By Tine Buffel, Patty Doran, Camilla Lewis, Chris Phillipson & Sophie Yarker (Manchester Urban Ageing Research Group)
The impact of changes – social and medical – brought about by Covid-19 will not be known for some time. So far, in the UK at least, numbers have dominated public debate, with a warning that up to 500,000 people could die, reducing to around 20,000 with social distancing. Much has been made of the public response, with complaints of ‘panic buying’ receding as 750,000 people respond to calls for volunteers; and 20,000 former and retired doctors and nurses offer to return to work for the NHS.
However, the social context in which Covid-19 operates has been the subject of less discussion, even though the virus is as much a social as a medical phenomenon. As social scientists, we believe our various disciplines will have a crucial role to play in the months ahead in understanding the challenge posed by Covid-19. We are especially concerned with issues relating to older people but many of the problems we are working on have relevance to all age groups.
Much of our work considers the impact of Covid-19 on social institutions and social groups, especially regarding attempts to manage the spread of the virus. We think that an understanding of its social impact is especially important: both for increasing the effectiveness of interventions and for mitigating the consequences for particular groups – notably those living in low income communities.
Two issues are of particular concern at present, first, terminology, and, second, social inequality.
Terminology has, we would argue, raised particular problems. Herd immunity – relying on people to get the disease and acquiring immunity as a result – emerged as an initial response to Covid-19 in the UK. However, use of this term obscured the huge dangers for ‘at risk’ groups – especially older people and/or those with underlying health problems.
Herd immunity has now been replaced by social distancing, with guidelines produced by the UK Government1. These focus on those 70 and over, and those under 70 with a particular health condition. The reasons for social distancing are well-grounded but the term itself raises difficulties, for example:
- The Guidelines play down the extent to which social distancing may turn into social isolation for those without a strong network of family and friends.
- The value of online support is emphasised in the Guidelines, even though nearly half of those 75 and over do not use or do not have access to the internet.
- The idea of ‘social distancing’ might itself be difficult to interpret for people with learning difficulties and also open to differing interpretations amongst groups for whom English is a second or third language.
- The mental health consequences of social isolation are underplayed – notably for those suffering from anxiety and depression or diagnosed with dementia.
Terminology, then, is one concern: inequality another. Much of the discussion has presented society coming together in a battle against a common enemy. Developing a language of solidarity will certainly be essential – especially if, as seems likely, action to combat the virus will be spread over months and possibly years. But it is important to acknowledge how Covid-19 may aggravate existing inequalities . This may happen because:
- The pandemic is taking place, as the recent Marmot Report highlighted, when health inequalities between poor and richer neighbourhoods are increasing – the effects of a decade of austerity compounding the medical impact of the virus.
- Although people over-70 are at substantially greater risk of dying from Covid-19, it is also the case that research on chronic health conditions suggests that the threshold may be as low as age-55 for people from lower socio-economic groups.
- People in precarious forms of work may be especially vulnerable to the risk of contracting Covid-19. Many occupations in health and social care carry a high risk of exposure but the groups involved (overwhelmingly female) are often paid poverty wages and given minimal protection in their work.
- Some local communities are better equipped than others to respond to the crisis. Poorer communities have been affected by the loss of ‘social infrastructure’ (libraries, local shops), limiting their capacity to mobilise resources to reach out to those most at risk.
- Ethnic minority people in the UK tend to be at heightened risk of experiencing various health and social inequalities and the potential for a higher risk of exposure to Covid-19.
New social strategies for combatting Covid-19
We suggest at least three areas of work need to be developed in the present crisis:
- Strengthening communities: A major gap in the Government’s response has been failure to provide aid to the UK’s poorest communities. These have been hit hard by 10 years of austerity, bearing the brunt of the almost £900 million cuts to public health over the period 2014-2019. Key areas of support provided through voluntary organisations and food banks are being lost, with income substantially reduced as a result of the lockdown. We argue that the Government should create a new ‘Communities in Crisis fund’ bringing together new and existing sources of assistance, working with local authorities to strengthen social resources in the most vulnerable neighbourhoods.
- Developing new guidelines on social distancing: As the Covid-19 crisis continues fresh guidelines on social distancing will need to be produced. New ways of maintaining social connections will have to be created – and not just through online platforms. Measures need to be taken to prevent the effects of extreme isolation. For example, there will be a pressing need to support the estimated 1 in 10 older people malnourished or at risk of malnutrition.
- Ensuring a responsible mass media: The media has a crucial role to play in the current crisis, especially in challenging images which present old age as a condition of frailty and vulnerability. Indeed, a lesson from the pandemic is the sense of precariousness now affecting all age groups. The task will be to demonstrate how strengthening ties across all generations will be crucial in developing an effective response to the present crisis.