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TIn months of the SARS-CoV-2 pandemic, there is growing frustration that life has not returned to “normal.” Many American schools and businesses remain closed, people are reluctant to fly and enjoy vacations, and in many places, restaurants and indoor activities are severely limited, with dire financial consequences.
With patience wearing thin, it can be tempting to consider policies that will bring us back to normal, whatever the consequences.
This illusion describes the recent political consideration of herd immunity, a public health term that refers to the threshold at which enough people in a community are immune to an infectious disease so that it will not spread if it is reintroduced. Historically, herd immunity has been achieved solely through the use of vaccines. Trying to achieve herd immunity against SARS-CoV-2, the virus that causes Covid-19, without a vaccine is an idea that has become fashionable. But it is a wrong and dangerous approach that would not return life to normal and result in the deaths of 500,000 or more Americans.
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Secretary of the Department of Health and Human Services, Alex Azar, testified last week that “herd immunity is not the strategy of the United States government.” However, President Trump has stated that with further spread of SARS-CoV-2 “you will develop a herd mentality, like a herd. It’s going to be, it’s going to be herd, and that’s going to happen. ”Scott Atlas, an adviser to the White House Coronavirus Task Force, has supported that plan.
Alex Hogan / STAT
The White House has also been reported to “embrace” the Great Barrington Declaration, a statement written by three infectious disease researchers who have since joined the thousands of co-signers. This policy statement, funded by the American Institute for Economic Research, a libertarian think tank, calls for allowing “those with minimal risk of death to live their lives normally to develop immunity to the virus through natural infection, while protecting themselves. better to those “. who are at higher risk ”, until many people become infected with SARS-CoV-2 and recover, reaching the threshold for herd immunity.
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The statement proposes a vague set of “targeted protection” measures for vulnerable older adults, including testing of nursing home staff. The statement is simplistic and does not acknowledge the scientific uncertainties of immunity to the virus, the long-term consequences of infection, or that young people can, and do, develop severe cases of Covid-19 and sometimes die from it. he.
This statement profoundly underestimates the suffering that would result if this strategy were put into practice.
The statement ignores the scientific realities. Young people are not invulnerable to the effects of SARS-CoV-2 infection. While children tend to have fewer hospitalizations and milder illnesses than adults, more than 1,000 have suffered from multi-system inflammatory syndrome in children (MIS-C) that leads to vascular complications and shock. Risk factors for severe Covid-19 in people of all ages include obesity and diabetes, which comprise 40% of the US population.
Death is not the only measure of the impact of Covid-19. Many non-elderly adults infected with SARS-CoV-2 have become “long-distance carriers” and experience long-term health effects such as cardiovascular and respiratory problems. About 20% to 35% of American Covid-19 patients have persistent symptoms two to three weeks after recovery. The risk factors may not be obvious, as at least 10 soccer players develop a heart condition called myocarditis after infection. It is not known what additional long-term consequences may result; we still have a lot to learn about this new disease.
Achieving herd immunity would require that recovered people have long-lasting immunity, but scientists don’t yet know how long immunity lasts. Reinfections are rare, but have occurred. Although much has been learned about the immune response to SARS-CoV-2 and the importance of antibodies and T cells, there is no test that a person can perform to determine if they are immune or to know if their immunity has decreased.
Without a vaccine, the human cost to achieve herd immunity would be profound. There are a variety of models for herd immunity thresholds, depending on the importance given to the efficacy of the vaccine, the degree of social distancing, and the duration of immunity. Most models, however, indicate that it would take 60% to 80% of the population to be infected, which would be a minimum of almost 200 million cases in the US alone. About 8% of the population US population has been infected with SARS-CoV-2, based on antibody prevalence, so significantly more infections would be required, resulting in at least 510,000 deaths based on current death rate and equations for immunity collective.
Relying solely on herd immunity would overwhelm hospitals. And infections, hospitalizations and deaths would continue to disproportionately affect people of color, indigenous people and blacks, something the statement conveniently omits.
Calls for a herd immunity strategy have met stiff resistance from experts, including the 12,000 members of the Infectious Diseases Society of America, hundreds of signatories to the John Snow Memorandum, and 17 public health organizations, led by the Trust. for America’s Health. Anthony Fauci of the National Institutes of Health has condemned the idea as “nonsense and very dangerous.”
No country has successfully achieved herd immunity to the coronavirus. The example of Sweden’s approach, with minimal social distancing and masking measures, coupled with restaurants and schools remaining open, should serve more as a deterrent than a model, with a significant number of deaths and blows to health systems. .
America’s goals should echo the science-based layered approaches of countries like South Korea and Germany. Public health leaders point out that it is a false choice to do nothing to prevent infection or shut everything down. America needs a strategic approach with the common sense precautions we’ve heard over and over again. These measures and an eventual vaccine can save lives and livelihoods.
The way forward cannot depend on magical thinking: herd immunity is not a plan.
Gigi Kwik Gronvall is a Principal Investigator at the Johns Hopkins Center for Health Security. Rachel West is a Postdoctoral Fellow in the Center for Health Security and the Department of Microbiology and Molecular Immunology at the Johns Hopkins School of Public Health.
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