Takeaway: Defenders of the status quo face the prospect of choosing between receding from public life or risking disease and potentially death

Editor's Note: This is a complimentary research note published by Healthcare Policy analyst Emily Evans. CLICK HERE to get daily COVID-19 analysis and alerts from our research team and access our related webcasts.

The Cruel Irony of COVID-19's Disparate Effects On The 65+ Generation - 02.26.2020 black swan cartoon

COVID-19 looks like some sort of karmic payback to the generation of Americans who, for the past 30 years, have bent the economy and society to their will, with often disastrous results.

It is the cruel irony of COVID-19 that it passes almost benignly over the younger generations to whom Baby Boomers have refused to cede the stages of media, politics and business and attacks with almost certain mortality their fellow travelers.

The Cruel Irony of COVID-19's Disparate Effects On The 65+ Generation - COVID 19 Cohorts

The most influential generation in American history now faces a choice between withdrawing from public life as we know it or risking illness and possible death. As Baby Boomers would not accept the traditional risks of their forefathers like going to war or enduring economic downturns, nor will they go quietly into that COVID-19 good night.

A million years ago – say around mid-March – the response from public health officials and political leaders to the COVID-19 outbreak was mostly uniform. From King County, WA to New York State, the message to the public was “flatten the curve.”

To flatten the curve, the public was asked to limit commercial activities, avoid large groups, employ extreme hygiene measures, and eventually, wear face coverings when social distancing was not possible. The primary goal of flattening the curve was and still is to protect the health care system from being inundated.

The extreme measures adopted by most state governors allowed the public health system time to ramp up diagnostic testing, contact tracing and enforcement of self-isolation and quarantine orders. In effect, buy time so a traditional public health response could scale and be ready to manage the disease at a case level instead of using a population approach when and if it reoccurs.

The original timeline was a couple of weeks but in most areas of the US, stretched to the end of April.

The first week in April marked a divergence in approaches between public health professionals. Dr. Harvey Feinberg (age 74) of the Harvard T.H. Chan School of Public Health published an op-ed in the New England Journal of Medicine titled Ten Weeks to Crush the Curve. He echoed a similar call from Bill Gates (age 64) the week prior calling for an additional ten weeks of extreme social distancing and restrictions on commerce and assembly.

Joining Dr. Feinberg and Gates was something called the New England Institute of Complex Systems, a $1 million a year non-profit in Boston headed by Yaneer Bar-Yam, PhD (age 61), that, using classic grass roots campaign techniques, advocated for a “national shutdown” and as that did not occur, one for each state. It now, again using the tools of a grass roots campaign, advocates for “crushing the curve.”

The Cruel Irony of COVID-19's Disparate Effects On The 65+ Generation - Crush the Curve

The difference between “crushing the curve” and “flattening the curve” is the latter recognizes that the disease is an inevitability that can be managed using proper public health techniques. The former aims to eradicate the disease altogether using extended prohibitions on commerce and assembly, probably through July.

The beauty of “crushing the curve,” especially for someone that occupies a senior position in government or academia and can telework, is that, at least in theory, the disease will depart the US and never reappear. Risky events like TED Talks, conferences and symposia will resume, life will return to normal and boomers can remain at the center of the American story.

The problem with “crushing the curve” is that no one knows if it will work. COVID-19 arrived in the US via international travel. Most public health officials believe that COVID-19 will make its way back to the US in periodic re-occurrences, barring extended prohibitions on movement overseas. South Korea, often held up as a model by the “crush the curve” crowd has suffered setbacks in its disease management. To date the only human disease known to have been eradicated is smallpox, an effort that lasted from 1967 to 1980.

The US public health system has little experience with the type of extended draconian restrictions for which Yaneer Bar-Yam, Gates and Feinberg advocate. The tried and true methods of testing, contact tracing and isolating, while allowing people to go about their business, have a successful history of containing the polio epidemic and deadly flu outbreaks in 1957 and 1969. These practices are built into the disease management infrastructure at the Centers for Disease Control and state and local health departments.

While public health officials are afforded broad police powers, they are limited to what is reasonable and supported by science. The science supporting an extension of the extreme measures “crush the curve” advocates promote is thin and anecdotal.

There have been few attempts to compare various countries’ approaches in a way that controls for health system capacity and expertise, population age or environmental factors. Additionally, that experience is all of five months old- too early to conclude extended draconian measures actually eradicated the disease anywhere.

Another problem with “crushing the curve” is that it seeks to impose economic hardship on other Americans, especially those occupying low wage, low skill jobs (read: generations younger than Boomers) especially in the hospitality and leisure industries. Unemployment rose to a 90-year high this week, with these sectors being the hardest hit.

Advocates for “crushing the curve” don’t appear to care. Andy Slavitt, former Administrator of the Centers for Medicare and Medicaid under the Obama Administration has concluded that people who work at barbershops and tattoo parlors should not be permitted to return to work. Meanwhile in the East Village, assault has been deemed by some in the community an acceptable response to joggers who don’t wear facemasks, despite the lack of evidence that outdoor exercise poses a risk to anyone.

The Cruel Irony of COVID-19's Disparate Effects On The 65+ Generation - empathy

Governor Jay Inslee, whose public health response to COVID-19 has been exemplary, has extended Washington State’s Stay-at-Home order to the end of May despite a steep decline in confirmed cases, a low positive rate in testing and a half empty hospital system. In extending the order, Governor Inslee moved the goal posts from managing a declining infection rate to ending it altogether.

“I fully recognize the impact this is having on families, workers and businesses, but we have not yet won the fight against this virus,” Inslee continued. “We continue to see infection rates, hospitalizations and deaths across the state from COVID-19.”

The battle is joined. A generation which has so firmly controlled the levers of economic and social power faces an existential threat. To defeat that threat they must impose on the entire American economy and its people limits unheard of and intolerable to many, especially those whose work with their hands does not involve a keyboard.

For once, I would not put my money on the Boomers being successful. Economic interests of states and their residents will likely prevail over a still theoretical outcome of disease eradication. Instead, governors and mayors, knowing full well the capacity of their public health systems, will seek to manage the disease by protecting vulnerable and at-risk populations while allowing others to get back to business, albeit slowly.

In the weeks, months and not-as-many-years as you think ahead, the generational shifts in attitudes toward taxes, trade policies, regulation, health care and anti-trust enforcement will accelerate as the chief defenders of the status quo shelter in place.