What grandparent would choose to have their grandchild live a life of lower quality or opportunity than they had? What parent would accept that their child's health be harmed as a matter of policy?
These may seem like ridiculous questions, but the decision to do all these things is being made on a daily basis in our response to COVID-19. If that is true, we need to discuss if this is what we really want to accomplish.
We are not people who want to see older people die. We are physicians, we are mothers, and we are daughters. We love our children and we love our parents. We care for COVID-19 patients and see the damage it has done.
However, it is with increasing distress that we have watched Canadian decision-makers de-prioritize the legitimate needs of our youth. We write this article out of love and to remind everybody of our responsibility toward creating a society that values the health of all, and especially of the particular needs of the young, who often have no voice but will take over the reins of our society.
We have watched young children be denied free play in parks and community centres, socialization, and education — and with these losses, much-needed access to social services for the most vulnerable.
Even now, with schools reopened, many schools are not providing the full-time service that our young people deserve and need in order to thrive. Some return-to-school plans include as little as 105 minutes per day of in-person learning. This limited time is not only inadequate to meet curricular milestones and prepare students for the rigours of university, it also leaves them isolated for hours every day and deprives them of the socialization they need to develop into healthy adults.
Almost all universities are offering only online classes and denying access to places on campus that allow social and academic interactions.
Youth and young adulthood is the time that people develop the skills and relationships that last their lifetimes. The people we meet in high school, university, at our first job, or wherever else young adulthood brings us, become friends for life. This is also the time we fall in love, fail, and fall in love again with the hope that we will eventually get it right. We learn what real friendship means as we navigate the chasm between childhood and adulthood. Recent years have seen young people increasingly struggle with this transition.
The medical and statistical truth is that the young are not at risk from COVID-19. Compared to other common respiratory infections like influenza, COVID-19 is less deadly and less likely to result in hospitalization for those under age 30.
For example, influenza claimed the lives of 10 children in Canada under the age of 10 during the 2018-19 flu season. In comparison, COVID-19 has been associated with two deaths under the age of 20 and nine deaths among those between 20 and 29. Further, it's not clear how many of those deaths were due to COVID, rather than due to another cause with COVID as an incidental finding.
In fact, the risk of dying of COVID for the young is hundreds of times less than dying of other things, an event which is, mercifully, already rare.
While COVID-19 does not pose a significant health threat to children and youth, our response does. Suicides claim the lives of close to 4,000 young Canadians per year. In June 2020, more young Canadians died in one month alone from opioid overdoses than in the entire province of B.C. from COVID-19.
But those deaths are not being announced on a daily basis on social media. Increased distress associated with loss of social structure and educational opportunity is predicted to substantially increase this number.
Even a one per cent increase in suicide would mean 40 more deaths in young people, which is four times more than COVID has claimed. This doesn't include the increase in drownings, deaths due to inability to access medical care, or other unintended consequences. We are also forgetting the enormous economic impact reduced education and increased public debt will impose on our youth.
Yet we have demonized young people who wish to socialize. Those who are caught are paraded out on the media for group shaming, or receive hefty fines. We have ensured that the common places that young people would be able to meet are unavailable — schools, universities and athletic venues — especially for those who cannot afford private lessons or clubs.
Outdoor places are closed if the young are seen congregating too much, even though these are the places least likely to be associated with disease spread. The costs of restriction are higher, and will last longer, for this group. If anxiety and depression was high already, increased isolation, lack of supports and economic distress will increase it further.
In Canada, around 80 per cent of COVID-19 deaths have occurred in nursing homes. The argument to impose restrictions on the young is that if they become infected, the infections will inevitably percolate to the elderly, causing deaths. However, it is not because a 20-year-old university student goes to a seminar with 20 classmates that her grandmother will be infected. There are many opportunities to avoid this: by improving care in nursing homes, ensuring people avoid visiting the elderly when sick, and ensuring that those caring for them have sufficient security that they are not incentivized to come to work while ill.
Many will argue that choosing between children and the elderly is a false dichotomy, and it is. There is no reason that we can't ensure our children have what they need while also providing excellent care for our elders.
We propose that we do both by ensuring adequate funding for elder care and carefully considering how important it is to ensure the mental, physical and emotional health of the people whom we have pledged our lives to raise and protect.
About The Authors
Dr. Mary Kestler is an infectious diseases specialist and clinical assistant professor in the UBC Faculty of Medicine; Dr. Jennifer M. Grant is an infectious diseases specialist; Dr. Martha Fulford is an infectious diseases specialist and associate professor at McMaster University; Dr. Corinne Hohl is an associate professor in UBC's Department of Emergency Medicine and has been nominated principle investigator of the Canadian COVID-19 Emergency Department Rapid Response Network, which has harmonized data collection across 50 emergency departments across Canada to contribute scientifically to our pandemic response.