Our Pandemic in May: WHERE DO WE GO FROM HERE?  (May 31, 2020)

WHAT’S OUR STATUS QUO?

            California has confirmed 91,000 COVID-19 cases and 3,700 case-fatalities. In San Mateo County where Nancy and I live, the corresponding numbers are 2,000 cases and 82 related deaths. Given a state population of nearly 40 million and a county population of 730,000, these coronavirus statistics may not sound alarming. But the numbers are still climbing, not expected to peak for at least several more weeks.

            Within our retirement community, there have thankfully been no resident cases or deaths thus far. Three staff workers have been infected; all have been isolated and successfully treated without hospitalization.

            Reacting to public-health experts’ advice, complicated by intensifying political and economic pressure to reopen, here’s the authorities’ current strategy. California’s Governor is sponsoring a “Resilience Roadmap” for economic and social reopening. San Mateo and other counties have brought their own pandemic-management programs into line. At this stage, private- and public-sector enterprises allowed to open include retail (curbside and delivery only), related logistics and manufacturing, office workplaces, limited personal services, outdoor museums, child care and “essential businesses.” The latter roster is extensive: healthcare, emergency services, food and agriculture, energy, water and wastewater, transportation, communications and IT, government operations, financial services, chemicals and hazardous materials and the defense industry.

            For us older adults (65+), the original shelter-in-place restrictions remain in effect. In view of our greater risk of serious illness, these ground-rules include staying at home, cancelling all non-essential travel and appointments, keeping up outdoor exercise, wearing masks and observing social distancing outside our homes, and frequent hand-washing. Our retirement community’s management has emphasized their determination to be more conservative than these governmental guidelines.

            The seniors I’m acquainted with fall generally into two pandemic groups: those still occupying their own houses and those, like Nancy and me, who have moved into continuing care communities. Between these two groups, I detect a pattern of pandemic trade-offs. My shorthand label is Freedom vs. Protection. All of us are subject to governmental authorities’ directives. But our friends at home have broad freedom to venture out, tempered by the risk of encountering infected strangers. Those of us within CCRCs are comparatively constrained – no entry or exit – but correspondingly better protected.

            My overall impression is that, thus far, most seniors within my acquaintance in both groups are coping rather well. (Our community’s Executive Director concurs. She estimates that 80% of Independent Living residents are abiding by sequestration rules without complaint.)  Inconvenienced, to be sure; a tad claustrophobic and antsy, but not seriously harmed. In dramatic contrast to front-line health workers risking their lives or other employees dealing with layoffs and idled children, our short-term discomfort has been manageable and mild.

            I also see and hear abundant evidence of my fellow seniors’ innovative adjustments. At-home friends are relishing surprise visits from out-of-town grandchildren, sharing back-deck barbecues at separate tables. A lucky few have escaped to scenic retreats on islands or in remote forests. Retirement community residents have no comparable opportunities but are rapidly cobbling together substitute pleasures: intranet and closed-circuit TV for workshops, concerts and movies; deliveries from favorite restaurants. Both groups are launching creative confined-to-quarters projects. Both are phoning old and new friends for heart-to-heart conversations.  The tacit consensus to date appears to be that isolation has been tolerable and necessary.

WHAT COMES NEXT?

            Late May feels like the eye of the storm. What comes next is impossible for pandemic storm-trackers to confidently forecast. In a best-possible scenario, California coronavirus cases will sharply diminish, authorized reopenings will expand and accelerate with little or no adverse consequences, safe treatments and vaccines will be swiftly perfected. In that eventuality, I anticipate that most seniors I know would happily reconstruct their pre-pandemic lives. Unfortunately, no responsible public-health experts I’m aware of endorse such an optimal prospect.

            At the opposite extreme, all hell could break loose. Premature reopening could provoke a new surge of infections. An autumnal Second Wave could have a similar calamitous impact. Hospital facilities, services and supplies could be overwhelmed. If mandatory lockdowns were reinstated and intensified, political polarization could spill over into civil conflict, possibly compounded by a disputed election. Vaccine development, testing, scaled-up manufacturing and distribution could take years, not months. Even then, anti-vaccine militancy could compromise herd immunity. My hope is that this worst-case scenario does not erupt. If it does, we seniors may literally and figuratively get caught in the cross-fire.

            For me, a less tumultuous middle track is the most likely path forward — in California, though not uniformly nationwide. Phased reopenings may continue over the coming year: monitored, measured and, as necessary, modified and even suspended. No disastrous spike in cases or deaths may occur before a vaccine is distributed.   

            In such a slow-fix scenario, I can readily imagine that we seniors might continue to be treated by the authorities as a special group. Certainly, there could be sound policy grounds for relaxing our isolation restraints more gradually. Nursing-home residents alone are estimated to account for more than a fifth of all COVID-19 deaths nationwide. Closer to home, our CCRC’s Executive Director recently relayed some breath-taking San Mateo County statistics. The case-fatality rate (deaths per virus-infected person) is only 1% for persons 20-65 years of age; 6.5% for 70-79 year olds; but 25% (!) for patients 80 and above. (To underline the point, in our community, 200 of 250 Independent Living residents are in this oldest age-group.)

            Public officials’ appropriate objective of continuing to protect vulnerable seniors might be reinforced by the authorities’ parallel determination to restart the economy. Most of us are retirees, neither employers nor employees. As such, we have less potential to contribute directly to business recovery. This combination of public-health and economic bases for keeping us out of circulation led me to narrow my focus onto two senior-specific issues.

SENIOR RESILIENCE OVER THE LONG HAUL?

      My first concern was how well we seniors would hold up if our pandemic sequestration were indefinitely prolonged. To complement my own assessment, I put the question to a circle of San Francisco Bay Area seniors. All are my valued friends. They inhabit all of the six Bay-shore counties, and span a broad spectrum of political persuasions. Males and females, some are single, some married. Most have kids and grandkids; some do not. Most live at home; some have moved into CCRCs. To keep us all on the same page, I asked whether extension or renewal of shelter-in-place directives through the end of 2020 or stretching into 2021 would work a major hardship for them or only a manageable inconvenience. Their responses were candid and insightful, often moving. I promised to keep attributions anonymous, in order to respect individuals’ privacy in this intensely personal domain.

      Three themes repeatedly resonated. The first was a broad recognition that we seniors are singularly privileged and protected. Not risking our lives like front-line service providers. Not shocked by income interruptions like laid-off workers. Our lockdown burdens are comparatively modest.

      A second common response was that duration is crucial. Short-term isolation is annoying but bearable. Extend it over several more months and we’d be entering another, less acceptable, domain.

       Several respondents also emphasized that their most painful loss, steadily intensifying, has been physical separation from children, and even more so, grandchildren.  Zoom offers virtual contact, but it’s no substitute for hugs. These echoed declarations were passionate, not playful. “Suddenly, the virus has trampled all types of plans to visit family, the most important aspect of our senior years. This may be the sharpest sting.” Or again, “[If lockdown were extended,] not seeing our children and their families regularly would be a total hardship. They’re our reasons to be alive, now that I’ve retired.”   

      Beyond this broad consensus, individual comments revealed other burdens of indefinite lockdown. One friend’s shared reflections were exceptionally moving. “Yesterday we learned that my brother-in-law has pancreatic cancer. He and his wife left our home after getting the oncologist’s report. He’ll have intensive chemo in his own town. As I was just watching a bumblebee pollinate my wife’s sweet peas, I was thinking how hard it will be not to be able to travel to say goodbye to him, or to not be able to celebrate his life and our family in a service of our choosing, if and when we lose him.”   

      Less emotional but hardly trivial was the possible necessity of cancelling already-booked commitments, especially for international travel. “I’ve looked forward to this trip for a year. I’ve got my air tickets. I’ve rented an apartment. How long do I wait before bailing?”

      I was especially touched by one friend’s overarching sentiment: “Long-term lockdown would be a manageable inconvenience, but frustrating because I feel like we’re getting older without being able to fully live out the last years of our lives.”

      Distinctly a minority view was the opinion that even extended sequestration would not be a serious problem: because most activities and relationships could be sustained from home, with electronic connectivity. 

     Compared with most of these friends, I was surprised to find my own take on continued isolation to be relatively relaxed. After two months of initial lockdown, I’ve adjusted to restrained mobility more easily than I’d anticipated. To be sure, I’m surrounded by a generous array of benefits: my best friend as spouse and roommate; a comfortable apartment and secluded patio; a voluminous library; hot meals delivered to my door, supplemented by local-grocery deliveries; on-campus woods and a meadow to walk in; telephone access to family and friends; TV and the internet for entertainment and education. Not least, a vigilant professional team protecting me from virus intrusions. If necessary, I think I could stick this out for the long haul.

      The main modification I would most welcome in our community’s isolation regime would be loosening constraints on residents’ off-campus travel. Right now, we’re allowed to keep essential medical appointments but only if quarantined for two weeks on return. (Case in point: Nancy and I have just begun a fortnight confined to quarters after twin Stanford Health appointments on May 28.) If community lockdown were extended for the long term, without flare-ups, I’d hope that on-return testing would suffice. More wistfully, I have a trio of planned domestic and international trips on hold. But I’d be willing to keep postponing these adventures until a proven vaccine is distributed. Just don’t keep me waiting so long that I forget where I wanted to go!

MY SECOND QUESTION: HOW WILL WE HAVE CHANGED?

      Dozens of articles (on-line, on-air, in print) address macro-level impacts of the continuing pandemic. How deep will be the economic recession, and how swift or slow the recovery? How can governments better prepare for the next generation of mutating microbes? Will high-visibility cleaning and non-interactive check-ins restore consumer confidence in the flattened travel and tourism industry? Has work-from-home become the new normal; and if so, what will scaled-back offices look like? What about telemedicine? On-line learning? Is there any way for a post-pandemic world to preserve uncongested roads and breathable urban air?     

      At our micro level, I’m wondering how my fellow seniors and I are changing and what we are learning from our pandemic experience. Is enforced isolation encouraging us to rethink our priorities? Or as I put the question to my Bay Area peers, “When you finally emerge into reopening, what facet(s) of your pre-pandemic lifestyles are you least likely to reactivate?”

      There was near-unanimous consensus on one re-emergence theme. Almost all my respondents agreed they will take pains to avoid physical proximity to strangers. This principle’s practical applications were extensive and not immediately obvious. No more airports or flights; no public transport, Uber or Lyft. “I wouldn’t even want to take a car trip, for fear of encountering the virus in a motel or restaurant along the way.” No movies or concerts, no stadium sporting events. “I’ll have to reevaluate my volunteer activities as several involve lots of interaction with groups of people I do not know.” No distant meetings, conventions, conferences or reunions, “at least until data and a proven vaccine establish tolerable risk.”

      More philosophical were one friend’s reflections on changed priorities and lessons learned: “I’ll be less interested in continuing casual friendships with people I don’t feel close to. Less interested in shopping for clothes or anything I don’t really need. I’ll be less willing to go to fundraising events for nonprofits and politicians. But I’ll be very excited about seeing close friends.”  

      One 90-year-old friend’s comment struck me as particularly poignant. “It’s hard to say what I’ll surrender. Part of this is age-related. No more trips to Indonesia!”

      Again, a minority position was that even an extended pandemic would change nothing. “There’s nothing I won’t reactivate. I’ll resume all of my pre-lockdown lifestyle.” In the same camp, “I’m busy and my irons in the fire will be no less attractive and demanding: family and friends; NGOs; church; research; the election; national professional organizations.”

      Finally, two friends couldn’t resist a grin and a wink.  “Once this is all over, I will never wash my hands again.” And, “A fine kettle of bats this has turned out to be.”

      My own first emergence observation is that seniors’ re-entry is unlikely to be swift or smooth. Repeated experience in other countries is confirming that, despite governments’ promotions and prodding, sequestered citizens and consumers are only creeping out. The companion realization is that, for the foreseeable future, at least in our part of California and especially for wary seniors, emergence will be accompanied by continued attempts at self-protection: mask-wearing, six-foot intervals, avoidance of physical contact, avoidance of groups, and surface-sanitizing.

      Without being paranoid, might we seniors also have to anticipate being targets of intensified ageism? Look no further than the abuse and scapegoating already being directed at Asian-Americans.

      As for my personal candidates for pre-pandemic practices to jettison, two aspirations are firming up. I’ll dedicate myself to reducing busy-ness, mindless animation. This was an Agile Aging objective from the outset. Isolation has only increased my determination to stop wasting time. A companion discard will be discourteous inattentiveness, especially during conversations. Retirement community lockdown has essentially limited our face-to-face conversations to snatched exchanges with perambulating neighbors and errand-running staffers. We’re all re-learning to make the most of a few words.

      Turning from discards to acquisitions, when this is over I’m going to try and sustain new projects and practices begun during isolation: spontaneous but comfortingly intimate phone calls with family and friends, silent wildlife-watching, and twilight meditation. Seclusion has reminded me to value each day as a gift from a diminishing fund. And since my career was in public-policy advising, I’m convinced this pandemic has been gravely exacerbated by federal-government bungling. I’m pledging to get as involved as I can in the November election, even if lockdown constraints are still in place.

OVER TO YOU

            I’d love to hear from blog subscribers and readers. Here’s one sub-topic to stimulate your engagement. If social distancing remains the norm for the foreseeable future, what non-touching gesture of greeting would you prefer? My own favorite is the eyvallah. The centuries-old Ottoman custom combined right-hand-over-heart with a slight bow. How would you like to say hello in a six-feet-of-separation world?