Has the time come to accept Covid-19 for what it has truly become, the newest of the inevitable life-ending diseases that we all must one day face?
“While overall COVID deaths remain much lower than earlier in the pandemic, the share dying who are 65 or older (88 percent) is the highest yet,” the Kaiser Family Foundation, a non-governmental organization (NGO) focused on U.S. health issues reported earlier this month.
Covid-19 might kill anyone who gets infected with SARS-CoV-2 virus, the reality is that it mainly kills the old.
Of the 1.1 million Americans reported to have died of Covid-19 since the pandemic began in early 2020, KFF reported 790,000 – or more than 70 percent – were age 65 or older.
And as the deadliness of the virus has declined and treatments against the disease have improved over time, the proportion of old people dying has only increased.
Sixty-five is the original age of retirement for Social Security purposes. It was based on how long people were expected to live 90 years ago.
“If we look at life expectancy statistics from the 1930s, we might come to the conclusion that the Social Security program was designed in such a way that people would work for many years paying in taxes, but would not live long enough to collect benefits,” a history of the act written by the Social Security Administration concedes.
“Life expectancy at birth in 1930 was indeed only 58 for men and 62 for women, and the retirement age was 65. But life expectancy at birth in the early decades of the 20th century was low due mainly to high infant mortality, and someone who died as a child would never have worked and paid into Social Security. A more appropriate measure is probably life expectancy after attainment of adulthood.”
Those who made it to 65 were, at the time, looking at an average survival time of approximately 13 more years for men and 15 more years for women. But the pool of those who made it to that retirement age was a lot smaller than it is today.
Along with that higher infant mortality, there was significantly higher adult mortality between the ages of 21 and 65. Heart disease was then, as now, the leading cause of death, but influenza and pneumonia were basically tied for second with cancer, now number two. And motor vehicle accidents were number three.
A lovely debate can be had about whether that latter change is due to today’s lack of exercise and exposure to environmental contaminants (willfully in the form of tobacco, alcohol and sun exposures or unwillfully in the form of environmental pollutants) or largely due to people simply living longer.
Whatever the case, before the SARS-CoV-2 virus arrived on the scene and Covid-19 started killing people, modern Americans were living a lot longer than their ancestors even if many of them were pumped full of drugs designed to control chronic diseases.
More than 46 percent of men and almost 40 percent of the women who made it to age 21 in 1935 failed to survive to age 65, according to Social Security data. These numbers shifted dramatically over time, especially for women.
By 1990, 83.6 percent of women who lived to age 21 were surviving to age 65, or to put it another way, the death rate between the ages of 21 and 65 had been more than halved.
Men weren’t doing quite as well. Almost 28 percent of them were still failing to make it from age 21 to age 65, but that still marked a 61 percent improvement.
Actuarial tables from 1929-31 record that a white man who made it to age 20 in that time period was expected to live to the age of 66.02 although a similar black man was projected to live only until the age of 59.2.
Suffice to say that when Social Security, a bit of Ponzi scheme in which new enrollees pay to support retiring enrollees, was created in 1935, the government didn’t anticipate supporting the more than 50 million people now collecting that retirement benefit.
The U.S. population at the time was only 127 million. Fifty million people would have equaled nearly 40 percent of the population.
Luckily, the population boomed and the U.S. now numbers almost 330 million, meaning only 15 percent of the population is collecting Social Security retirement.
Still, that has been enough to create huge problems for a program never expected to carry such a load. By 2019, the New York Times was reporting “the cost of Social Security, the federal retirement program, will exceed its income in 2020 for the first time since 1982. The program’s reserve fund is projected to be depleted in 16 years, at which time recipients will get smaller payments than they are scheduled to receive if Congress does not act.”
Then along came the pandemic.
Social Security is still spending more money than it takes in, but its annual report this year noted the deficit is now coming down instead of going up.
“The projected reserve depletion date for the Old-Age and Survivors Insurance trust funds is 2035, a year later than in last year’s report,” the Trustees announced in June. “(And) for the first time since the 1983 Trustees Report, the Disability Insurance Fund is projected to be able to pay full benefits through the end of the 75-year projection period (2096 in this year’s report).”
Due to ” a stronger-than-expected recovery from the recession, higher expected levels of labor productivity, and lower anticipated long-range disability incidence rates,” the Trustees reported, Social Security is today operating with a smaller deficit.
The weak and the old
The long-range disability costs have gone down because a lot of people with what were once called “chronic diseases,” now commonly lumped into the category of “co-morbidities” were killed by the SARS-CoV-2 virus.
“Most patients with chronic illnesses do not have a single, predominant condition. Rather, most have comorbidity, the simultaneous presence of multiple chronic conditions,” according to the Annals of Family Medicine. “This will come as no surprise to practicing primary care clinicians, for whom the straightforward patient with diabetes and no other medical problem is the exception rather than the rule.
“More typical is a patient with type 2 diabetes who is depressed and obese and has coronary heart disease and osteoarthritis.”
The pandemic has been cruel to such patients. The latest report from the Centers for Disease Control indicates almost 95 percent of those reported dead from Covid-19 were suffering from some other disease as well, and “for deaths with conditions or causes in addition to Covid-19, on average, there were four additional conditions or causes per death.”
Like the rest of the animals on the planet, homo sapiens remained largely tied to the fundamental law of nature that dictates death is most likely to come to the young, the weak and the old.
Our species has done a superb job of altering the equation for the young and made some progress in prolonging the lives of the old while actually increasing the population of the weak.
Many of the Covid-deadly co-morbidities of today are linked to immunosenescence, which is, in turn, linked to lack of fitness and age.
“Remodelling of the immune system with age — immunosenescence — is a substantial contributor to poor health in older adults, with increasing risk of infections, cancer and chronic inflammatory disease contributing to age-related multi-morbidity,” researchers from the U.S. and the United Kingdom noted in a peer-reviewed study in Nature Reviews Immunology in 2019.
“What is seldom considered when examining the immune response of an aged individual is that the immune system is profoundly influenced by physical activity. Habitual physical activity levels decline with age with significant consequences for muscle mass and function. Skeletal muscle is a major immune regulatory organ and generates a range of proteins, termed myokines, which have anti-inflammatory and immunoprotective effects.
“Several studies indicate that maintaining physical activity has immune benefits in older adults, for example, it reduces the systemic inflammation associated with chronic age-related diseases.”
It has been shown especially effective against Covid-19. A British study of walkers early in the pandemic found that fast walkers – fast-walking being a basic measure of cardiovascular fitness – found slow walkers had a near quadruple change of death from Covid-19.
Among those more than 400,000 people with a median age of 68, “slow walkers had the highest risk regardless of obesity status,” the researchers reported in the peer-reviewed International Journal of Obesity in February 2021. “For example, compared to normal weight brisk walkers, the odds ratio of severe disease and COVID-19 mortality in normal weight slow walkers was 2.42 and 3.75, respectively. Self-reported slow walkers appear to be a high-risk group for severe COVID-19 outcomes independent of obesity.”
Since then, a variety of studies have reached similar conclusions, although the estimates of protection have varied.
The latest, a meta-analysis published in the British Journal of Sports Medicine late last month, concluded regular exercise could lower the risk of Covid-19 death by 43 percent and the risk of severe illness by 44 percent.
That’s not as good as the protection offered by vaccines, although it is close to the real-world performance of vaccines in the face of Omicron, the latest SARS-CoV-2 variant. And it is in some ways it is better than the vaccines.
The benefits of exercise don’t fade as vaccines do. Exercise has been shown to be protective against every Covid variant to date. And not only that, exercise protects against a long list of other diseases.
But many Americans, for better or worse, are now conditioned to believe health is largely about the drugs and procedures sold by the medical industry, and fitness is secondary.