Social distancing has transformed the lives of everyone in society. However, some groups have been affected more than others, such as those already socially isolated, people in poor health, or those living in low-income communities. In this blog, Tine Buffel, Patty Doran, Camilla Lewis, Chris Phillipson and Sophie Yarker, from the Manchester Urban Ageing Research Group, explore the different ways COVID-19 and social distancing measures affect various groups within the older population.

• Social distancing may lead to social isolation for people who don’t have a strong network of family and friends.
• With health inequalities increasing between poor and richer neighbourhoods, COVID-19 can affect over-70s in very different ways.
• The UK’s COVID-19 response needs to include measures to prevent extreme isolation and support the country’s poorest communities.

The impact of changes – social and medical – brought about by COVID-19 will not be known for some time. So far, in the UK at least, numbers have dominated public debate, with a warning that approximately 500,000 people could die, reducing to around 20,000 with social distancing. Much has been made of the public response, with complaints of ‘panic buying’ receding as 750,000 people respond to calls for volunteers; and 20,000 former and retired doctors and nurses offer to return to work for the NHS.

However, inequalities between social groups have been the subject of less attention in public debate. We are especially concerned with social and economic differences affecting the older population, but many of the issues we raise have relevance to all age groups.

How social distancing affects people in different ways

Terminology has, we would argue, raised particular problems. ‘Herd immunity’ – relying on people to get the disease and acquiring immunity as a result – was reported as an initial response to COVID-19 in the UK. However, use of this term obscured the huge dangers for ‘at risk’ groups – especially older people and/or those with underlying health conditions.

Herd immunity has now been replaced by ‘social distancing’, with guidelines produced by the UK Government. These focus on those 70 and over, and those under 70 with a particular health condition. The reasons for social distancing are well grounded but the term itself raises difficulties, for example:

• the guidelines play down the extent to which social distancing may turn into social isolation for those without a strong network of family and friends;
• the value of online support is emphasised in the guidelines, even though nearly half of those 75 and over do not use or do not have access to the internet;
• the idea of social distancing might itself be difficult to interpret for people with learning difficulties and also open to differing interpretations amongst groups for whom English is a second or third language;
• the mental health consequences of social isolation are underplayed – notably for those suffering from anxiety and depression or diagnosed with dementia.

Social inequalities

Terminology, then, is one concern; inequality is another. Much of the discussion has presented society coming together in a battle against a common enemy. Developing a language of solidarity will certainly be essential – especially if, as seems likely, action to combat the virus will be spread over months and possibly years. But it is important to acknowledge how COVID-19 may aggravate existing inequalities.

• The pandemic is taking place, as the recent Marmot Report highlighted, when health inequalities between poor and richer neighbourhoods are increasing – the effects of a decade of austerity compounding the medical impact of the virus.
• Although people over 70 are at substantially greater risk of dying from COVID-19, it is also the case that research on chronic health conditions suggests that the threshold may be as low as age 55 for people from lower socio-economic groups.
• People in precarious forms of work may be especially vulnerable to the risk of contracting COVID-19. Many occupations in health and social care carry a high risk of exposure but the groups involved (overwhelmingly female) are often paid poverty wages and given minimal protection in their work.
• Some local communities are better equipped than others to respond to the crisis. Poorer communities have been affected by the loss of social infrastructure (eg, GP surgeries, local shops), limiting their capacity to mobilise resources to reach out to those most at risk.
• People from ethnic minority groups in the UK tend to be at heightened risk of experiencing various health and social inequalities and with the potential for a higher risk of exposure to COVID-19.

New social strategies for combatting COVID-19

We suggest at least three areas of work need to be developed in the present crisis.

1. Strengthening communities: A major gap in the Government’s response has been failure to provide aid to the UK’s poorest communities. These have been hit hard by ten years of austerity, bearing the brunt of the almost £900 million cuts to public health over the period 2014-2019. Key areas of support provided through voluntary organisations and food banks are being lost, at the same time that income is substantially reduced as a result of the lockdown. We argue that the Government should create a new ‘Communities in Crisis fund’ bringing together new and existing sources of assistance, working with local authorities to strengthen social resources in the most vulnerable neighbourhoods.
2. Existing guidelines on social distancing will need to be amended: As the COVID-19 crisis continues fresh guidelines on social distancing will need to be produced. New ways of maintaining social connections will have to be created – and not just through online platforms. Measures need to be taken to prevent the effects of extreme isolation. For example, there will be a pressing need to support the estimated one in ten older people malnourished or at risk of malnutrition.
3. Ensuring a responsible mass media: The media has a crucial role to play in the current crisis, especially in challenging images which present old age as a condition of frailty and vulnerability. Indeed, a lesson from the pandemic is the sense of precariousness now affecting all age groups. The task will be to demonstrate how strengthening ties across all generations will be crucial in developing an effective response to the present crisis.

Take a look at our other blogs exploring issues relating to the coronavirus outbreak.

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