Wednesday, July 29, 2020

Geroscience and COVID-19

For over a decade most of my academic research has been devoted to establishing the case for the following two theses:

(1) the aspiration to promote health in late life for humans is one of the most pressing societal predicaments of the 21st century, and

(2) achieving (1) will require altering the aging process itself vs simply extending the number of years humans survive by managing multimorbidity, disability, frailty and postponing death.

I believe it is accurate to say that neither of the two theses I identify above is currently a prominent position in the humanities and social sciences. Undergraduate students coming out of University with a degree in the humanities and social sciences will have taken many courses exposing them to the importance of topics like patriarchy, economic inequality, racism, colonialism, multiculturalism, global poverty, and climate change. All important topics. But these same students will receive little, if any, exposure to the realities of population aging. Nor are they likely to have taken any courses which will help them perceive the empirical realities of today through the explanatory lens of evolutionary biology. Instead most will receive a steady dose of insights from paradigms like "ideal theory" or, conversely, identity politics. And finally what will be absent from the discussions of those research paradigms will be any engagement (outside of perhaps climate science) with the significant of science, and science policy, for addressing the future of humanity. Ideal theory and identity politics are not well equipped for addressing the societal predicaments raised by population aging, artificial intelligence, climate change, or infectious diseases like COVID-19.

The COVID-19 pandemic ought to serve as a "slap in the face" wake-up call to scholars in the humanities and social sciences. We are ill equipped for addressing the societal predicaments this virus, and our response to this virus, has thrown us into because our theorizing about the world's problems is often detached from the complex realities like the fact that there are nearly 1500 different species of infectious organisms have been identified as causing disease in humans. Students in first and second year courses in philosophy, politics, sociology, and history (perhaps an exception will be a history of pandemics course) are unlikely to even learn about this reality of the human predicament. And by the time these students finish their degree they still might not, and thus they can be forgiven for forming the impression that human beings go through life disease-free till the day they die. For that is the impression of the world they receive from what they learn in University. They will learn about combating the threats of global capitalism, racism, patriarchy, colonialism, etc. but it is unlikely they learn much about the things that will actually cause the most disease and death in the world today. And I think this is deeply problematic for many reasons. We are failing the mission of higher education when this happens.

One consequence of the COVID-19 pandemic is that this might change things, and hopefully for the better.
The pandemic ought to compel scholars in the in the humanities and social sciences to re-think their neglect of population aging and the importance of scientific innovation. The pandemic has compelled me to think very deeply about how we are responding to this virus (i.e. has it been proportionate and evidence-based?), and what the pandemic’s impact is likely to mean for aging research in the future. I believe these questions will fuel my research over the coming decade.

For those who haven’t followed this blog or my academic career, my list of publications on the importance of aging research includes the following (just to make it clear that I am not jumping on the "hey, disease and science is now important" bandwagon! It has been the primary focus of my research for 20 years):

Genetic Ethics: An Introduction
Biologically Modified Justice
Aging, Geroscience and FreedomRejuvenation Research 22(2) 2019: 163-170.
Justice and Life Extension” in End-of-Life Ethics (edited by John Davis) (New York, NY: Routledge Publishing, 2016).
Empirical Ethics and the Duty to Extend the Biological Warranty PeriodSocial Philosophy and Policy 30 (2013): 480-503.
Why the NIH Should Create an Institute of Positive BiologyJournal of the Royal Society of Medicine 105 (2012): 412-15.
Biogerontology and the Intellectual VirtuesJournal of Gerontology: Biological Sciences 67(7) (2012): 734-46.
"Positive Biology” as a New Paradigm for the Medical SciencesNature’s EMBO Reports 13(2) (2012): 186-88.
Global Aging, Well-Ordered Science and ProspectionRejuvenation Research 13(5) (2010):607-12.
Equality and the Duty to Retard Human AgingBioethics 24(8) (2010): 384-94.
“Why Aging Research?Annals of the New York Academy of Sciences 1197 (2010): 1–8.
Mind the Gap: Senescence and BeneficencePublic Affairs Quarterly 24(2) (2010): 115- 30.
Framing the Inborn Aging Process and Longevity ScienceBiogerontology 11(3) (2010): 377-85.
Has the Time Come to Take on Time Itself?British Medical Journal 337 (2008):147-48.
A Tale of Two Strategies: The Moral Imperative to Tackle AgeingNature’s EMBO Reports 9(7) (2008): 592-95.

The COVID-19 pandemic of the past 6 months has revealed a number of interesting things about the popular attitudes people, the media and policy advisors have towards disease, aging and death. In what we might call the “pre-pandemic” era, say the decade preceding the outbreak of COVID-19 in 2020, I would commonly encounter the following attitudes from students, scholars and the general public when discussing the prospect of extending the human lifespan via modifying biological aging:

Aging and death are natural.
There are too many people on the planet already so why would we want to extend the lifespan!?!
It is unfair to extend the lifespan when there are other pressing problems, like poverty, malaria, climate change, unemployment, etc.
Altering aging is science fiction.

Now contrast those sentiments with the following sentiments which have quickly become more mainstream among the public, media and policy experts and advisers in just the past 6 months:

COVID-19 is the worst public health threat in over a century!
Spend whatever needs to be spent on preventing the spread of the virus.
Spend whatever needs to be spent developing a COVID-19 vaccine and expediate the trials to get the vaccine within the next year.
Enforce prolonged lock down measures (limiting work, public transport, friendships and romantic intimacy; closing schools for children; banning travel, etc.) to prevent the spread of the virus and minimize the risk of dying from COVID-19.
Mandate compliance with the wearing of face masks if there is any chance doing so could help prevent the spread of the virus and reduce the risk of death from COVID-19.

The COVID-19 pandemic has really brought to the fore a number of inconsistencies and fallacies in the way people think about the aspiration to prevent disease and death. The complacency many have for the most common causes of death- the chronic diseases of late life like cancer, heart disease and stroke- stands in sharp contrast to the vigilant (even militant) attitude many take to preventing death from this new virus. I have found this both surprising and puzzling.

Just to be clear, I am among the most staunch defenders of promoting the health of the elderly, and yet I have been a critic of many of the strict (and unsubstantiated, in terms of the evidence for effectiveness) measures taken by developed countries in responding to the virus (the one exception being Sweden, the country I think has responded the most rationally and proportionately to the virus). My main opposition to most strict lock down measures is that little to no care was given to consider the adverse side effects of the lock down measures themselves- the harms to children, victims of domestic abuse, the newly unemployed, those at risk of addiction, suicide, and anxiety disorders, not to mention the delays in diagnosing and treating medical conditions unrelated to COVID-19 (which is the VAST majority of health problems plaguing the Canadian population). There are also substantial harms to the economy and liberty.
If the lock downs had been a drug, we never would have pursued them on grounds of both safety and efficacy. At a minimum we ought to have at least required "informed consent" before locking people up indefinitely. But fear, uncertainty and a rush to action won the day.

All of the risks and harms I just mentioned, risks and harms which have been incurred by the lock down measures themselves, were inflicted for the benefit of (mostly) reducing the mortality risks of older persons who already suffer multi-morbidity and would most likely pass within a few months, maybe years, in their nursing home. In other words, had we prevented most of the COVID-19 deaths doing so would still not have scored high in terms of what is called "QALYs"- quality-adjusted life years saved. An 87 year-old who is in the final stages of cancer progression and develops COVID-19 in their nursing home while undergoing chemotherapy would not survive many months even if a cure had been discovered for COVID-19. This is why aging researchers argue that tackling aging itself, and not simply the diseases of aging, is so important. Because of the reality of co-morbidity in late life. COVID-19 is not the only fatal disease among the elderly, nor is it the most fatal.

The data on COVID-19 deaths in Canada make vivid the role aging has played in our susceptibility to COVID-19.

To date Canadians over age 80 account for only 16.2% of our positive infection numbers, this is roughly equal to the percentage of Canadians who tested positive between the ages of 20-29 (14.9%), 30-39 (14.2%), 40-49 (15.1%) and 50-59 (15%).

And yet the percentage of Canadians who died from the virus between the ages of 20-29 was only 0.1% (9 people), for those ages 30-39 the deaths account for 0.2% (15 people), the 49 people between the ages of 40-49 who have died account for 0.6% of the total COVID deaths. And finally 2.3% of deaths have occurred among those age 50-59. These 4 younger age categories account for a total of 59.2% of the known positive COVID-19 cases and yet they only account for just over 3% of the total deaths.

By contrast, the 16.2% of known positive cases for those over age 80+ account for 71.5% of the total deaths from the virus. Canadians over age 70 account for roughly 90% of all our COVID-19 deaths.
Like cancer, COVID-19 is much more lethal for the elderly than it is for the young. But the death toll from cancer will be much more significant than that from COVID-19, and for Canadians at all stages of the lifespan. Cancer will kill an estimated 83,300 Canadians this year alone, nearly 10 times the current total deaths from COVID-19 to date. Every day cancer kills 228 Canadians. This number never makes the evening news. I suspect it rarely ever gets “tweeted” or mentioned on social media.

150 Canadian children under the age of 15 die every year from cancer. To date there are no reports of any COVID-19 deaths among children in Canada (under the age of 15). One person under the age of 19 does appear on the data for COVID-19 deaths in Canada. But there has not been any disclosure of the age, nor any more details on the cause of death for Canada’s youngest COVID-19 death (e.g. were there other contributing factors?).

It is also worth noting that the country now has 115,000 documented positive cases of the virus, which means there has probably been around 1,000,000 people infected in Canada if we assume the findings from this study in the US also apply to Canada.

If only a fraction of the popular support for prioritizing the effort to reduce COVID deaths among the elderly could also be harnessed towards support for aging research itself (which would help us prevent ALL the diseases of aging, including COVID-19 and any new future viruses) we would reap a much bigger health and economic dividend than simply slowing the spread of one virus. But of course aging is not a virus, nor did it originate in a foreign country, and its health and economic toll is not reported everyday in the news. Framing and exposure to information is everything when it comes to our collective priority setting.

But there is some reason for optimism that reason, evidence and a sense of proportionality will, in the end, prevail! Some of the leading aging researchers in the world have a forthcoming editorial in the journal Aging and Disease highlighting one of the biggest lessons the medical sciences can learn from the COVID-19 pandemic—we ought to target the aging process itself to help protect today’s aging populations from the multimorbidities of late life. A COVID-19 vaccine will not, by itself, be a panacea when the chronic diseases of aging are so prevalent among the elderly. A sample from the policy implications section of the editorial:

“The COVID-19 global emergency has emphasized to vast masses of people the vital need to prevent old-age multimorbidity, protect the elderly and improve their health span. Proponents of geroscience have argued for the importance of such preventive measures for many years. Now we see in front of our own eyes the disastrous consequences of the deficit in such preventive measures, and the portent this gap in our approach represents for the future. We are witnessing how this new infectious disease is wreaking havoc among individuals, the healthcare system and the entire social fabric around the world, while the rapid aging of the population represents the main risk factor and aggravating condition. Therefore, arguably, one of the most important lessons to be learned from this pandemic, is the need to therapeutically address degenerative aging processes to prevent aging-related ill health as a whole.

…. Conquering the current pandemic will require a multipronged approach, including primarily an ‘offensive’ approach represented by the development of vaccines and treatments, as well as a ‘defensive’ approach focused on strengthening the resilience of affected individuals. Importantly, the offensive part of our arsenal requires the urgent development of a new vaccine, curative and palliative treatments for each successive pandemic and epidemic confronting the world. This aspect of our approach is unfortunately both slow and specific to the currently relevant virus or pathogen. In contrast, the defensive arm proposed here is pathogen-blind insofar as the interventions are pathogen independent. Therefore, a geroscience-focused response to the COVID-19 pandemic can be deployed not only against the current emergency, but the same approach will certainly be relevant to future infections, be them pandemic, epidemic, endemic, or even those affecting any one individual."

I hope the COVID-19 pandemic will put aging and aging research on the “global radar” as an important priority for global health. Many of the ageist and irrational objections to promoting health in late life I have encountered for over a decade in my research and teaching will be much harder for people to raise as a result of the outbreak of this pandemic and people seeing (a small reality of) of the impact global aging has on our health prospects.