An elderly man stretches on a machine, with a sign advising residents to avoid exercising outdoors during the coronavirus outbreak, at a park in Shanghai on March 12. Photo: Reuters
Colleen K. Howe
Colleen K. Howe

The coronavirus epidemic is a warning for Hong Kong, and others, to prepare for the reality of an ageing world

  • Because the coronavirus disproportionately affects people over 65, health care systems in countries with large elderly populations are struggling to cope
  • The epidemic should prompt governments to think through how policies such as social distancing affect the elderly and to bolster health care systems well in advance
The Covid-19 pandemic is exposing weak spots in our medical systems, our supply chains and our political structures. It has also highlighted an often invisible source of strain: demographic risk.
The world is getting older. As highlighted in forthcoming research by the Asia Business Council, many countries in East Asia – including Hong Kong and China – are in the early years of demographic decline. There will be fewer young working-age people supporting an ever-increasing older population.

Covid-19 is an alarm bell, reminding us of the need to be better prepared to protect our most vulnerable citizens – both now and in preparation for future epidemics. Some of the countries most affected by the virus are also among the world’s oldest.

Japan and Italy are the global leaders in ageing. The percentage of residents over 65 is at a global high of 28 per cent in Japan and 23 per cent in Italy, according to the World Bank. Nearly all countries with significant recorded outbreaks have senior populations above the world average of 9 per cent.

Like the flu, Covid-19 disproportionately affects older people. The mortality rate of the new coronavirus is still poorly understood, but a recent study by China’s Centre for Disease Control based on data in the country found that 14.8 per cent of people aged 80 and older who are infected die of the virus.

The study found an 8 per cent death rate for people in their 70s and a 3.6 per cent death rate for those in their 60s. By comparison, estimates of the death rate in the overall population are around 1 per cent or lower.

Today’s crisis in Italy foreshadows Hong Kong’s and China’s future. The United Nations projects that in 25 years – a single generation – nearly one in three Hongkongers will be over 65, up from around 18 per cent this year.

Covid-19 has already strained medical systems to breaking point. In Italy, there are not enough respirators and intensive care units to meet demand, and doctors may face the task of deciding who should receive life-saving treatment. Italy’s unusually old population offers a worrying vision of our collective future.

Future epidemics could have a much higher death rate – as severe acute respiratory syndrome did, though it did not spread as easily – and a significantly larger portion of the population will almost certainly be susceptible. Hospitals bursting with patients mean people will be even more likely to die of the typical ailments of old age, like cancer and heart disease.
An elderly woman sits on a bench in Codogno, Italy, on March 12. The Lombardy cluster of Covid-19 was first registered in the tiny town of Codogno on February 19, when a patient tested positive, and has been a red zone until the end of seclusion and return of production in recent days. Photo: AP
It is a future that we are woefully unprepared to face, as the global response to Covid-19 suggests. We know that the virus has spread in nursing homes in the US and Spain. Such facilities should have been the first targets of protective measures, even before the virus began to spread, given their high-risk populations.
Many countries decided instead to close schools, even though children rarely become seriously ill from the coronavirus. This had some unforeseen consequences: following the announcement that Japanese schools would be closed at least until April, hospitals reported reduced capacity because nurses had to stay at home to care for their children.

Some medical specialists have questioned whether countrywide school closures were warranted. Would it have been more effective to allow those children who live with older adults or adults with pre-existing health issues to stay home from school? Policymakers need to put plans in place ahead of time – in consultation with medical experts and with an eye towards each country’s situation and demographics – to avoid such ad hoc responses in the next crisis.

Hong Kong’s success in containing the virus, thanks to a quick government and public response alike, is laudable. But more thought could be given to how practices like social distancing, which is almost universally recommended, are affecting older adults, some of whom are already lonely and socially isolated.

Reports of older adults living in tiny flats in Hong Kong who are now afraid to venture outdoors are worrisome, not least because Hong Kong’s ageing, often subdivided, apartment buildings may actually risk spreading the virus.

Cities like Hong Kong could put in place crisis response teams specifically for the older population – checking up on them, ensuring that this “less digital” portion of the population has access to accurate and updated information, and perhaps even providing reassurance and a social outlet.

Social activist Benson Tsang Chi-ho (right), who has distributed supplies and vouchers regularly since he founded Fair Sharing Action nine years ago, hands out masks, which were donated by individual contributors, to senior citizens in need in Sham Shui Po, Hong Kong, on February 8. Photo: Xiaomei Chen

These sort of elderly-focused intervention teams could go some way towards mitigating not just epidemics but other crises that disproportionately affect older adults. The elderly will be heavily affected by climate change, too, as they are vulnerable to heatwave-induced medical issues and are at risk from extreme weather events like hurricanes.

Such disasters have seen older adults trapped in flats without functioning lifts or unable to refrigerate their medication. A heatwave in France in the summer of 2003 killed as many as 19,000 people, many of them senior citizens.

It’s crucial that we pay attention to who is most vulnerable and take corresponding measures to halt the crisis without bringing the global economy to a standstill.

A woman walks past empty shelves where toilet paper was stocked at a shop in Tokyo on March 1. Photo: AFP
The economic cost of the crisis will be especially challenging for older adults who find their retirement funds running out. Longer life expectancies are making many pension systems unsustainable, but most people working today are not saving enough for retirement.

Higher investment in medical systems to cope with ageing populations will necessarily come at the cost of other social services. Public health issues will increasingly become economic issues as the working-age population is hollowed out.

Hong Kong and China need to double down on creative thinking and action to get ready for an ever-older future. The Covid-19 crisis will pass. But the challenges of an older society will remain.

Colleen K. Howe is a programme associate at the Asia Business Council