On October 13 the White House confirmed that it is embracing what the Los Angeles Times editorial board calls the “let people die” strategy in the face of the COVID-19 pandemic. The strategy involves deliberately letting the novel coronavirus rip through the population while attempting to shield the most vulnerable, such as the elderly and those with pre-existing health conditions.
This approach, roundly rejected and discredited by scientists worldwide, is at the heart of a controversial new statement, titled the Great Barrington Declaration, written by three academics with views far outside the scientific mainstream—Jay Bhattacharya, Martin Kuldorff, and Sunetra Gupta. Senior Trump administration officials told the New York Times that the White House is endorsing the declaration.
Bhattacharya, Kuldorff, and Gupta want to see more people infected with SARS–CoV–2, the virus that causes COVID-19. They believe that if enough people get infected and survive, they will be immune and then society will reach “herd immunity” from natural infection. In other words, enough of us will supposedly be immune that the virus would no longer be able to spread through the community. They want most Americans to stop worrying about getting infected and just go back to normal life right away—back into offices, schools, colleges, universities, sports stadiums, concert halls, and restaurants—while attempting to protect the most vulnerable from infection.
From a public health and ethical viewpoint, the fact that the Great Barrington Declaration is now the Trump administration’s official policy is deeply troubling. The declaration, says Gregg Gonsalves, an epidemiologist at Yale University, has “shocked and dismayed the vast majority of people working in public health and clinical medicine.”
For a start, no pandemic has ever been controlled by deliberately letting the infection spread unchecked in the hope that people become immune. We must do all we can to protect people from COVID-19, not let them get infected, to buy scientists time to develop vaccines and therapeutics to end the outbreak and alleviate suffering.
Scientists estimate that a large fraction of the population, 50% or more, would need to be immune to reach herd immunity against COVID-19. Let’s be clear: The only way to achieve this without huge costs in terms of illness and deaths would be through vaccination with safe, effective COVID-19 vaccines. It cannot be reached by natural infection and recovery. Too many people would die or become disabled; hospitals, clinics, and morgues would be overwhelmed; and even if some people developed immunity, it would probably just be temporary so there would continue to be ongoing waves of deaths and illness. The experience of the city of Manaus, Brazil gives an indication of what the toll of the virus is when it is left unchecked: 66% of the city was infected and an astonishing 1 in 500 people died of COVID-19.
A recent study from Stanford University suggests that only about 9% of the U.S. population has antibodies to the new coronavirus. Basic math shows that around 156 million more Americans would need to get infected to reach the 50% threshold for herd immunity from natural infection. You’ve seen the devastation caused by 7.7 million cases, so just imagine the impact of another 156 million cases.
The Great Barrington Declaration authors argue that most of us wouldn’t need to worry about this kind of wildly uncontrolled transmission—Gupta even believes that people under 65 shouldn’t be concerned. This is a very dangerous assertion. Letting the virus ran rampant in young adults inevitably leads to infections and deaths in older people. A strategy of going for herd immunity from natural infection would lead to a massive death toll—estimates suggests the result could be somewhere between 1 million to 2.5 million dead Americans. The U.S. health system would buckle under the weight of so many hospitalizations and ICU admissions. With the health system pushed to breaking point by the virus, services for diseases like cancer, diabetes, and heart disease would be disrupted, which could lead to an increase in deaths from these other conditions. And among those who are infected and survive, research suggests that 10% of people at any age may develop a long-term illness, called long-COVID, that appears to affect the lungs, heart, brain and joints, and can be highly debilitating.
Allowing millions more Americans to get COVID-19 would also be devastating for the U.S. economy. An economy cannot be healthy if its population is sick. Assuming that the virus only affects health until the fall of 2021, the COVID-19 crisis will cost the U.S. economy $16 trillion, a herd immunity strategy would push this cost much higher.
So, the Great Barrington Declaration strategy would cause a massive burden of death and disability, and further harm the U.S. economy—yet there’s no guarantee that it would even lead to herd immunity. It isn’t clear whether being infected with the new coronavirus and recovering leads to long-term, persistent immunity.
There is mounting evidence that the level of antibodies against SARS-CoV-2 falls quickly after infection. We also know from a small number of case reports that the virus can re-infect people who were previously infected. While we don’t know how common such re-infection is, and perhaps it may turn out to be rare, nevertheless the renowned Yale immunologist Akiko Iwasaki says that “reinfection cases tell us that we cannot rely on immunity acquired by natural infection to confer herd immunity; not only is this strategy lethal for many but also it is not effective.”
And what about the idea of “shielding the vulnerable”? This would be both impossible and inhumane.
Supporters of a shielding approach don’t specify exactly who they mean by “the vulnerable.” Let’s assume that the vulnerable are those who are at higher risk of infection with SARS-CoV-2, or of death if they become infected. The U.S. Centers for Disease Control and Prevention estimates that over 40% of Americans are at increased risk of infection due to pre-existing medical conditions, so all of these people would have to be shielded. In addition, you’d have to isolate all people of color, all people who are disabled, and all people who are elderly. What kind of society would contemplate locking away tens of millions of vulnerable people for months or years on end?
Leaving aside the dubious morality, shielding isn’t even an effective approach to preventing outbreaks in the vulnerable. Sweden’s experiment in trying to build herd immunity through natural infection while attempting to shield older people in nursing homes was a catastrophic failure. At least half of COVID-19 deaths in Sweden were in nursing homes, the country has one of the highest death rates in the world, and only 7.1% of the population has antibodies. The reality is that vulnerable people, including the elderly, cannot and must not be walled off from the rest of society. Many elders, for example, live with their children and grandchildren. When pushed to explain how shielding would be achieved in such multi-generational households, Bhattacharya struggled to answer.
In response to the recent rise in new daily cases in the U.S., now is the time to intensify our scientifically proven measures to curb viral transmission, not to let the virus rip. In the medical journal The Lancet, I’ve joined an international team of public health experts in laying out the scientific consensus on the actions all countries need to take. “Controlling community spread of COVID-19 is the best way to protect our societies and economies until safe and effective vaccines and therapeutics arrive within the coming months,” we say.
We can look to many of the Pacific Rim nations, like China, New Zealand, Taiwan, and Vietnam, which collectively have under 1,000 new infections per day, compared with 55,000 per day in the U.S., to see what a multi-pronged, comprehensive control strategy entails. We must identify cases by widespread testing and then isolate the infected. We need to trace contacts and quarantine the exposed. We should promote the full range of tools for personal protection: face masks, distancing, and avoiding crowds and poorly ventilated indoor spaces. And we have to provide financial, community, and social support to those affected by the pandemic, including those who have lost their jobs or who or are at home isolating due to infection or quarantining after exposure.
Many countries in East Asia and the Pacific have been able to return to near normal living by suppressing the virus in this way. In contrast, here in the U.S., the Trump Administration’s embrace of herd immunity through natural infection shows that it has thrown in the towel and admitted defeat.
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Contributor: Gavin Yamey