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The Washington PostDemocracy Dies in Darkness

Many parts of America have already decided to sacrifice the elderly

The U.S. has a patchwork of social-distancing rules. The weakest ones exist where older people live.

Spring break revelers gather in Pompano Beach, Fla., on March 17. Florida, home to many retirees, was slow to institute social-distancing rules. (Julio Cortez/AP)

For a tense moment last month, talk of a grim Faustian bargain was in the air. The hypothetical deal — voiced most prominently by Texas Lt. Gov. Dan Patrick (R) — would involve restarting the economy while possibly sacrificing those most vulnerable to covid-19, including older Americans. “No one reached out to me and said, ‘As a senior citizen, are you willing take a chance on your survival in exchange for keeping the America that all America loves for your children and grandchildren?’ ” Patrick told Fox News Channel’s Tucker Carlson. “And if that’s the exchange, I’m all in.”

A host of voices, most of them conservative, joined in either welcoming such a trade — serious health risk for some in exchange for a functioning economy — or at least entertaining its framing. President Trump, too, flirted with an economy-first, health-second approach when he called for a return to economic normalcy by Easter. When Trump extended the federal social-distancing guidance through the end of April, the nation’s at-risk groups appeared to have been given a reprieve. (Although the saga may repeat itself: Trump is itching to reopen the United States on May 1.)

Unfortunately, the current patchwork of stay-at-home policies nationwide — which persist despite the recommendations of the federal government — effectively discriminates against vulnerable populations anyway. Many states have lagged in adopting social-distancing rules, while others are enforcing them only sporadically, at county or municipal levels. And of the swaths of the country with late or scant social-distancing orders, many are home to populations older than the national average. These pockets include Sun Belt retirement destinations where older adults have congregated as well as rural regions throughout the country that younger people have fled.

The sacrifice-old-people trade-off was always built on rotten logic. Any policy decision leading to mass casualties, even if concentrated in certain groups, would grind the economy to a halt just as readily as stay-in-place orders and mandatory shutdowns. And, of course, the idea that covid-19 affects mainly very old people, or only people with compromised immune systems, turned out to be a fiction.

But even if those arguments against prematurely restarting the economy disappeared, the proposition would still be an economic loser. You can’t choose the economy over Grandma, it turns out, because, in a very real sense, Grandma is the economy — and that’s doubly true in rural regions and retirement destinations.

Despite CDC warnings to practice social distancing, some spring breakers didn’t let covid-19 stop them from partying at the beach the week of March 13. (Video: The Washington Post)

Nationally, Americans age 50 and older — that is, 35 percent of the population — account for 40 percent of U.S. gross domestic product, or $9 trillion as of 2018. They also contribute 43 percent of American taxes. One reason their economic footprint is so large is that older people, contrary to their popular conception, are not only consumers, but producers. Americans age 65 and older have more than doubled their presence in the U.S. labor force since 2000 and now account for 7 percent of it — a figure that climbs to more than 23 percent if you lower the bar to age 55. Today, workers in that age group occupy critical positions throughout the economy. Twenty-two percent of U.S. construction workers are 55 and older, as are a quarter of manufacturing laborers.

Farmers, crucial figures in any economy, are nearly 58 years old on average. Farmers age 55 and older manage two-thirds of U.S. farmland, and much of that land is found in aging, rural regions that have not adopted strict social-distancing rules. Iowa, the second-most agriculturally productive state after California, has lagged behind other states in instituting social-distancing orders, as has Nebraska, agricultural producer No. 4. Texas, producer No. 3, waited until April 2 to institute statewide protections, long after most states had made the shift.

Nationally, 16 percent of Americans are older than 65, but in rural areas, the figure rises to 19 percent. Such areas currently tend to have fewer confirmed cases of covid-19 per resident than their more densely settled counterparts, but their older populations and more lax rules put them at high risk of serious outbreaks.

Should older residents in these areas fall sick in disproportionate numbers, regional economies would be devastated. Farming, for example, often depends on seasonal, timing-dependent periods that can’t be put off: Either the work gets done or the window closes. The best way to make sure the agricultural workforce remains healthy in the vital weeks and months to come is for rural states to embrace social-distancing measures now.

The health-care industry, more essential than ever, is also an aging field — particularly so in rural regions. Nationwide, nearly one third of practicing physicians are 60 and older, and nearly a quarter of registered nurses working in hospitals are older than 55. The numbers skew older in rural areas (and there are fewer doctors per capita there, too). The same is broadly true of physicians’ assistants and nurses. The rural health care workforce, already under stress, will be at disproportionate risk if state and local governments don’t more firmly embrace stay-at-home orders.

Older Americans also provide an outsize share of informal caregiving both in rural areas and nationwide; such caregiving supplies about $470 billion in unpaid labor each year, according to some analysts. If that population gets sick, that could set off a domino effect in which younger people must leave the workforce to assume caregiving responsibilities, while shouldering major unplanned-for expenses.

As in the case of rural counties, the demographics of the nation’s retirement meccas make them particularly vulnerable to covid-19; what’s more, they lack the advantage of low population density. Some of these retirement destinations are taking the new coronavirus more seriously than others. As of Sunday, Maricopa County, Ariz., home to such retirement-centric communities as Scottsdale and (even more so) Sun City, received a D-plus social-distancing rating from Unacast, a company that has compared cellphone mobility data from before and after the coronavirus outbreak. Florida’s The Villages, the country’s largest retirement community, is faring even worse. The Villages sprawls into Sumter County as well as adjacent Lake and Marion counties; those counties currently hold a D, D-minus, and D-minus, respectively.

Major retirement communities can be regional economic juggernauts, creating jobs ranging from nursing to construction. Anything that hurts them will also grievously hurt their surrounding communities. Both Florida and Arizona trailed the national movement of instituting stay-home orders statewide. But in a crucial stretch of days at the end of March, Arizona fell in with the nationwide trend, while Florida’s governor, Ron DeSantis (R), pursued a policy largely focused on keeping people from such covid-19 hot spots as New York and New Orleans out of Florida. We are witnessing the cost of that delay in infections and lives.

The current geographic variation in stay-at-home orders is deadly — and although older people and other at-risk groups will pay a more severe price, everyone stands to lose. The virus is in every state; the call is now coming from inside the house. We still have much to learn about the novel coronavirus, but one thing it has proven conclusively is the porousness of our carefully drawn boundaries. We’re all connected — by economic ties, by our personal and family relationships, by the mechanics of contagion. These forces vault lines of geography, party and age. The effect is an interlinked society where no group can suffer in relative isolation while the remainder go about their ordinary business. Any policy that puts the people most susceptible to the virus at risk puts us all at risk. That was true last month, when a few rash voices proposed that older people might sacrifice themselves for the common good. It’s true now, when some states are still putting vulnerable people in harm’s way.