Logan’s Run is a sci-fi film first released in 1976. Based on a novel of the same name by William F Nolan and George Clayton Johnson, it depicted a futuristic world where you could live a life of hedonism and luxury until the age of 30, at which point you were ‘renewed’, or, as we find out a later in the film, exterminated. Of course, in the book (and film) there are those who do not want to die and decide to ‘run’, called Runners. The namesake of the movie, Logan, is a policeman (or Sandman) given the task to infiltrate a group of people who resist the regime, ie those who wish to live longer. For anyone who wants to see the film, I shall not give any more away, suffice it to say, of course, that there are no older or elderly people in existence in this hedonistic ideal world within the confines of its city.

Fast forward to 2020 and you could be forgiven for thinking that we are entering the set of a science-fiction horror movie. A devastating new virus has enveloped the world, causing widespread panic, deaths and possibly the worst economic crisis since the 1930s. As of December 2020, 1.6 million people have died, the vast majority of whom are older patients with co-morbidities or underlying ill-health that comes with advancing years. In March, the world watched in disbelief as a region in northern Italy, Lombardy, battled the novelle virus, not knowing the best way to treat it or to stop its spread. The speed of its progression and escalation overburdened their health system to the extent where, quite openly, doctors were choosing who would live and who would die.

The choice was made through the pre-existing value of youth, who were not only deemed more likely to survive, but also more likely to contribute towards the future of a society (think economy, tax) yet to unfold. These two criteria were underwritten by the appeal to the sentiment that older people had ‘had their lives’ (already), and that younger people have still yet to live theirs. Recently, a former supreme court judge in Britain told a cancer sufferer on live television that his grandchild’s life was more valuable than hers because they had more life ahead of them than she did.^[1]

Current debates on sustainability, climate change, the carrying capacity of the earth, and rethinking our economic system are all interwoven with a polarisation of youth and the aged, and whether things add to or deduct from the quality of life found on earth. Our economic systems require more consumerism, more young people to buy, to consume and to reproduce the same wealth cycle for an ever growing smaller minority holding the majority of material, cultural, and social wealth. As F Scott Fitzgerald put it: ‘the rich get richer and the poor get children.’

The concept of sustainability is embedded in the current economic system not likely to give up the ghost just yet. Both concepts of ‘the youth’ and ‘the elderly’ or frail, have been used in a variety of political motifs at many levels of governance, but more recently in an arsenal of fierce, anti-lockdown tactics designed to hang-on to and reinforce the status quo. As long as youth/growth and the aged/spent are two politicised and exploited extremes, the ideal of a new world in the spirit of equitable sustainability, at least, will be out of reach – if indeed it is something that we decide we truly need and if the fog of this current socio-economic system is ever lifted.

The following piece represent my musings over the timeline to date of the unfolding crises.

The future-past: the politicisation of ‘the youth’ as a separate class

While ‘women and children first’ is one of those dictums most prominent in our popular lexicon of mores and standards, I would say that it is in the more recent years that the emphasis on children, young adults and the more general term, youth, has really made in-roads into policies, especially at the inter-regional level. In my own research, which focuses on Europe in relation to North Africa/Middle East, policy documents in the late 1980s began to highlight the mis-match between the emerging demographic trends and poor economic growth there, warning against migrant-drifts into Europe in search of employment and a better life.

The discourse on youth between the EEC/EU and the MENA was captured as ‘demographic matters’ in the Renovated Mediterranean Policy (RMP) established in 1989–90, as international attention was freed from its binary Cold War logic. Subsequent policy frameworks include the Barcelona Process/Euro-Mediterranean Partnership Agreements from 1995, in which ‘the youth’ were first identified for special attention (employment, education, training, job creation) under the Partnership in Social and Cultural Affairs.

The historic relationship between the countries of the EEC/European Union and the MENA has been maintained by a few strings of mutually politicised concerns. The ‘youth bubble’ and how to keep them in place have been constant, variously reworked motifs into the theme of ‘cooperation and development’. In 2007, Oliver Roy in the Politics of Chaos in the Middle East wrote about this burgeoning youth bubble, as has Richards, Waterbury, Cammet, and Diwan in their 2008 edition of the Political Economy of the Middle East, drawing attention to the dangers of the growing numbers of youth between the ages of 15 and 25, and their lack of opportunities finding outlets in either terrorism, crime and uncontrolled immigration into Europe.

In South Africa, during 2015, the youth-driven Fees Must Fall movement took hold and morphed into a kaleidoscope of social justice concerns – all of which were believed to have been engineered through political opposition groups. Many of the first demonstrators were overtly prejudicial and aggressive towards their older political and well established – and until then, respected – counterparts. I was present as a number of public meetings and conferences where older ANC recognised stalwarts were shouted down by people less than half their age, telling them that they were old, to ‘go home’ and ‘you don’t speak for us.’ Political agendas aside, the denigration and rejection of ‘the past’, in addition to the generations who had inhabited it, is a worrisome divergence from a culture we have come to understand as steeped in respect and acknowledgement for their elders and, indeed, their ancestors (in the metaphysical sense).

A year later in 2016, the new United Nations Secretary General Antonio Gutierres’s inaugural remarks pointed to ‘youth unemployment’ as having ‘exploded’^[2]. By 2017 he had appointed a Special Youth Envoy, such was the concern to show the high importance he was assigning to the category^.[3] Later, in the same year and addressing the General Assembly, Gutierres highlighted the propensity for ‘young people’ to become radicalised through ‘real and perceived injustices’ and ‘high levels of unemployment and grievances’.^[4]

At the inter-regional EU-Africa level, the same sentiment and tone expressed by Gutierres between 2016–2017, was carried over in the Joint Africa EU Strategy 2017 Summit, entitled ‘Investing in Youth For a Sustainable Future’, which captured these precursory framings into policy.

In December 2019, in his New Year message for 2020, Gutierres, proclaimed ‘young people’ are the ‘world’s greatest hope’, adding that ‘This year, the world needs young people’^[5], something that seemed to play out in the first observances of the way the virus behaved across demographic spectrums throughout the world, at least.

While all of this acted as a barometer of political perspective and change at the regional and global policy level, I believe we reached another major turning point with what I like to call the ‘Greta Thunberg phenomenon’, a combination of popular extremism and the evolved youth concept in international politics. A young woman at the age of 15 was chosen to represent the NGO Climate Justice Now, and given access to the United Nations Conference on Climate Change in Poland to address leaders assembled there. She emotionally proclaimed that they – and their generation and before them – had ‘stolen’ her future. The following year in New York at the same gathering, her redress was even more emotional: ‘how dare you!’ – was the taunt. The event was televised and lauded worldwide by adults declaring how wonderful she was, despite the spectacle looking very much like any other teenage tantrum performed in any other number of countless houses all over the world, between truculent, emotional children and their parents.

The difference here, of course, is that it was not just about not being able to have the latest iPhone or being allowed out on a school night, but about damage to the world’s (natural) environment and the impact of climate change now, and into the future.

Greta’s considerable influence has sparked copy-cat school strikes, birth strikes (#nofuturenochildren), flygskam (or flight shaming), and ‘eco-anxiety’ from other school children and ‘the youth’ across the world.

How children not going to school can be called a ‘strike’, I, personally, have never really understood: Whether or not children go to school does not cause any direct detrimental economic impact to warrant a standoff with government – albeit that their parents have to find and pay for baby sitters or carers while they are not at school.

Previously clear-thinking adults decided that Greta, scolding her parents – here the leaders of the world – was a laudable event, purportedly because it drew attention to climate change. Finally, the inference was that perhaps this scolding from a child would make world leaders sit up and take notice, as if – suddenly – international politics would be pushed aside and all the countries in the world would commit to climate change targets. Of course, world politics being, well, politics, was not; and, apart from galvanising the extremes and issues further, no results other than Greta’s varying degree of anger made media headlines. No one questioned how or why she had been able to turn the roles around with such ease. The end goal – the importance of the subject matter, climate change – was seconded by the combined spectacle of her youthful age, her anger and her apparent courage or ‘moxie’ (thank you, Hillary Clinton).

The only people to not praise her tirade and, attempt to point out the obvious role reversal, were those identified as the hard right or, in America, as Trump supporters. Anyone who agreed with them did so quietly, not wanting to face the same backlash – or worse – be subsumed under the same category and called (Oh! The horror!) a Climate Change Denialist.

This kind of polarisation of attitudes has become commonplace and a necessary part of drawing attention to any cause in today’s world. Extremism, radical behaviour with the threat of anger and violence, have become a necessary condition for ‘activism’, with no middle ground or space for discussion in between: you are either for or against one issue or another. It is this aspect that has a devastating effect on the current attitudes towards older populations, on the one hand, and their contrasted, more valued, youthful counterparts, on the other.

More recently, Ms Thunberg, commenting on the Black Lives Matter movement in America, observed that people can ‘act with the necessary force’^[6] in order to counter injustices where needed, as if to voice her approval for the same level of aggression for use in other movements or causes confronting perceived injustices. (One has to assume that the injustices she speaks of are qualifiable, and would not include what we term terrorism of any kind.)

From framing the youth as troublesome and problematic, they have now become hallowed as the world’s saviours, ‘our future’. It is as if world policymakers have attempted to mollify the great masses of youth by inviting them to a seat at the table, as not only equals in experience and knowledge, but revered political barometers and totems. I do not believe this is as straight forward as it appears to be. In doing so, a permanent division between the ‘youth’ and anyone who falls above this point has been inaugurated, in spite of the fact that the category is inevitably transient. This aspect, however, is not emphasised or dwelt on. In this way, revolving generations of youth are already being conditioned to accept that once past a certain age, they too must give up their places in society, their belongings and fade into the background – no longer ‘special’ or revered.

As in most cases where exclusivism is installed in any society and the few are elevated and called ‘special’, the consequences for the rest are not pretty. The polarisation of our evolving debating culture in the media has only exacerbated the effects of this.

Ushering out the old, weak and vulnerable

The absence or marginalisation of the older population in Western societies is not new. I could perhaps refine this further by saying that the marginalisation of older people in societies that have adopted neoliberal economic models, is not new. We are accustomed to the concept of ‘retirement’ and our popular zeitgeist is replete with the consciousness that older people go off into the sunset and enjoy their retirement, having worked hard all their lives to earn it. Once there, however, we no longer see them. They become invisible – especially on entering Retirement Homes or Frail care facilities, which are often out of the way and far from city centres.

While this picture of retirement is true for some, it is only true for a minority who have been lucky enough to have had lucrative younger lives to begin with. The vast majority find ways to work past their retirement age to make ends meet, or because they still crave the social contact and validation that working and interacting with others brings to their lives: loneliness, and feeling as though you are now unable or not needed to contribute, is a bitter pill to swallow for anyone, yet these circumstances are socially and systemically imposed on a section of society.

Once past a certain age, and if deemed incapable (read here too frail, or vulnerable to falls, forgetting to take chronic medication and so on) of living alone as a single person, many younger family members who can, opt to put their older generations into Care Homes (in South Africa, there are Retirement villages that take people from the age of 50 upwards, below the age of retirement here at the moment)

From the beginning of the worst outbreaks of COVID-19, during the first waves in Italy, Spain, and the UK, it was evident that older people (with or without comorbidities) were succumbing to the virus more readily than members of the younger demographic. Of course, the term ‘younger’ varies depending on the demographic benchmarks in each country. However, it became clear that the older age bracket could include those entering their 50s and beyond, with fatality rates increasing commensurately with age.

Thereafter, outlier cases of babies, young children and a few younger adults in their twenties, came trickling through. As if to mitigate the effects of the virus on the older generation, these cases acted as a counter weight in the beginning, together with younger, fitter people testifying that they had been ‘hit hard’ and were now struggling to recover. There was, it seemed, a collective world-wide sigh of relief: this virus, at least, did not discriminate.

As 2020 dragged on, evidence mounted again to the contrary, as did the inevitable counter narratives and conspiracy theories proclaiming the virus to be nothing more than a ‘flu – and remarkably – that the excess deaths recorded over and above past years were not caused by or from the COVID-19 virus, but due to pre-existing ‘co-morbidities’; the COVID-19 virus just tipped people over the edge and their deaths were due to ‘natural causes’.

On 14 October, 2020, Amnesty International called for an inquiry into the UK’s handling of the COVID-19 pandemic earlier in the year with the publication of their report As if Expendable. It came to light that 25 000 elderly patients were discharged into care homes across the country without having any tests performed as to their infection status, putting those already there, together with their carers, at risk of infection.^[7] It was also reported that their release was so rushed, that neither patients nor their relatives knew where they were going until the day of their move, and that ‘teeth and glasses’ went missing in the transferrals.^[8]

Care homes were being pressurised into including Do Not Resuscitate (DNRs) orders into elderly patients’ files, at times without either the patient’s knowledge or understanding, or those of their families – if indeed they had any.^[9] Other vulnerable groups include those with learning disabilities, long acknowledged to receive less than adequate healthcare and what MenCap has called ‘institutional discrimination’ from the National Health Service (NHS). A number of independent inquiries and reports have been published showing that people with learning disabilities historically receive substandard care in NHS hospitals leading to – on average – 1200 unnecessary deaths per year.^[10]

As part of Britain’s response to the COVID pandemic, the Covid 19 Rapid Guideline: Critical Care in Adults and Clinical Frailty Scale (CFS), in addition to its algorithm (both contributed by the National Institute for Health and Care Excellence [NICE]), were meant to provide a rapid assessment tool prior to COVID-19 testing. It was on the basis of this that patients thereafter were admitted to hospital and their relative care-paths chosen (admittance to critical or palliative care, for example). Their use, however, led to 78% of all patients with learning disabilities having DNR orders placed in their files, often without their families’ knowledge or the patients’ understanding.^[11]

It is not hard to see why or how this happened: the CFS and its algorithm has more in common with ‘paint by numbers’ than providing quality healthcare to people and, although updated since its first publication in March of 2020 on the NHS website to caution against using it in isolation with certain vulnerable groups, the use of the CFS and its algorithm has remained unchanged in regards to people over the age of 65.^[12] According to the NHS website, using the CFS to assess frailty should take ‘no longer than one minute’.^[13]

The Amnesty report goes on to detail incidences of standoffs between nurses in care homes, general practitioners (GPs) who refused to see patients and hospitals who either refused to take patients in, or discharged (untested) patients and delivered them after hours into care homes when admitting-staff had gone home– thus side-stepping formal procedures put in place to mitigate the spread of the virus.

The report, overall, is a shocking testimony to the culture of neglect, disregard and marginalisation of the elderly and vulnerable in Britain today.

Narratives of the ultimate sacrifice and creating our own Carousel of Renewal

As schools were set to reopen in January of this year, British Prime Minister Boris Johnson announced a ‘back to school’ approach as usual. Within 24 hours, he reversed his decision, declaring schools’ closure, after exposing more people to COVID-19 in the process. This occurred during the grips of a ‘second wave’ of COVID-19. The recklessness of this action is still being debated, with a seemingly larger section of society calling for schools to reopen to maintain as much normalcy as possible, arguing that children need to be around their peers and continue receiving education, even during the worst crisis Britain – and the world – has faced in a long time. The phrase ‘we must put the children first’ has become a maxim that no one disputes.

Children, it might be counter-argued, do not exist in an isolated bubble (yet). For better or worse, they have been brought into this world by other humans. Only now, during the second wave, are teachers and parents – and teachers who are also parents – in Britain speaking out from the other side of the argument, declaring that they do not want to risk their lives or those of their families by returning to teaching environments that are clearly among the most dangerous in terms of exposure..^[14]

In South Africa, the US and the UK, narratives of dissent and conspiracy among smaller pockets of society have caused mayhem and confusion. Often using medical Drs (although not virologists or immunologists), community leaders, media personalities, and other proponents of this narrative variously claim the COVID-19 pandemic a hoax; not a ‘new virus’; not more deadly and not worth the Lockdown or restrictions put in place by the Government to legitimise their stance. Still, after a year, people around the world refuse to wear masks and publicly parade their defiance on social media.

One South African media personality, staunchly anti-Lockdown and who could be placed well-within the ‘COVID-19 is just a flu’ group, hosted a medical Dr (an anaesthesiologist) in the last month of 2020 of equal persuasion who proceeded to urge ‘as many young people to get infected as possible’. This, he stated, would be the best thing for South Africa in order for the virus to run its course. When asked what alternative solution should be he suggested that ‘old people’ should be sent to Hotels for the duration of the pandemic, if, that is, they were unable to isolate at home.

The interview took place just after the South African government had called for Matric Rage attendees (social events that mark the end of examinations for the year which take place betwen November and December across the country – the equivalent to the US’ Spring Break) to urgently get tested for COVID-19 and to isolate. Two attendees of the Ballito, Kwa-Zulu Natal (KZN) Rage event had already tested positive for COVID-19.^[15]

A few days later on 18 December, 2020, a new, more infectious and virulent mutation of the original virus, now referred to as the South African strain, was discovered emanating from the same province. In a recent interview, Professor John Bell, Regius Professor of Medicine at Oxford University (and who oversaw the development of the adenovirus vector vaccine) stated that they were not sure that the current AstraZeneca vaccine that had been produced would cope with the South African (or the alternative Brazilian) strain of the virus, whose mutations were ‘so profound’.^[16]

The backbone of the main denialist narrative has always been placed in balance to the economy. Keeping the economy going and, therefore, keeping children in school, educational timetables on track (presumably to provide the role of child care for busy parents) has, for this narrative, been more important than preserving lives, especially for those who are in the older age range who may be teaching or lecturing them. The older, weak, or vulnerable (with co-morbidities) as a section of society particularly at risk from COVID-19, have received considerable backlash.

The same media personality alluded to above, expressed his disgust of Britain in particular, which, compared to South Africa, has ‘added weight on their demography’ (weight here meaning extra pressure due to the balance of older people to their youth). According to him, ‘we [have] managed largely to weather the storm.’ He went on to say that [in the UK] ‘those old people have more say than they should have […] So those old people are mortgaging those young people’s lives so they can have more time on earth, which I think is disgusting’.^[17]

The evidence to support his claim that we, in South Africa, have indeed ‘weathered the storm’, is still unclear. It is also possible that we may never be clear on what our overall costs have been, but his attitude is very familiar. Not once are the contributions of ‘those old people’, already partially used by ‘younger people’ in society, taken into consideration as an equal right to still have a say in how society treats them. His co-host went on to say in as many words that people have become afraid of dying ‘as if that wasn’t going to happen’ in any case.

I would venture to say that everyone accepts death as a part of being human, but rather the way that we die has much to do with the element of fear that his co-host was referring to. The development of Air Respiratory Syndrome, as part of COVID-19’s progression, is not without great pain or discomfort, as the body is starved of oxygen and essentially suffocated. Most patients pass away in the company of strangers rather than close family or friends.

I would think these conditions would make even the most socially aloof (bar psychopaths) balk at the prospects.

One of the sub-themes used to legitimise the case for the anti-Lockdown movement and for ‘business as usual’, are: ‘my children come first’ and ‘I want to provide a future for them.’ A whole organisation, in fact, has been built around opposition to Lockdowns, judging its economic ramifications and debunking the gravity of the pandemic through whichever means possible (See Pandata.org). While the economics of the pandemic are very real and painful (and I do not think anyone would dispute this), no one has stopped to challenge an economic system that forces us into a position where we have to make a choice between dying and making money to live.

For many people, sacrificing yourself for your children is considered to be the noblest calling, the expression and sentiment of which is considered to be universally accepted and unchallengeable. In the wake of the COVID-19 pandemic, older people in isolation have been made the focus of political pressure in Britain to allow for family visits over the holiday period at Christmas. Grandparents want to see their grandchildren over the holidays, irrespective of the risk of passing on the virus. In the light of so much confusion and misinformation, it is likely that many grandparents were persuaded into thinking that the risk to their own health was secondary, as older people accustomed to being classified as lesser value, seeing their grandchildren at Christmas was worth more.

Arguing that older generations should be allowed to decide for themselves whether to visit their loved ones at Christmas, one British Member of Parliament pointed out that the death of someone in their 80s could not be called a tragedy, whereas the death of someone in their 20s could.^[18] According to this framing, the age at which we die is directly related to the value we place on our deaths. In other words, our lives lose value as we age. The MP framed this argument in the context of civil liberties and the freedom to make one’s own choices, once again based on age. The implicit message is that grandparents should be allowed to sacrifice themselves and die for the love of their children and the value of family holiday gatherings if they so choose. With popular sentiment steering them in this direction, it is unlikely that many would feel they could resist.

This argument prompted the British Prime Minister to give Britain ‘5 days off’,^[19] a decision that reports have now shown to have led to a rapid increase in reported cases of infections and a subsequent second wave of deaths, which it is still going through.^[20] Under normal circumstances, grandparents routinely sacrifice their independence, houses, life-times’ belongings and head off into retirement homes and care facilities, to make life easier for their younger generation. The paradigm of older generations sacrificing themselves for the sake of the young, is not new. The pandemic has just brought it out more prominently and put a macabre spin on it, with economic considerations playing a co-conspiratorial role.

An economic system unfit for people (and non-human animals)

(Or An economy that hates people)

Close to the time of finalising this piece, Britain went into a third lockdown subsequent to the government’s flip-flopping on whether to re-open primary schools. Although evidence and insights into the COVID-19 virus seems to change on a daily basis, evidence is rising, however, to show that children and younger adults are primary (asymptomatic) transmitters of the virus.

The condition of Lockdown worldwide has not only rapidly emphasised the weaknesses in our economic systems, but our social and political systems too. The ideology that I have referred to as neoliberalism, has corrupted our ability to see the failure of our governments and political systems clearly and their inability to support lives and livelihoods when it counts. The concept of sustainability as we understand it within this ideology, has also played its part.

Under our contemporary conditions, people, businesses and organisations, rather than see that our ideological system is skewed to economic extremes, look for other shortcuts to find a way of maintaining – and moreover reinforcing – what should be recognised as a spent value system. Having to resort to choosing who lives or dies, based on economics and planetary sustainability, should be seen as a world gone mad, but it is not.

In 1987, the Bruntland commission’s Our Common Future, sustainable development is ‘development that meets the needs of the present generation without compromising the ability of the ability of future generations to meet their needs.’ The definition has been criticised (rightly) for not spelling out inclusivity: Saving the future for the few is very different to saving the future for everyone, and while ‘generations’ appears to apply generally, it is not sufficiently circumspect to guarantee it.

Our popular understanding of sustainability has warped into one where its sole emphasis is understood as being futurized, with little acknowledgment to the roles and lives of those in the present en balance, and while this may sound as though it has commonality with Covid hoaxers or denialists pushing for a lifting of Lockdowns and our economies to go on, ‘business as usual’ to save the future, it isn’t.

The reification of youth and the younger generations as the saviours of our world is strangely counterproductive: if our current socio-economic system is reproduced by subsequent generations in the same way, as the anti-lockdown virus hoaxers would have it, there will, in fact, be nothing left to save.

And here is the missing link in all of this: What kind of economic system not only forces us, but makes us want to measure lives against one another in terms of value and worth? How can the present be measured against the future? Why should we measure at all? The truth is that what we currently call our economic system, reproduced globally – or our ways of making a living, if this is indeed something we wish to preserve – and even an economic system based on monetary value, will have to disappear if we are to change our current social and environmental trajectory.

Without openly declaring it, those pursuing the sustainable roadmap have only one possible route, which is to reduce the world’s population, today. Greta Thunberg may have declared that ‘she’s not telling anyone what to do’^[21] but the contemporary zeitgeist of her generation is clear: #nofuturenochildren. Whether this is a valid threat or promise is no one’s call at this point, and if ‘the youth’ as a globally (unified) concept cannot be persuaded to stop having (more) children at an exponential rate, then at least it would seem our attitudes towards the vulnerable, weak and elderly as disposable, can make up for it.

While today’s youth believe they are the world’s saviours, the old, weak and vulnerable are being jettisoned out the proverbial pandemic window, making it easier for a world primed for furture self-sacrificing Logans (pre-Runner) to emerge. And as the numbers of older generations become rapidly diminished, our memories of the way we were, what lessons we learnt and the ways we learnt them, will have no point of reference. Cycles of change in our socio-economic systems will become smaller and faster and we will exist as chains of eternal consumers, living for today while talking about a future someone else will inherit until the next pandemic erupts and each consecutive world is renewed in the same cast.

Welcome to the City of Domes.

Other sources used

Learning Disabilities Mortality Review (LeDer) 2020 Deaths from COVID19 reviewed as part of the LeDeR programme. Bristol University. https://www.bristol.ac.uk/media-library/sites/sps/leder/Summary%20of%20findings%2050%20LeDeR%20reveiws%20of%20deaths%20related%20to%20COVID19.pdf

Clinical Frailty Scale: https://www.mencap.org.uk/sites/default/files/2020-03/Clinical-Failty-Scale.pdf

National Institute for Health Care Excellence (NICE), Covid 19 Rapid Guideline Critical Care https://www.nice.org.uk/guidance/ng159/resources/critical-care-admission-algorithm-pdf-8708948893

Endnotes:

1. Hancock, Sam, “Lord Sumption tells stage 4 cancer patient her life is ‘less valuable.’” Independent, 18 Jan, 2021, https://www.independent.co.uk/news/uk/home-news/lord-sumption-bbc-cancer-patient-lockdown-b1788690.html. Accessed 29 Jan, 2021; Ferrari, Nick, “Former Judge Lord Sumption tells cancer sufferer her life is ‘less valuable’ than others.” LBC Radio, 18 Jan, 2021, https://www.lbc.co.uk/radio/presenters/nick-ferrari/former-judge-lord-sumption-deborah-james-cancer/. Accessed 2 Feb, 2021. ↑
2. António Guterres “Secretary-General-designate António Guterres’ remarks to the General Assembly on taking the oath of office.” 12 Dec, 2016. https://www.un.org/sg/en/content/sg/speeches/2016-12-12/secretary-general-designate-ant%C3%B3nio-guterres-oath-office-speech. Accessed 29 Jan 2021.
   

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3. Special focus on Youth has been in UN policy since 2011. The first Youth Forum event took place in 2012 and has been growing since then. See UN News “Youth can play ‘critical role’ in creating a peaceful world for generations to come – UN Chief.” 17 Aug, 2017.https://news.un.org/en/story/2017/08/563202-youth-can-play-critical-role-creating-peaceful-world-generations-come-un-chief. Accessed 2 Feb 2012 ; and United Nations Economic and Social Council (UN ECOSOC) Youth Forum, “About Us” https://www.un.org/ecosoc/en/ecosoc-youth-forum. Accessed 29 Jan, 2010.
   

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4. Gutierres, Antonio, “Address to the General Assembly.” 19 Sep, 2017. https://www.un.org/sg/en/content/sg/speeches/2017-09-19/sgs-ga-address. Accessed 2 Feb, 2021. ↑
5. UN News “Guterres’s message for 2020: In world of turmoil, youth are its ‘greatest source’ of hope.” 29 Dec, 2019, https://news.un.org/en/story/2019/12/1054381. Accessed 2 Feb, 2012.
   

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6. “ ‘Act with necessary force’: Greta Thunberg says BLM protests & ‘corona crisis’ give blueprint for climate change fight.” Russia Today (RT), 20 Jun, 2020, https://www.rt.com/news/492475-greta-thunberg-black-lives-matter/. Accessed 5^th Feb, 2021.
   

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7. Amnesty International, 2020. “United Kingdom: As if expendable: The UK government’s failure to protect older people in care homes during the COVID-19 pandemic.” Available at: https://www.amnesty.org/en/documents/eur45/3152/2020/en/. [Accessed online 2 Feb, 2021], p.18.
   

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8. Amnesty International, 2020. “United Kingdom: As if expendable: The UK government’s failure to protect older people in care homes during the COVID-19 pandemic.” Available at: https://www.amnesty.org/en/documents/eur45/3152/2020/en/. [Accessed online 2 Feb, 2021]. p19. ↑
9. Amnesty International, 2020. Op cit. pp.24-25. ↑
10. “Preventing avoidable deaths of people with a learning disability: Is LeDeR enough?” thebmjOpinion, 6 Dec, 2018. https://blogs.bmj.com/bmj/2018/12/06/preventing-avoidable-deaths-of-people-with-a-learning-disability-is-leder-enough/. Accessed 4 Feb, 2021; Buchanan, Michael, “Early death link to learning disabilities ‘Shocking’” BBC News Online, https://www.bbc.com/news/health-21837188. 19 Mar, 2013.
    

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11. Chao-Fong, Leonie. “Our Most Vulnerable Were Left to Die And Not Even Their Families were Told.” 17 Dec, 2020. HuffPost, UK. https://www.huffingtonpost.co.uk/entry/learning-disabilities-covid-left-to-die_uk_5fd8eb8dc5b62f31c200da6b. Accessed 5 Feb 2021. ↑
12. In March 2020, the guidelines stipulated that “Decisions about admission to critical care should be made on the basis of medical benefit, taking into account the likelihood that the person will recover to an outcome that is acceptable to them and within a period of time consistent with the diagnosis.” NICE, NICE Updates Rapid Covid-19 Guideline on Critical Care, 20 Mar, 2020, https://www.nice.org.uk/news/article/nice-updates-rapid-covid-19-guideline-on-critical-care. Accessed 4 Feb, 2021. Deciding healthcare pathways are now based on “using recommendations” that have been reworded and ordered in bullet points, but the resulting parameters have remained the same, in that – “the trade-off between the benefits and harms of an intervention,” and “the quality of the underpinning evidence”. NICE, Making Decisions Using NICE Guidelines, n.d. https://www.nice.org.uk/about/what-we-do/our-programmes/nice-guidance/nice-guidelines/making-decisions-using-nice-guidelines. Accessed 4 Feb, 2021. ↑
13. National Health Service (NHS) Specialised Clinical Frailty Network. https://www.scfn.org.uk/clinical-frailty-scale . Accessed 4 Feb, 2021. ↑
14. “Teacher schools Boris Johnson and shows how to protect yourself from this government: Daniel Kebede.” Youtube, Uploaded by Double Down News, 6 Jan, 2021. ↑
15. South African Government. “Health warns Matric rage gatherings identified as a spreader of Coronavirus COVID-19.” 6 Dec, 2020. Media Statements,
    

    https://www.gov.za/speeches/urgent-announcement-matric-rage-gatherings-identified-super-spreader-%C2%A0events-6-dec-2020 . Accessed 5 Feb, 2021. ↑

    
    
16. “New Covid variants could be a big problem”. YouTube, uploaded by Channel 4 News, 24 Jan, 2021,
    

    https://www.youtube.com/watch?v=4sbqXgWzhEU. Accessed 24 Jan, 2021. As a side note, this interview was aired last week. However, it is worthwhile to note that Dr Campbell, a now well-known retired medical professional who delivers in-depth analysis of ongoing research of the pandemic, has provided some interesting information on the testing of various vaccines in South Africa, and their efficacy. Please see “Two New Vaccines Work.” YouTube, Uploaded by Dr John Campbell, 9 Jan 2021, https://www.youtube.com/watch?v=ynyYvM7rzQ0&t=132s. Accessed 2 Feb, 2021. As a further note on the vaccines that use adenovirus vectors as a base (Johnson and Johnson, CanSino Biologics, and the University of Oxford), please also see advice published by the Chemical Engineering Society on the adenovirus vector vaccines, and a note of caution published by the Lancet Journal respectively. Cross, Ryan, “Adenoviral vectors are the new COVID-19 vaccine front-runners. Can they overcome their checkered past?” Chemical Engineering News. 12, May, 2021. https://cen.acs.org/pharmaceuticals/vaccines/Adenoviral-vectors-new-COVID-19/98/i19. Accessed 2 Feb, 2021; Buchbinder, Susan P, McElrath, Juliana M, Dieffenbach, Karl, and Cory, Lawrence. “Use of Adeno-type 5 Vectored Vaccines: A cautionary tale.” 19 Oct, 2020. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32156-5/fulltext. Accessed 2 Feb, 2021.

    
    

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17. Cliff Central Radio, “Big Pricks and sick princes.” 5 Nov, 2020, http://cliffcentral.com/gcs/big-pricks-and-sick-princes/. Accessed 4 Feb, 2021. (1^st half of the recording). ↑
18. “Removal of Liberties! Charles Walker’s plea to let people take their own risk.” YouTube, Uploaded by The Parliamentarian, 2 Dec, 2020, https://www.youtube.com/watch?v=c8eq8W4-zeM&pbjreload=101. Accessed 4 Feb, 2021. ↑
19. Walker, Peter, Elgot, Jessica, Brooks, Libby, Morris, Steven, and Grover, Natalie. “Five days of Christmas UK Covid plan lets three households mix UK: Four governments agree relaxed rules, and scientists expect rise in cases to follow.” The Mail and Guardian. 25 Nov, 2020, https://www.theguardian.com/world/2020/nov/24/christmas-covid-uk-plan-lets-three-households-mix-for-five-days. Accessed 5 Feb, 2021.
    

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20. Holden, Mike, and Holton, Kate. To fight new COVID strain, PM Johnson reverses Christmas plans for millions.” Reuters, 19 Dec, 2020.
    

    https://www.reuters.com/article/uk-health-coronavirus-britain-idUSKBN28T0K9. Accessed 5 Feb, 2021. As of the end of January, Britain has reported over 100 000 deaths, second only to that of the US, which has recorded over 400 000. See Worldometer, Corona virus by Country, https://www.worldometers.info/coronavirus/#countries. Accessed 5 Feb, 2021. While the rates of recoveries appears hopeful, a report published by the University of Leicester and the Office for National Statistics in the UK, stated that 1 out of 8 people recovered and sent home from hospital, die within 140 days of other complications from kidney, heart, lung conditions, or developing type 1 diabetes. The information uses, apparently, data from the first wave of infections when treatments were less affective. Important caveat: the study has appeared in a pre-print form and is yet to be peer reviewed. Owen, Cathy and Mack, Tom. “1 in 3 discharged coronavirus patients returned to hospital within 5 months, researchers say. About 1 in 8 ended up dying of Covid-related problems.” 18 Jan, 2021, https://www.leicestermercury.co.uk/news/leicester-news/1-3-discharged-coronavirus-patients-4899087. Accessed 5 Feb, 2021; Ayoubkhani, D, et al. 2021. “Epidemiology of post-COVID syndrome following hospitalisation with coronavirus: a retrospective cohort study.” medRxiv, Available online: https://www.medrxiv.org/content/10.1101/2021.01.15.21249885v1.full.pdf Accessed 4 Feb, 2021. ↑

    
    
21. Siddique, Haroon. “Greta Thunberg at 18: ‘I’m not telling anyone what to do’”. The Mail and Guardian, 3 Jan, 2021, https://amp.theguardian.com/environment/2021/jan/03/greta-thunberg-at-18-im-not-telling-anyone-what-to-do. Accessed 5 Feb, 2021.
    

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