There is a dire need to address disaster response issues faced by Pakistani older people during the outbreak of pandemics like coronavirus

A recent editorial in the British Medical Journal (BMJ) highlights serious disproportional concerns of the impact of coronavirus on older people living in low- and middle-income countries like Pakistan. This is particularly worrying since the awareness about the rights of older people in Pakistan is poor!

Pakistan is one of only 15 countries worldwide with over ten million older people. It is estimated that currently seven per cent of the population (about 14 million) is over 60 years old.

A rising life expectancy means that the population of older people in Pakistan is predicted to increase to 16 per cent or 44 million by 2050. It poses new challenges for a better understanding of care needs of older people in Pakistan.

In the limited time since the outbreak of this previously untreated virus, COVID-19, one aspect is very clear: the risk of dying from it is higher for old age persons.

A study of more than 44,000 patients carried out by the Chinese Centre for Disease Control and Prevention has confirmed that the death rate from coronavirus, grows drastically with age:

80+: 14.8%
70-79: 8.0%
60-69: 3.6%
50-59: 1.3%
40-49: 0.4%
This shows that among the diagnosed cases of coronavirus in China, nearly 15 percent of patients who died are aged 80 or more. The death rate for younger population is significantly lower: for those younger than 40, the death rate is below 0.5 percent.

There is no evidence yet that older people are significantly more likely to get the coronavirus than younger people. But medical experts say that if older people are infected, they are more likely to have a life-threatening disease, even in those cases where their general health is good.

The mortality risk of those infected is particularly high for those with chronic conditions such as pulmonary hypertension and other cardiovascular disorders. Experts say that some of the risk can be attributed to a weakening of the immune system with age.

This leaves older people and their families wondering what extra precautions they should take. Several best practices have been recommended by the World Health Organization, geriatricians and infectious diseases specialists.

There may be several reasons why older people require special services. Firstly, it is often difficult for older people to self-quarantine. Furthermore, their movement to separate quarantine facilities requires extra diligence. These older people may face barriers to obtaining food and other essential supplies if quarantine conditions become scarce or more widespread.

Secondly, another problem is the ability of health systems to cope with surges in demand for those needing respiratory support and those with physical mobility constraints. Even at normal times, our public health system faces severe capacity constraints in providing specialized geriatric care. Our medical services are unlikely to be able to offer the care needed in the outbreak in Pakistan of the pandemic from coronavirus.

Finally, there is a considerable risk that the spread of such contagious virus may cause a collapse in social contact that is particularly hard on the older populations most vulnerable to isolation and loneliness.

These facts require development of specialized public health and clinical responses for older people. Yet, up until now, no specific guidance has been made available for this high-risk group, not just in poorly resourced country Pakistan but also in high income countries.

The administration should also bear in mind that a large number of older people are illiterate. Thus, awareness campaign may not be equally effective to target older people unless designed exclusively for them. An older age perspective should be included explicitly in the development of all national planning to avoid spread of coronavirus.

An expert group on older people should be formed at the National level to prepare specialized responses for disaster management. As new knowledge emerges, this group can identify and evaluate cost effective treatments and interventions that address the particular needs of older people in Pakistan.