WHO Country and Technical Guidance – COVID-19: Update on Consideration of Older People
The World Health Organization (WHO) advised in April 2020 that over 95% of COVID-19 fatalities worldwide were among adults over the age of 60 years. As the disproportionate impact of COVID-19 on older people continues to evolve, there is an undeniable urgency for Member States to focus pandemic response policies and protocols on protecting and respecting the lives of older people during this unprecedented time.
The WHO Country and Technical Guidance website contains tools and resources intended to equip Member States to appropriately prepare for and respond to the COVID-19 pandemic. Whereas an analysis of the publications available in late April 2020 revealed only 27 of 76 resources focused specifically on the needs of older people, more than half of new and updated guidance since published have responded to the global call to focus on this disproportionately impacted group.
The International Federation on Ageing (IFA) as a global point of contact for those working for and alongside older people recognizes that important lessons are being shared through the WHO Country and Technical Guidance and seeks to understand how to best channel global efforts moving forward.
Summary of new and updated guidance focusing on older people
Since the IFA’s initial analysis of WHO Country and Technical Guidance in April 2020, there is improved consideration of the heterogeneity of the ageing population. Explicit references to older people in a variety of settings and scenarios in 12 of 21 new and updated guidance documents demonstrate a more comprehensive consideration of the diversity of this population.
Several documents provide recommendations around preventing the spread of COVID-19 among older people in everyday life. “Considerations in adjusting public health and social measures in the context of COVID-19” recommends implementation of specific protections in the workplace, schools and other institutions. “Strengthening Preparedness for COVID-19 in Cities and Urban Settings” recognizes the diversity of subpopulations of densely-populated urban settings including older people and those with underlying medical conditions and calls on municipalities to leverage their essential service personnel and community groups to respond to the needs of vulnerable populations. Furthermore, the “COVID-19 SMS message library” and “Q&A: Older people and COVID-19” provide key messages targeted to older people with general day-to-day recommendations. Of note is the implicit recommendation for private and non-profit sectors to collaborate on pandemic response measures (i.e. quarantine at-risk individuals in empty hotels) and on solutions that enable resumption of economic or social services.
Guidelines on surveillance, tracing and clinical management of COVID-19 cases consider specific protocols required for effective outreach to and treatment of at-risk groups including older people, with specific focus on long-term care facilities. “Surveillance strategies for COVID-19 human infection” recommends dedicated surveillance for high-risk populations. “Contact tracing in the context of COVID-19” describes ways of engaging communities to participate in contact tracing in high-risk settings. “Clinical management of COVID-19” guides the care of older people through all phases of the disease. “Advice on the Use of Masks in the Context of COVID-19” notes the use of medical masks is recommended for older people and those with comorbidities.
Furthermore, “Maintaining essential health services: operational guidance for the COVID-19 context” highlights the discretion of local government to designate “essential health services” based on local health system burden of disease but recommends focus on prevention of communicable diseases, maintaining treatment regimens for chronic conditions and managing emergency interventions. “Community-based health care, including outreach and campaigns, in the context of the COVID-19 pandemic” lists a variety of ways for civil society organizations to contribute to sustaining pandemic response and supporting vulnerable populations, primarily by establishing and maintaining responsive communication and disseminating guidance and reliable information.
Extraordinary circumstances of older people experiencing violence and crisis are explored in several guidance documents. For instance, “Addressing violence against children, women and older people during the COVID-19 pandemic: Key actions” and the related “COVID-19 and Violence Against Older People” note the ten-fold increase in risk of abuse and neglect of older people during the pandemic and identifies factors leading to this increase including socioeconomic stressors, reduced access to social supports networks and likelihood of increased substance abuse. Recommendations to combat violence target a variety of stakeholders including government and policy-makers, programme managers, facility managers and health care providers
As much of the world begins to shift to a post-COVID-19 perspective it remains evident that the needs and issues affecting older people are diverse and intersect a multitude of disciplines including public health, media and communications and urban planning. Guidance from the WHO designates authority to Member States to implement recommendations in a manner that is culturally and contextually appropriate. Therefore it is incumbent upon governments and decision-makers to recognize and prioritize policy changes needed to better respond to the needs of older people through the ongoing COVID-19 pandemic and in future.
Prevention of Infectious Diseases in a COVID-19 World
A fundamental component of planning for the future of national healthcare systems must be to better invest in and support preventive interventions such as life course immunization programs. The WHO’s Immunization Agenda 2030: A Global Strategy to Leave No One Behind offers essential guidance for creating immunization policies that are founded upon equity and access through an evidence-based framework of action. Core principles underpinning proposed action as part of the Immunization Agenda 2030 which align with the WHO Country and Technical Guidance include:
Living ‘with’ COVID rather than post-COVID will rely upon a collective understanding that those most vulnerable to infectious diseases in all societies can be protected through effective preventive interventions. The guidance provided by the WHO Country and Technical Guidance alongside the Immunization Agenda 2030 offers actionable next steps which must be taken by decision-makers, civil society organizations and older people founded upon a rights-based approach.