Spared at first, elderly hit hard by Covid-19

Up until two months ago, health experts were perplexed as to why mostly younger people were dying of Covid-19 in Nepal and other South Asian countries. In Europe and North America, it was mainly the elderly who were victims. 

In fact, age-wise breakdown of coronavirus mortality by Health Ministry in August showed that most deaths recorded were of people in the 41-50 years category. This was explained by the fact that younger people were moving about more, and were bringing the virus back from India or from hotspots within Nepal.

But since then, the virus is spreading within the community and families, younger asymptomatic people who have not been tested are infecting elderly family members at home.

September-October saw a sharp rise in the fatality of people in their seventies and above from Covid-19, even though infection rate is much higher in the 21-50 age group. On 31 October when Nepal registered 23 deaths a day, 13 of the fatalities were above 70, and 20 of them were aged between 60-70.

Health experts say this is striking proof that younger people are now taking home SARS-CoV-2 and making their parents and grandparents seriously sick. This trend may have been exacerbated by families travelleing to far corners of the country for get togethers over Dasain, and a new spike in infections is expected in the coming week. 

Despite being the most susceptible to coronavirus, the elderly were already getting the least priority from the state, society and increasingly even within families. Physically fragile, suffering memory loss, or lonely seniors are politically ignored and socially ostracised. 

“We know senior citizens are at the most risk, focus should have been on saving them during this crisis, but they are literally on the bottom of the ladder in terms of society’s priorities,” says Krishna Murari Gautam (pictured left), social scientist and founder of Ageing Nepal that helps old age homes manage the coronavirus. 

“Most households are misinformed: people think old people cause and spread Covid-19 but it is the younger people who are exposing them to the virus, so they have to be mindful of their behaviour,” Gautam adds.

To be sure, the elderly were already the most vulnerable, but now the pandemic has added to all the pre-existing problems they faced: collapse of joint families, children and grandchildren abroad for studies or work, economic hardships and expensive health care.

Older people are now more isolated than ever within their homes and communities: they cannot go out and mingle within a limited circle of friends and relatives, visit temples or take part in community bhajans and other religious activities.

To make matters worse, they have been terrorised by the daily television headlines that highlight the death toll. Many are now showing psychosomatic symptoms of coronavirus without actually being infected out of sheer anxiety.

In others, mental health illnesses has become an increasing problem. Those on medication for depression and dementia are suffering relapse due to additional stress, say health experts.

Gautam, who was recently awarded the UNESCO Literacy Prize for his activism on behalf of Nepal’s elderly, says: “Most seniors are either illiterate or at least digitally illiterate. A much more effective option would have been to utilise our great network of female community health volunteers spread across the country or even cooperatives to spread awareness about Covid-19 among the elderly.”

Lockdowns in the initial phase of the crisis to contain coronavirus added to the problem. Old age homes soon ran out of daily essential supplies and donations they relied on. The elderly at these care institutes also need regular health check-ups as well as stock of medicines for various conditions.

Rosha Shrestha of Harmony Care Home in Bansbari worked early on to prepare for the oncoming crisis. In January, as the country was recording the first case of Covid-19, Shrestha started looking for an alternative should an outbreak occur and worked meticulously to develop her own protocols to keep the virus at bay.

Harmony is now segregated into red, yellow and green zones for all people and materials entering inside or going out of the home, everything has to be disinfected. Shrestha who is a nurse by profession also equally focused on uplifting the moral of her family of senior citizens as well as in enriching their diet, using traditional home recipes.

As a result, none of the occupants have symptoms and have not had to visit a hospital in the last nine months, unlike in the past when they needed to be hospitalised every once in a while for their different ailments. 

Shrestha has also trained other nursing homes and regularly consults older people over the phone, trying to dispel the notion that Covid-19 is catastrophic, that it is like any other epidemics of the past, not without casualties but also not something we can’t overcome with safety measures.

“Despite these positive steps I know that I have to save my older people for at least another year or two so that they won’t have to visit hospital for any reason, which is now unsafe and also unavailable,” says Shrestha. “It was a grave mistake on the government’s part to allow all hospitals to admit Covid-19 patients instead of segregating a dedicated facility. Where do I take my ba and ma if they fall sick now?”

With increasingly more youth migrating abroad for jobs and further studies, there is now a dire need of geriatric caregivers in Nepal. In fact, even as Nepalis take up elderly care jobs in Israel and Japan, they might be needed more at home in near future.

Since the 1950s, Nepal have added over 40 years of life expectancy, a dramatic public health achievement. But how well have we planned those added years or realised its potential?

Says Gautam: “It’s ironic that on the face of Covid-19 crisis, we have more or less abandoned the elderly when this was what we strived to achieve for so long. The good news is it is still not too late to care for them and their needs, especially this winter when the risks go up.”