Over the weekend we went hiking to a small mountain. My 5- and 7-year-old girls have been excited to go on these little adventures over the past couple of months, in part because that is the only real exercise they get while we have been under stay-at-home orders, but also because they have a chance to see and interact with people while we are there.
They love to tell people what is coming up on the trail, and about some piece of lore or family information that I’m sure those passing us had never imagined they wanted to know. At some point nearing the end of the hike, as we clambered over rocks, my 5-year-old claimed she was so proud that she had done all of this alone. I smiled because of course she should be proud—not very long ago, she would have been entirely overwhelmed by such a hike. But I also laughed because at that exact moment, I was holding her up by her back because she was having trouble getting up over the last rocks and had already slipped and scraped an ankle. Her pride illustrated the essence of individualism on a personal level, the principle of being independent and self-reliant.
But the central claim of individualism on a societal level is that a single person should have the freedom to do as they wish without considering the collective good, and taken a step further, proponents believe that individual actions are the only real way that things get done. In this guise, the rights and freedoms of individuals are seen as paramount to the needs of, for instance, a pandemic response, and it is up to individuals to fight this pandemic through responsible behavioral change.
Unfortunately, no one person can possibly defeat the coronavirus through their own actions. For example, despite having the best protective equipment, many people working in hospitals still contract COVID-19, partially because this disease is highly infectious indoors, but also because both their immune systems and the hospital protective systems are overwhelmed by the stress of the disease.
Results of Individualism Obvious in Data
I see the results of this stress in my work as a life-course epidemiologist who studies bodily systems that change as people get older. A lot of my work revolves around neurodegenerative diseases, in part because there are a huge number of truly difficult problems in this field, and in part because my grandmothers both died of neurological conditions. I manage a team of neuroscientists and epidemiologists who study a range of problems, from social inequalities in brain health to studies of stroke biomarkers and neuroimaging studies. My role during the pandemic has been as the chief modeling staff for our academic hospital, for which I have had access to a huge trove of data at the town and hospital level.
Coronavirus is a new, uncharted and dangerous disease for our oldest community members, but is causing heart and brain damage and death in some of our youngest individuals, too. In our hospital, while we had more than 1,500 patients, the average age of the people who were severely ill was 60 years old, and the average age of those who died was 73. But these statistics hide the fact that many of the deaths in our area occur in the very young. Our youngest patients were only days to weeks old, and the youngest person to die from COVID-19 was in their 20s. Also 5.2 percent of those who died were younger than age 45. People ages 45 and younger stayed for more than a week (10 days on average) in the hospital.
It is also worth noting that many of these younger people made choices that disregarded the value of older people. Those who were sitting in nursing homes were often victims of non-intervention orders, making them incredibly unlikely to receive any treatment or help. In many hospitals, older individuals were not protected because resources were diverted to the younger patients who needed help. In this case, there may have been no collusion—a simple decision was made to seek out less care or to delay care for older patients when there are a slew of possibly younger patients seeking care. In dire times, hospitals may develop groups to determine resource allocation—to decide who deserves care. Such groups will undoubtably determine that older, sicker or weaker patients should receive less care.
Defined by Our Actions Toward Elders
As a society, we are often defined by how well we treat those who need help the most. It is, therefore, our responsibility to protect those who we know will have trouble accessing or receiving care, to prevent them from getting sick in the first place. Instead we are attempting to manage a global problem by telling older people it is their responsibility to be careful.
As a community, we must instead work together to solve this problem—we need leadership that works with communities who engage members in the solutions. We must each of us not only be personally responsible (by wearing masks and skipping that enticing summer party), but we must be responsible to the community and acknowledge and support those who are working on our behalf.
Older people cannot bear this burden alone because, like hospital workers, they, too, will be infected at high rates, even if they take the best precautions. The adage of one of the youngest presidents applies—we should not ask that our communities protect individual rights and freedoms above all else, we should instead seek to ask how we as members of a larger community can help out in defeating this new and terrible disease. In that light, a focus on individualism is really not a strength but a story the weakest among us tell to defend these weaknesses. How many people are we prepared to lose to defend these weaknesses?
When hiking, we treated my daughter as a child and celebrated her success. However, as parents we also recognized that my daughter was not the sole architect of her success. We all must come together to achieve our most impressive successes—no one does it all on their own. In the case of COVID-19, younger people who face little risk but who may still need intervention have acted as the locus to distribute the disease to older people with whom they work or live. Those people bear the brunt of the disease’s worst effects, and are at higher risk because of their age. There is a simple way to achieve success, by having the population to act as one to take responsibility for fighting this disease.
Sean Clouston, Ph.D., is associate professor in the Department of Family, Population and Preventive Medicine, Program in Public Health, at Stony Brook Medicine in New York.
Editor's Note: The opinions expressed in this article are those of the authors. They do not necessarily reflect the opinions or views of ASA management or its members.