The Age of the Plague

The stupendously underdiscussed importance of age to COVID-19.

Note: This article uses American figures as their statistics are convenient to retrieve and the COVID-19 epidemic has gone on long enough in the USA that we can be sure there isn’t some obscure local factor that is skewing the figures badly. Australia has a similar age/fatality distribution.

Before reading the rest of this article, do this short self test. Write your answer down so you can see how well your risk perception is calibrated.

1. In the US, using official figures, an 80 year old is how many more times likely to have died from COVID-19 in 2020 and 2021 than a randomly selected 25 year old?
   A. 1.5
   B. 10
   C. 50
   D. 500
   E. 2,000
2. In the US, using official figures, randomly selected person over 65 is how many more times likely to have died from influenza in a typical year than a randomly selected 25 year old?
   A. 1.5
   B. 4
   C. 20
   D. 80
   E. 2,000
3. People over 85 years old make up 1.8% of the population of the USA. They make up what percent of COVID-19 fatalities?
   A. 1.8
   B. 3.6
   C. 7.2
   D. 14.4
   E. 28.8
4. In an typical year, a randomly selected person under 18 is more likely to have died of influenza than COVID-19 in 2020 and 2021 (to August) combined, true or false?
   A. True
   B. False
5. In an typical year, a randomly selected person over 18 is more likely to have died of influenza than COVID-19 in 2020 and 2021 (to August) combined, true or false?
   A. True
   B. False

Public discourse is amazing. COVID-19 has probably been the biggest news event in the world since 9/11 and the Iraq War, and certainly for the last two years. The average Kiwi, whatever their views on the virus, lockdowns, etc, feels that they are relatively well informed. We know a few things about COVID-19, we think. We mentally list risk factors, including things like poor health, obesity, ethnicity, sex, age, and by curious mental alchemy, think we have a gut feel for how these factors might combine.

We don’t.
Not even close.

That quiz? The correct answers are: E, D, E, True, False. Yes, that first question’s answer was E. “Two thousand?” people ask incredulously, “The headline gave it away, but there was no way I was going past D”.

Yes, and it’s about 6,000 if we compare children to over 85 year olds. It’s worth digressing for a moment to consider how large 2,000 really is. Some people may be able to conceptualise 2,000 as a wooden cube, or a number of hours worked. It’s a big number. One hundred grams is the weight of a rat, whereas 200 kilograms is the weight of an exceptionally morbidly obese person.

^{Population numbers and COVID deaths taken from:
1) https://www.census.gov/data/tables/2019/demo/age-and-sex/2019-age-sex-composition.html
2) https://www.cdc.gov/nchs/nvss/vsrr/covid_weekly/index.htm#SexAndAge
3) Australia is similar: https://www.health.gov.au/resources/covid-19-deaths-by-age-group-and-sex}

One would have thought that a risk factor with effects as dramatic as age has on COVID-19 fatalities would be front and centre of the news everywhere for the last two years. You would think that everyone would know that nana isn’t just a few times more at risk than mum and dad, or that the kids really are all right. But they don’t.

What explains such lamentable ignorance at almost all levels of society?

The first answer has to be the media. Every time you’ve had a story about a lockdown chocolate soufflé recipe pushed into your news feed, every time you’ve e seen an emotive story about a father of five that did or did not get the vaccine and died repenting of their COVID beliefs instead of their sins, and most importantly, every time you’ve seen some “serious”, “What you need to know” explainer, people either kept this information from you or from the person who wrote it.

Stuff has received millions of dollars from Google to publish “The Whole Truth”; at a rate of one article a day, they’ve probably published fifty articles, and not once did they think that maybe this was something that might be worth knowing. Not for you as an individual, not for you as member of a society debating public health measures, probably not even for you as a doctor or a nurse.

Well, our media are largely people who failed hard at maths at school and scraped in with C’s in English, so the average journalist is probably not even aware, and thus not culpable. And the soufflé recipes actually are good. Their bosses are less easily excused though, and there remains the larger question:

How about policy makers, and the government?

The official Unite Against COVID-19 website is united with the media in treating it as a matter not worth mentioning concern. Shaun Hendy lists his pronouns and even now and then the garbagy parameter values he inputs into his models, but hasn’t mentioned it. Ashley Bloomfield is the best as he has made vague references to age quite frequently, but still not to how supremely important age is.
It is totally absent from our discourse.

Ignorance and stupidity can’t explain every one of our trusted luminaries from telling us about this. Mentioning age as a risk factor simply doesn’t cut it when we are talking factors of thousands. It has to dishonesty, and the obvious motive is to keep people ignorant so that 17 year olds fear for their lives if they don’t get vaccinated. The obvious side effect of dramatically hardening the attitudes of those who already distrust the experts is ignored, as is the value of just being truthful for the sake of it.

Yes, they make the transmission argument too, but the fact that we had a public debate over the relatively low vaccination rate of Maori under 40 and that that debate ended up with preferential access despite under 40s collectively making up about 1% of COVID deaths, shows that our policy makers are determined to ignore the blindingly obvious . Vaccinating three more 70 year olds of any race would be more worthwhile than one hundred Maori 25 year olds, but predictably, age hardly even entered the discussion, because policies based on race help satisfy ideological urges in a way that focusing on a factor that outweighs all others combined when managing a pandemic doesn’t.

Who cares if it might result in better policy or public understanding?

On the other side of the fence, one has to ask relatives who never kept in touch until COVID-19 came along to stop sending screenshots of pseudonyms on Gab talking about Ivermectin, Rumble videos of doctors I’ve never heard of, etc., but never a discussion of age (one notable exception: a few Americans turned to data when op-eds about dying Florida schoolchildren were common. But that’s about it.).

We have had no public discussions about maybe securing rest homes once the country starts to open up. We have had no public discussion about maybe helping grandma to get a taxi instead of taking a bus when the virus gets here, despite spending umpteen billion dollars of borrowed money. Do rest homes have good ventilation? Who knows? Who even cares?

In other words, our discourse is stupid when it isn’t outright dishonest.

If you feel the same way after reading this article and verifying the figures, tell someone else about it. Let’s be less stupid.

Supplementary Table - Influenza:

^{3) https://www.cdc.gov/flu/about/burden/2018-2019.html
4) https://www.cdc.gov/flu/about/burden/past-seasons.html
5) https://www.cdc.gov/nchs/fastats/deaths.htm
6) https://www.cdc.gov/mmwr/volumes/70/wr/mm7014e1.htm}

Notes to tables:

Influenza deaths from 2020 at the CDC COVID deaths page are anomalously low (only 25% of normal; 2019 is a more normal figure), and presumably have been ascribed as COVID-19 deaths and/or were lower than normal due to public health measures. See Source 4.

Subtracting a typical year's (e.g. 2019) flu deaths from the COVID-19 tallies makes a small (10%) difference to the overall C19 death figures.

Influenza deaths were not broken down between 18-49, so have been assumed evenly distributed among these age groups. In reality, 40-49 year olds are probably well underestimated and 18-29 year olds well overestimated.

Influenza deaths were not broken down between 65+ age groups, so have been assumed evenly distributed among these age groups. In reality, 65-74 year olds are probably well underestimated and 85+ year olds well overestimated.

Flu deaths could be multiplied by 1.5 or 2 for time period-adjusted risk. To compare the COVID19 pandemic to the annual flu, this is pointless.

Total mortality increased in the USA from ~2.85m (2019) to ~3.35m (2020), meaning that incorrect attribution of death to COVID can as a worst case explain about 20% of deaths.