It has been eight long and devastating months in the United States since the start of the pandemic. An impressive number of people have been sick and hospitalized and hundreds of thousands have died. People are isolated from those they care about, businesses suffer, education has suffered and so is our mental health.
It is understandable, therefore, why the concept of ending the pandemic by strengthening herd immunity continues to attract appeal. Advocates of herd immunity, who want all schools and businesses to reopen and sport and cultural activities to resume, say they want to ease the burden of the pandemic: “Those who are not vulnerable should be immediately allowed to resume life normally.”
The authors of the Declaration – a trio of scientists from Harvard, Stanford and Oxford whose views, we should say, are outside the mainstream – call their approach “targeted prevention.” The big idea is that we could let the virus spread among younger, healthier people, while making sure we protect older and more vulnerable people.
The statement attracted 10,000 signatures (although the names of those who signed were not made public) and has fans on the right and in the White House, where pandemic adviser Scott Atlas (who is a neuroradiologist, not an epidemiologist) has it. previously suggested is a good thing to do. “When younger, healthier people get infected, that’s a good thing,” he said in an interview in July with a local San Diego news station.
Yet there are ample reasons to fear that this “targeted prevention” strategy that allows young and healthy people to get sick to build population immunity to the virus will never work. And it could cause devastating unforeseen consequences.
“It just assumes this level of control that you can really isolate high-risk people,” Natalie Dean, a biostatist at the University of Florida, told me earlier this year. Society does not clearly separate into risk groups. We have seen epidemics that started in younger populations that have moved to infect older ones.
The Barrington Declaration has received a lot of attention in the news and through viral social media posts. This has caused alarm among scientists who see through its subtle scientific reasoning. One group wrote a counter piece in Hand.
“The prolonged isolation of large sections of the population is practically impossible and highly immoral,” writes a group of scientists who represent the dominant thought in a letter they call the John Snow Memorandum (named after the “father” of modern epidemiology).
It is unethical for many, many reasons. Here because.
Herd immunity through natural infection is unethical because disadvantaged people are more at risk of becoming seriously ill
There are multiple dimensions that put someone at serious risk of Covid-19. It’s not just age. Conditions such as diabetes and hypertension aggravate the risk. So do social factors such as poverty, working conditions and incarceration.
Serious deaths from Covid-19 and coronavirus have had a disproportionate impact on minorities and the least advantaged in the United States. This herd immunity strategy risks further isolating these already marginalized communities from society as they may not feel safe in a more relaxed environment. Or even worse: we risk sacrificing their health in the name of building a level of population immunity sufficient to control the virus.
The risk of transmission is complex and multidimensional. It depends on many factors: contact pattern (duration, proximity, activity), individual factors, environment (eg external, internal) and socio-economic factors (eg crowded housing, job insecurity). (2 / n) pic.twitter.com/0mEiHhbnWa
– Muge Cevik (@mugecevik) 21 September 2020
Harvard epidemiologist Bill Hanage points out a grave inequality here: herd immunity gained through natural infection would come at an excessive cost to some of the most vulnerable groups in the country.
“Due to the fact that some groups are more at risk of getting the infection than others – and they are mostly purebred people [and] ethnic minorities and predominantly poor people with poorer housing: we are effectively forcing these people to have a higher risk of infection and bear the brunt of the pandemic, “Hanage says.
I think of my grandmother, who recently died at the age of 94, in her last years of life in a nursing home, where she spent most of her time confined to her room, due to the precautions of Covid-19. “I’m so alone here,” she would say when I called. Older people do not deserve to be erased, further isolated and forgotten.
Or as John Snow’s memorandum (signed by Hanage) states: “Such an approach also risks further exacerbating the socio-economic inequalities and structural discrimination already exposed by the pandemic.”
Herd immunity through natural infection is also a bad idea scientifically
Typically, the term herd immunity is thought of in the context of vaccination campaigns against contagious viruses such as measles. The concept helps public health officials think about how many people in a population need to be vaccinated to prevent epidemics.
“Never in the history of public health has herd immunity been used as a strategy to respond to an epidemic, let alone a pandemic,” World Health Organization Director-General Tedros Ghebreyesus said this week. “It is scientifically and ethically problematic.”
We count the reasons why.
1) Even if we could limit exposure to people least likely to die from Covid-19, this group can still suffer enormous consequences from the infection, such as hospitalization, long-term symptoms, organ damage, missed work and high medical bills. . The long-term health consequences of the virus have just been studied. When we expose younger, healthier people to the virus (on purpose!), We don’t know what the consequence of this will be down the road.
2) We have a lonnnnnngggggg well done. There is no one, perfect estimate of what percentage of the US population has already been infected with the virus. But, by all accounts, it’s nowhere near the figures needed for herd immunity to kick in. Overall, a new one Hand The study – which drew data from a sample of dialysis patients – suggests that fewer than 10 percent of people nationwide have been exposed to the virus. No one knows the exact threshold percentage for herd immunity to kickstart a meaningful way to help end the pandemic. But common estimates are around 60 percent.
So far, there have been more than 200,000 deaths in the United States. There is much more to the potential for death if the virus spreads at true herd immunity levels. “The cost of herd immunity [through natural infection] he’s extraordinarily tall, “says Hanage.
See what happened in Manaus, Brazil, an Amazonian city of about 2 million people, which suffered one of the most serious Covid-19 outbreaks in the world.
Researchers now estimate that between 44% and 66% of the city’s population have been infected with the virus, meaning it is possible that herd immunity has been achieved there. (This research has yet to undergo peer review.) But during their epidemic period, there were four times more deaths than normal for that point of the year.
3) Scientists don’t know how long naturally acquired immunity to the virus lasts or how common reinfections might be. If immunity wanes and reinfections are common, it will be even more difficult to develop herd immunity in the country. In the spring, Harvard epidemiologists sketched out the scenarios. If immunity lasts a couple of years or longer, Covid-19 could fade within a few years, according to their analysis published in Science (too long to begin with, if you ask me). If immunity wanes within a year, Covid-19 could make a comeback every year until an effective vaccine is widely available.
At the same time, we don’t know how long immunity provided via a vaccine would last. But at least one vaccine will come without the cost of increased disease, hospitalizations, and long-term complications.
If immunity does not last, “such [focused prevention] The strategy would not end the COVID-19 pandemic but will result in recurring outbreaks, as was the case with numerous infectious diseases before the advent of vaccination, “states the John Snow Memorandum.
4) By letting the pandemic rage, we risk exceeding the herd’s immunity threshold. Once the herd immunity threshold is reached, that doesn’t mean the pandemic is over. Once the threshold is reached, “all it means is that, on average, each infection causes less than an ongoing infection,” Hanage says. “It’s of limited use if you’ve already infected a million people.” If each infection causes, on average, 0.8 new infections, the outbreak will slow down. But 0.8 is not zero. If one million people are infected by the time herd immunity is achieved, according to Hanage’s example, those already infected people could infect another 800,000.
There are many other unknowns here as well. One is the type of immunity conferred by natural infection. “Immunity” is an umbrella term that means many different things. It could mean real protection from getting infected with the virus a second time. Or it could mean that reinfections are possible but less severe. You could potentially get infected a second time, never feel sick (thanks to a quick immune response), and still pass the virus to another person.
Scientists who prefer some continuous distance have never argued for infinite blocks
The mainstream scientific consensus on fighting the pandemic has never required infinite blockages and infinite suffocation of our economy.
Rather, health experts have argued that the first thing we need to do is manage the transmission of the virus in the community and then prevent massive new outbreaks from forming with aggressive testing, contact tracing and interventions such as universal masking, better internal ventilation and spacing. social.
But we have never been able to bring the virus down to contained levels. (It’s not impossible; other countries like South Korea and Japan do.) So here we are.
The last thing that strikes me as truly cynical about the Great Barrington Declaration is that it avoids discussing how the government could have done more to help people suffering from the downstream economic impacts of the pandemic. Instead of forcing restaurants to choose between their livelihoods and putting their customers and staff at risk, they could have been paid by the government to stay closed. Instead of allowing people to deal with the harsh psychological insecurity of a missing paycheck, Congress and the White House may have extended unemployment insurance benefits by now (they haven’t).
For so many reasons, the Great Barrington Declaration – like all proposals on herd immunity – looks just like giving up, sacrificing the health of the young and the health of the marginalized. Do not give up. There is no easy way out.
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