Globally, the Covid-19 pandemic has taken a toll on older people. In some Western countries, the average age at death due to Covid-19 is about 80 years. Covid-19 related mortality rates are high among the aged and in people with co-morbidities such as diabetes and high blood pressure. The virus affects the young, but does not cause severe disease and high death rates. In developed countries with good health care and social welfare systems such as Sweden, the United Kingdom (UK) and Canada, a large proportion of deaths were in old-age homes, usually referred to as care homes.
In the West, care homes for the elderly are part of a well-developed social arrangement in which people voluntarily admit themselves into care homes when they cannot manage a home on their own, and need to be looked after since children do not usually take care of their parents. So, it is surprising how and why developed countries failed to protect the elderly against the virus.
In India, however, most of the elderly either live with their children, alone with house help or with relatives. But in the last few years, there has been a surge in numbers of old-age care homes in big cities since children are increasingly moving to places, often far away from their parents.
During the pandemic, on hearing that the elderly are at most risk and high mortality rates were seen in care homes, we dug a little deeper. The data published shows that at higher age groups especially after 50, the mortality from Covid-19 is much higher. The case fatality rate among people above 70 in India is upwards of 15%, while for those below 30 years it is 0.5% or lower. But surprisingly, there are no reports of deaths in India’s care homes. This is inexplicable, especially because outside of the elderly care homes, there is a high proportion of deaths among the elderly due to Covid-19.
So, it would appear that in the West, care homes, which are well-funded, have good infrastructure, and are professionally managed could not protect the residents from the pandemic leading to a high number of deaths, whereas Indian old age homes have been able to protect the elderly against the Covid-19 pandemic despite lacking the resources and professional management. Our systematic study gives us a few insights: Informal inquires tell us that old-age care homes in India took several steps to protect their residents. The home administrators first stopped all contact with the outside world to the extent possible; decongested the old-age homes by sending some residents to stay with relatives; and stopped the infection from spreading by ensuring that care workers were given temporary accommodation in the homes themselves. Proper sanitisation of all the items from the outside including vegetables was being done on an everyday basis. They also sanitised the premises frequently.
While it is difficult to believe, it was these simple steps taken by Indian old-age homes that seemed to have been able to ward off the deadly virus to a large extent.
Are there any other explanations for this? A more thorough study on a larger sample of old-age care homes and sero-surveillance in the old age homes may tell us if the residents were not affected at all or had contracted a very mild form of the disease and were cured without treatment.
Unfortunately, none of the research agencies or other individual researchers has been able to identify the course of developments in Indian old-age homes during the Covid-19 epidemic. So far, no one has taken the pains to study it in a scientific manner. If we embark on a serious study of the old-age care homes in India, it may open a new chapter in the ongoing process of understanding the effects of the Covid-19 pandemic on the elderly. This could prove interesting and educational and shed light on an aspect of the disease which has not been fully understood yet.
Jallavi Panchamia and Dileep Mavalankar are with the Indian Institute of Public Health, Gandhinagar
The views expressed are personal