitcom-verse, they are Golden Girls and Sunshine Boys. There are senior centers in many communities, cosmetic processes for every sag, medals for nonagenarians who run marathons. Age is no barrier to political success. But the aura of well-being is fragile. It depends largely on the shelter of assets and white privilege. In an emergency like this, the interests of many old people are marginalized. Their need for safety is met with inefficiency or inaction. This obliviousness is nothing new, but the pandemic is a grim reminder that it can be deadly.
The vulnerability of the old haunts the statistics as Covid-19 continues to spread. Large-scale events such as the motorcycle rally in South Dakota led to major outbreaks in 20 states. In Florida, where a quarter of the population is elderly, a spike in hospitalizations followed the governor’s decision to reopen bars and restaurants. In Texas, allowing such businesses to operate seeded a surge of infections, especially in immigrant communities, where many people live in multigenerational families. (About 25 percent of restaurant employees in the U.S. are Latinos.) The state’s lieutenant governor put it bluntly when he told Fox News that “there are more important things than living.” There is an unspoken assumption behind this remark: some people can be sacrificed for the greater good. Among these disposable groups is one not usually considered a target of bias: the aged.
For much of 2020, the federal government was missing in action. When elder-care facilities in Florida asked FEMA for desperately needed safety equipment, the agency sent shopping-bag gowns and masks made from recycled underwear, with fragile paper straps. As the caseload reached its apex in New York, the state had to compete with the feds — as well as other states — for ventilators. Governor Andrew Cuomo railed at the inept response from Washington. “Whose grandmother should I kill?” he fumed. But Cuomo’s own directive that nursing homes accept infected patients leaving the hospital may have spiked the death toll. Nearly 6500 hundred people perished in those facilities, including many grandparents.
At the beginning of the crisis, New York City’s progressive mayor, Bill de Blasio, assured his constituents that the virus was hard to transmit, and he insisted that large gatherings were not dangerous. He resisted closing the schools until powerful unions and parent groups insisted that he act. Though the death toll was still low at the time, it was clear that, once Covid-19 arrived, the city — an international travel hub — would be hit hard. The mayor was not responsible for the disaster that ensued, but he might have judged the situation differently if he had focused on the threat to old people from the start. There are many reasons why nearly 35,000 New Yorkers have perished from Covid-19, but in the terrible early day of the pandemic, hesitation and misinformation at the local level endangered lives.
No one will say that the old must die so that others can live. That would conjure up images of people cast adrift on ice floes. But an elder’s demise rarely produces the same shock as the death of someone in their prime. Is that rational? It depends on how we define the value of life. If economic activity is the point, younger patients should matter more, since they are likely to work for many years after they recover. Only 16.4 percent of people over 65 are still in the labor force, so the survival of the old is less crucial when it comes to productivity. Preserving their lives is largely a moral imperative, and when a crisis like this strikes, the obligation becomes more tenuous, because the only payback is that they will remain alive. In a society shaped by profit, the aged seem less useful and therefor more disposable. Many euphemisms hide this uncomfortable fact.
Like other biases, agism is always present, but its most virulent form emerges in times of distress. This is why the death toll from Covid-19 should not be regarded as a purely medical phenomenon. It is also a social fact. One must say, clearly and angrily, that when the old die in great numbers because they cannot count on their leaders to protect them, it is a crime. Let us call that fatal neglect what it is: geronticide.
The first step toward confronting this injustice is to understand that growing old is not just a biological event. There is no schedule for senescence: it occurs differently in each person. The loss of strength and stamina that cannot be hidden by fitness or botoxed away — these are signs, but not necessarily evidence of incapacity. Yet, at a certain age, one enters the order of the elderly. As Simone de Beauvoir notes in her magisterial work The Coming of Age, “the aged person comes to feel old by means of others.”
Though race and class make an enormous difference, most old people suffer a decline of income and status when they lose their place in the working world. Over time, internalizing society’s judgement leads many seniors to feel useless and powerless in their bodies and minds. This is not so different from what other oppressed groups experience. Yet, there is no woke lexicon for the toll that agism takes. The same culture that plies the old with products to hide their deterioration also pacifies them. For all that they are encouraged to be youthful, enveloped in a nimbus of bright colors and tinted hair, they must accept their marginalization. Covid-19 has tightened the boundaries that were already drawn around the old. They have always been encouraged to occupy separate spaces. So, why should we shutter the economy to maximize their safety? Let them do what they should do anyway: stay out of sight.
Of course, different cultures produce distinct responses to aging. Latino communities in the Southwest are more likely than the anglo societies around them to emphasize protecting their elders; wearing masks is often associated with caring for one’s grandparents. This ethic of generational solidarity has been cited by Pope Francis, who recently issued a strong protest against discarding the old like “waste material.” Though his statement does not mention the pandemic, its timing is significant, as is his critique of societies “planned on efficiency, which consequently ignore the elderly.” Such systems, he insists, “are perverse.” That is not a sermon one is likely to hear from Hasidic Jewish leaders who allowed thousands to gather illegally at weddings, or from fundamentalist Protestant clergy who urged their flocks to attend services in violation of regulations. Those who died didn’t rise in three days.
It is easy to see the folly of rejecting scientific evidence when it collides with faith. But that ignores the more liberal version of this belief system, which holds that the aged are better off when they are removed from the larger society. A vast industry is dedicated to housing seniors in dedicated spaces. The real purpose of these institutions is revealed by the fact that reforming them has no political traction. Segregating old people assures that they will not disrupt the flow of activity with discomforting reminders that we are all subject to decay. They will not raise feelings of pity and disgust that might sour the shopping experience. Personal violence against them may be scandalous, but the collective dimension of disregarding the old is lost in the space between sentimentality and silence.
A heartwarming segment on the CBS Evening News showed teenagers delivering groceries to the homebound elderly. This is a touching tribute to human kindness, but the problem of sustaining old people who cannot wait in mile-long food lines is too massive to be solved by volunteers. Meeting their needs requires an organized public response, and the fact that no such effort has been made shows how dispensable they are. We have no idea how many seniors are suffering from malnourishment because they are afraid to go outside; how many have delayed crucial medical procedures or suffered unbearable symptoms of dementia in isolation. The same system that notices people of color only when they refuse to accept subordination also heeds the elderly mainly when they are in the way. It is easier to imagine discarding what is seldom seen in the first place.
I have been called a fascist for reminding people to wear a mask. “I’m old,” I said to one man, by way of explaining my insistence. “So stay home,” he replied. I took it in stride because in New York City, where I live, irritated candor is a way of life. But I also understand that chronic stress unleashes the resentment beneath gentility. The inequities of capitalism, intensified by this disease, pit the ambitions of the young against the survival of the old. With jobs disappearing at a stunning rate, it is hard to sacrifice for those who are cushioned by pensions. No wonder the whispered name for Covid-19 is “the boomer remover.” It must be tempting for the stymied young to believe that fewer old people means more money for them.
Why is your party more important than my life? I want to shout when I run into a gaggle of revelers with swaths of fabric dangling decoratively under their chins. But I can’t really blame them. Every gene in their bodies directs them toward mating, and baring their lips means being eligible for love. When I picture myself at their age, keeping a distance from the promise of intimacy — why would I do that if I didn’t think contracting the virus would be the end of me? My hormones would impel me to conclude that I am giving up urgent joys just to keep some geezer alive. I regard any young person willing to do that as a hero. But at their age, I was less then that. “Don’t trust anyone over 30” was my motto in the 1960s. Why should this generation treat me differently?
The answer is leadership. Most of us are an amalgam of moral possibilities, and the behavior we display reflects the values around us. American individualism is often blamed for the mask wars that have engulfed the nation, but that free-bird attitude didn’t prevent us from mobilizing in other times of crisis. The incendiary chaos of today is the product of free-market conservatism. Forty years of dominance by that worldview, even under liberal presidents, have shrunk the sphere of collective action, and when the virus arrived we were unprepared to deal with it. Donald Trump exploited this haplessness by conflating it with freedom. He convinced his followers that there was no need for them to worry about a blue state (read black and brown state) virus. In this racist fantasia, the aged are collateral damage, but there is nothing incidental about their deaths. Many of these corpses are not just casualties of the virus. They are also victims of a society with a hierarchical view of whose lives matter.
At the height of the crisis in New York, when the sound of ambulances cut the silence and a refrigerator truck was parked up the block, I received a postcard “signed” by the president. Stay home and away from other people, it read. I don’t need that advice. I stay home most days because I never know what I will find in the street. I venture forth now and then in quasi-surgical armor, lurking at the edge of sidewalks. I retreat from crowds of people drinking and mingling, like a fretful Puritan fleeing from sin. Only at home, after vigorous cleansing, do I feel truly safe. As I wring my soapy hands for the time it takes to sing two choruses of “Happy Birthday To You,” I see the querulous man I have become. I fear that he will linger within me even after I am vaccinated. I will always see the specter of a new virus in an unmasked face.
I try to manage my anxiety with information. I am an ardent follower of Anthony Fauci, parsing his words with Talmudic precision. I have seen the film Contagion three times. I track the progress of the virus map by map, blotches of disease spreading across the country like a rash. Dealing with terror by devouring data is an attempt to know the unknowable through a surfeit of facts. And reasoning does work in the daylight. But in the dead of night, images of tubes imbedded in every orifice wake me. I gulp a Xanax and glide toward dawn.
Let us ponder what the future holds. Even after the danger ebbs, the reflexes that have set old people apart during this pandemic could become a default position for all sorts of policies. We may be entering an era of age apartheid, in which premodern ideas about what it means to be old are revived. Let them withdraw so the rest of us can thrive. We will treat them if they sicken — up to a point — but we will not risk our prosperity to keep them safe. There are more important things than their lives.
This is a scenario that may never come to pass. But given the threat, the old have no choice but to pursue their interests. They must see through the mirage of respect, since it is killing them. And they must seek allies, because there are many marginalized groups in this pandemic, and many more who care about them. Health workers could play a central role in advocating for the vulnerable; scientists could devise a humane agenda for survival; young people could demonstrate that there is a different course for their generation than the embrace of selfishness, applying peer pressure to those who act irresponsibly. The Black Lives Matter movement could add health issues to its agenda, since what protects people of color against the virus benefits the old of any race.
By joining with all the groups at risk to demand a fair system of vaccine distribution and medical care, seniors could expand and amplify their influence. They are the nation’s largest voting bloc, and skillful organizers could direct that ballot power. A new lobby for the aged, far more militant than the AARP, could emerge from this crisis. It would be a fitting addition to the fight for social justice.
As for an agenda, it must call the system of biases that has imperiled so many people what Pope Francis did: perverse. It must demand that minorities and the old be front and center in media coverage of the pandemic, not just part of the news mix. It must monitor each state’s protocols for distributing scarce vaccines, so that the definition of an essential worker does not include the staff at film and video shoots (as is the case in California). It must petition international courts so that the civilized barbarism of states that have mistreated the old is punished. And it must be clear that, unless such mistreatment is regarded as a violation of human rights, the young will also be its victims, since old people are what they will eventually become.
Just as my generation came together to oppose an unjust war and struggle for civil rights, now we must unite to preserve our lives. One model for this movement is the activism that arose when AIDS struck. Middle-class gay men who had never been politically aware came to see the links between homophobia and the stigma of drug addiction. Not only did the AIDS movement transform the relationship between patients and researchers; it also demonstrated that people with that disease were fully human, hastening the advance of addiction services and LGBTQ rights. This pandemic resonates with a different set of biases, but the strategy of unity and resistance hasn’t changed. Once again, we must fight for the right to survive.
To those who are old and terrified; who have lost spouses, parents, or dear friends; and to the casualties yet to come, I offer the words of the great labor organizer Joe Hill as he faced his execution: “Don’t waste time mourning. Organize!”
An earlier version of this piece appeared in Jacobin magazine.