COVID Effects On People In their Twenties

September 24, 2020 by David Nitkin | Categories: Healthcare Series One: Issues | Tags: morale, Mortality

Photo by Samantha Gades

The Issue

Over the period between March and August, people over 80 years old made up the largest group getting sick as long-term care homes were hit hard, resulting in more older people getting tested. However, since mid-August, as we appear to be entering the time of pandemic wave two, infections among young people (under 30) have surged. Now, after a September of provincial school and park re-openings and expanded testing, this age group cumulatively outnumbers the elderly as new cases. This blog answers two questions:

First, what risk are 20-30 year-olds to both themselves and others (teachers, parents and grandparents)?
Second, what does such a new generation of victims pose for treatment, testing and recovery?

The 20-29 Year-Old Age Cohort: Synopsis And Implications

1. Who is getting the virus: This month, 20-29 year olds stand first, outnumbering every other age cohort in being newly diagnosed with the virus. This age group has a greater share of new cases than do those in their 50s and 60s combined. The cohort represents 17 percent of all confirmed cases, though thankfully, only 3 percent of all hospitalizations.

TABLE ONE: NUMBER CONFIRMED AND HOSPITALIZED CASES, CANADA

Age Cohort	Confirmed Cases			Hospitalized Cases
Age Cohort	Number	Rank	Percent	Number	Rank	Percent
Under 20	14,506	6	9.7	163	8	1.4
20-29 year olds	25,189	1	17.1	361	7	3.0
30-39	21,732	2	15.0	586	6	4.9
40-49	21,324	3	14.7	899	5	7.6
50-59	20,413	4	14.4	1,644	4	13.9
60-69	13,123	7	9.1	2,000	3	16.9
70-79	9,298	8	6.5	2,430	2	20.5
80 and over	19,478	5	13.7	3,789	1	31.9
Total	146,663		100.2	11,866		100.1

SOURCE: Statistics Canada, PHAC, Statista (September 22, 2020)

Various factors explain this phenomenon:

schools and other public facilities have been reopened, thus increasing exposures
this life-inexperienced, less mature, age cohort is more willing to tempt its fate with risky behavior that doesn’t comply with distancing and gathering rules
testing has expanded
the age group has greater interest in or passion for engaging in crowd culture (bars, private parties, networking)
there are a large number of people in their twenties who are both more mobile and live away from (parents’) home
both social and traditional media churn out COVID narratives (risk of death or serious adverse health) in order to generate more clicks and increase their audience
ongoing stress (like COVID) that lasts months to years in young people can lead to an increase in chronic mental-health issues like depression, suicide and drug overdose
despite public health or executive orders, campus fraternities and sororities are lax in overseeing and complying with rules that limit gatherings and require face coverings

2. Symptoms: COVID symptoms can vary by age group from youngest to oldest. Chills, sore throat and runny nose were reported more frequently among those under 50. While provincial case data is incomplete and varies by jurisdiction, the 9,000 hospitalization cases that do list those details suggest that people with COVID-19 suffer differently depending on age and symptoms. In people admitted to hospital, shortness of breath and fever were more common symptoms while headaches, sore throat and runny nose were seen more often in less severe cases.

3. Risk of Hospitalization in 20 Year Olds: Close to 10 percent of all Canadians who tested positive for coronavirus ended up in hospital, according to the cases tracked by PHAC. Of25,189 confirmed COVID diagnosis cases for persons 20-29 years of age, three percent (361) were severe enough to warrant hospitalization.Two percent of September cases landed in intensive care units (ICU) across all age groups but mostly among people over 50. The risk of hospitalization for infection remains particularly high for older people, but also those in their 20s, who have pre-existing chronic co-morbidities or medical conditions.

Photo by: https://unsplash.com/@babydog50

4. Risks of Death and Serious Illness: What are the real risks of dying from COVID-19? For some people, the risk is no greater than deciding to go on a 250-mile drive. For others, it’s like going on a WW2 raid with bomber command. According to infectious disease specialists, mortality is often linked to respiratory distress. Those showing an early symptom of shortness of breath would more likely be on a serious path to death. In America and Canada, suicide and drug overdoses kill more young people than COVID-19 as the two pre-existing epidemics have been exacerbated by the coronavirus pandemic.

Infection Fatality Rate (IFR) refers to the percentage of people who die once they are infected. (This includes people with asymptomatic infections or those who are infected but never get tested.) One group of scientists believes the rate for COVID is 0.1% to 0.41% (with a point estimate of 0.28%). Another group, which examined deaths in Geneva, Switzerland, concluded that the overall IFR is 0.38% to 0.98% (with a point estimate of 0.64%). IFR varies depending on age. Young people are far less likely to die of COVID than older people. The Swiss study IFR estimates are 0.64% for the total population; 0.0092% for those aged 20-49; and 5.6% for those aged 65 and over.

5. Perceptions of Risk: Perception and reality for risk of dying from COVID differ. According to a July 2020 Franklin Templeton–Gallup Economics of Recovery study, Americans overestimate the risk of death from COVID-19 for people aged 24 and younger by a factor of 50; and they think the risk for people aged 65 and older is half of what it actually is (40% vs 80%). For those Americans surveyed age 25–34, the share of those worried about serious health consequences is 90 times higher than their share of total COVID deaths.

Among the factors noted in the international literature about perception of risk are these:

twenty year olds in many cultures suffer from peer pressure, more sense of infallibility, and willingness to test, challenge or confirm their invulnerability
area colleges, universities and health departments in Europe and the U.S (North Carolina, Minnesota, and Texas) report alarming clusters of infections on specific campuses
a large number of transnational social media sites promote libertarian, “me first” thinking
the rate of growth of COVID cases and deaths in nursing homes has slackened
high rates of infections in India, Iran, Israel, Pakistan and other counties among people in their 20s have been attached to location-specific religious/congregational institutions

Photo by Jake Piereelee

6. Recovery Rates: The first cases of the coronavirus disease in Canada were reported toward the end of January 2020. The data, while incomplete and fraught with inconsistent recording of reasons for death, suggests that severity of fatal outcomes among COVID-diagnosed patients is lessening over time. In other words, in several locations, proportionally more first wave victims are recovering. We lack sufficient studies about quality of life versus extending length of days.

7. Testing Rates: The more tests performed, the greater the number of cases identified, especially among those without symptoms. Over 6,766,982 people have been tested for COVID-19 in Canada. This corresponds to a test rate of 180,024 per 1 million people. Of all people tested, 2.1% have been found to be positive.

Implications of Increased Infection Among Those In Their Twenties

Photo by: Prasesh Shiwakoti (Lomash)

1. More risk for education system, teachers and families: A twenty-five-year-old can be a primary school teacher or a university student. As revealed in EthicScan Blog, Planning-for-Recovery-Part-four-Re-opening-Public-Schools (July 14), there are many good reasons for allowing children and young adults to return to school. Socialization, mental health, skills development, and the relief of their parents are just four. Bur re-opening schools comes with increased risk for the 20-30 year cohort of exposure to the virus, especially for teachers, multi-generational families, and group living managers.

2. Changing stereotypes: Age, apparently, doesn’t tell the whole story about who is at risk of severe disease. In fact, it reveals underlying vulnerabilities in the wider population to an illness like COVID-19. While many of these factors are concentrated among older adults, younger people with certain underlying chronic health problems are also at risk. Because the lessons we learn from older patients could help us treat and prevent the spread, it is all the more important to understand the variables that put older adults at greatest risk so we can develop a strategy to protect society as a whole.

3. Strains in the social contract between age groups: Those under thirty are most likely to resist parental and government authority as it relates to lockdowns, social distancing, and partying culture. This libertarianism puts them at odds with overburdened nurses, medical assistants, therapists, doctors, and nursing home personal-care workers who are burning out under the strain of what appears to be the onset of virus wave two. The prospects of greater inter-generational antagonism is real.

Conclusion:

Photo by: Usman Yousaf

During the early stages of the COVID-19 pandemic, it was senior citizens who were asked to be extra careful along with others with comorbidities as they were susceptible to the virus. But six months later, as Canada continues to post a worrying potential second wave trend as far as numbers are concerned, it is the 20 to 29 age group that makes up a majority of cases in many locations.

David Nitkin, founder of EthicScan, is a full-time organizational ethicist. David’s original writing, teaching, consulting and research focuses upon ethical decision making; enhancing corporate accountability and reporting; and developing corporate ethics assurance programs, including transparency, risk management, integrity management, and safe partnering.

David has provided ethics training, advice and research for over 200 clients both internationally and in Canada who collectively employ over 750,000 employees. He consults and trains widely with a variety of clients, including corporations, industry associations, public service sector organizations (integrity commissions, human rights commissions, and anti-corruption tribunals social agencies, professional ethics certification organizations, not-for-profits; and civil society organizations.

The Issue

The 20-29 Year-Old Age Cohort: Synopsis And Implications

Implications of Increased Infection Among Those In Their Twenties

Conclusion:

Further Reading: