This pandemic has revealed our most precious asset

The coronavirus pandemic has made the world realize the value of our health, at whatever age. As we prepare for the International Day of Older Persons on October 1, prevention should inform the ‘Platform for Innovation and Change’, the first of 10 priorities outlined in the WHO campaign, Decade of Healthy Ageing 2020-2030.

The virus has shone a spotlight on other priorities in the campaign, including making the economic case for investment in healthy ageing, collecting better data on healthy ageing, and the critical role of technology in the quest to rebuild health and economic resilience post COVID-19. Crucially, the virus has exposed the terrible truth of ageism.

Prevention is the “cure”

A recent McKinsey report estimates that the cost of ill health was about 15% of global GDP in 2017, and that the COVID-19 pandemic and its repercussions will reduce global GDP by 3-8% in 2020. The authors write: “Long-term prevention and health promotion, which encompasses more than 70% of the benefits we identified, cannot simply be left to healthcare providers or healthcare systems. It is quite literally everybody’s business.”

Preventative health is vital to build up health and economic resilience. Indeed, arguably the even bigger crisis looming is the chronic disease “epidemic” – delays in cancer diagnosis and backlogs of cases have all increased, with people fearful of seeing doctors and going to hospitals, only adding to the significant burden that existed before the pandemic. The recent OpenSafely study showed that people were much more likely to die from COVID-19 if they suffered from obesity, diabetes, coronary heart disease and hypertension – all mostly preventable diseases linked to social inequalities.

The global reset

Most experts agree that we will be living with the coronavirus pandemic for some time, even if a vaccine becomes available in the next year. So far, governments around the world have injected over $9 trillion to save the global economy. While governments and healthcare systems wrestle with the immediate crisis, businesses have had to act quickly too.

There is no doubt that the fracture lines of society have been horribly exposed by COVID-19, with the elderly, those in the poorest health and living in deprived communities, hardest hit. In the UK, the US and other countries, a significant number of COVID-19 deaths have occurred in care homes, partly as a result of inadequate testing. The fact that this was allowed to happen to our most vulnerable, elderly people exposes our values and highlights the urgency with which we need to tackle ageism.

While ageism has been laid bare by the virus, it is heartening to see the incredible degree of compassion between young and old during the crisis. Altruism and volunteering have been prevalent in communities around the world. All this has accelerated a renewed look at our societal structures and value systems, and what a new social contract should look like.

We should harness these lessons quickly to engage people locally in purposeful activities that promote health and social engagement. This could be part of rebuilding society from the ground up after the pandemic. But we need to act fast.

Leaders have a once-in-a-lifetime opportunity to reshape how societies work, to provide healthier, greener, and more equitable outcomes for all; an opportunity that the World Economic Forum has hailed as the Great Reset. The cornerstone of this reset is a new “stakeholder capitalism”, a more socially responsible version of capitalism to restore social justice and ensure that wealth is distributed more fairly amongst all stakeholders in society.

The power of technology

The power of technology to help solve the global pandemic has emerged with startling clarity. AI is helping researchers analyze gigantic datasets to forecast the spread of the virus, to provide an early warning system for future pandemics, and to identify vulnerable populations needing help. It has also accelerated the pace with which we are identifying many promising vaccines.

Very early on it was clear that COVID-19 does not treat all age groups equally, and that many of the expected interventions such as vaccines, therapeutic, and symptomatic treatments will not work as well in the elderly.

The link between the elderly and risk of COVID-19 appears to be increased baseline inflammation present in older individuals. Recent studies have shown that the presence of excessive inflammation can inhibit immunity in both animals and humans and that this can be prevented by blocking inflammatory processes. This finding has important implications for the immunity of older individuals infected with COVID-19, or other future pathogens that cause overwhelming inflammation. Reducing inflammation as a therapeutic strategy for enhancing immunity in older people is a focus of research right now.

But while AI is being harnessed to accelerate research into vaccines and treatments for COVID-19, it should also be applied with the same urgency to help prevent chronic diseases and keep us healthy for longer.

When you ask people what they fear most about getting old, more often than not it is getting dementia, especially since there is still no cure for it. This is where the latest research using AI is so exciting, as it is beginning to unravel the complexities of the interplay between genes, environmental factors and, most importantly, the interventions which might minimize your risk of dementia, delay the progression of dementia, or even treat it directly.

This ability of AI to spot patterns using data has led to a new form of data for research called digital biomarkers, which will accelerate our understanding of Alzheimer’s disease. A digital biomarker is a quantifiable measure of a person’s physiological and/or behavioural state captured through connected devices, including wearables (such as blood pressure monitors or sensors), implantable devices (such as pacemakers or continuous glucose monitors) or smart devices in the home (such as voice assistants or gait sensors). They’re also sometimes referred to as digital signatures or fingerprints because their exact values tend to be unique to us. Identifying those digital biomarkers or combinations of biomarkers that indicate early risk of Alzheimer’s, such as certain sleep patterns, nocturnal blood pressure dipping, or changes in voice analysis, will help design possible interventions – whether lifestyle or drug – to delay, or one day even cure the disease.

Recently, Alzheimer’s Research UK announced a major study with funding from the Bill Gates Foundation, to analyze digital data captured from wearable devices such as smart watches, to develop these digital fingerprints. AI can be used to identify new insights into the early signals of disease, by combining digital fingerprints with traditional sources such as brain imaging and memory tests.

The use of AI to understand dementia highlights how complex the interplay between genes and our environment is, and how individual our risks and responses are to those factors. But it is also revealing the promise and potential of technology to improve our health, individually and at a population level.

Premature and avoidable ill health degrades people’s lives, local communities and their economies. Up until COVID-19 struck, the developed world was largely ignoring this, and governments have failed to pursue the great gains that prevention, early detection and mitigation can bring. Far more wellbeing and health can now be gained by preventing illnesses than by treating them. Indeed, prevention will always be better than the best treatment. We now know better how to do so, but a change in public attitudes and cultural norms is critical to drive impact.

Hopefully this will be one of the positive legacies of COVID-19 with the most impact: how precious our health is. We need to cherish, nurture and protect it. We can’t take our health for granted at whatever age. This must become the platform for the Decade of Healthy Ageing.