For critics of aggressive stay-at-home orders, the solution seems clear: the economy will reopen and enough people will eventually be infected by the new coronavirus to achieve ‘herd immunity’, even before a vaccine is available.
The idea is that eventually a sufficient percentage of the COVID-19 population will have survived and become immune, which in turn protects the rest of the uninfected population by interrupting the spread of the virus.
But the disastrous situation that has developed in the San Quentin State Prison over the past two months is the last word of several cautious stories that show how any attempt to achieve herd immunity before a vaccine is available would come with enormous costs in terms of illness and death.
COVID-19 spread unreservedly across California’s oldest prison in ways that surprised public health experts, despite efforts to control the disease. As of Monday, there had been more than 2,200 cases and 25 deaths, among a population of more than 3,260 people. On Sunday, a guard became one of the last to die.
That means more than two-thirds of the prison’s population is infected, said Dr. George Rutherford, an epidemiologist and infectious disease expert at UC San Francisco.
And while new cases are slow, they still come – with 60 reported in the last two weeks – suggesting that herd immunity has not yet been achieved.
The death toll from San Quentin translates to a mortality rate of about 767 people who die out of every 100,000 people.
If that same rate happened in California, that would translate to a whopping 300,000 deaths statewide – many times greater than California’s cumulative death toll of more than 10,400. Nationally, that would equate to 2.5 million deaths; the current cumulative U.S. death toll is more than 163,000.
“You could not help it, but it came – you stay in a place without ventilation,” Michael Kirkpatrick, 62, told The Times a week after he was released. Kirkpatrick was released on July 13 from San Quentin after his dissertation on a burglary was accelerated due to the outbreak. He tested positive for the virus and has since recovered.
Kirkpatrick said his cellmate was infected, along with most of the rest of the residents in the 50 or so cells on his tiger.
“They put a little white paper on the door of anyone who was positive,” Kirkpatrick said. “On our wing, there were, like, maybe five cells that didn’t have that piece of paper on.”
San Quentin is an incomplete institution to help understand when herd immunity can be achieved. Prisons are full of institutions that will promote the transmission of coronavirus more than among people in other institutions, such as those who live in single-family homes.
“San Quentin’s experience – like other data – shows that in the absence of a ‘vaccine’ to achieve something that approaches herd immunity, we will have to get something good on the extreme side of 50% of people infected.” said Rutherford. “What comes with a resultant high cost in mortality and severe morbidity.
“If you believe the San Quentin goods, you had to get in the way before you start seeing transmission delays,” Rutherford said.
Dr Anthony Fauci, the US Government’s top expert, ordered last week that it would probably require 50% to 75% of a population before they reach immunity to herds – a goal that should be achieved not only by restoring infected people, but also through vaccination.
California has a long way to go before the vast majority of its residents are infected.
In May, only about 2% of LA County residents had test results indicating the presence of the antibodies to the coronavirus, indicating previous exposure to the virus. This means that 98% of LA County residents have been susceptible to infection since late spring.
The prevalence of past coronavirus infection in the Bay Area was even lower, with only 1% having evidence by the end of April, according to the U.S. Centers for Disease Control and Prevention.
Sweden famously followed a strategy for herd immunity when she decided not to set up a heavy lockdown.
But now Sweden has one of the highest mortality rates among European countries, and has a worse rate than that of the United States.
Sweden has reported 5,763 deaths – a mortality rate of 57 deaths for every 100,000 inhabitants, according to Johns Hopkins University. The United States reports a mortality rate of 50 deaths for every 100,000 inhabitants.
The neighbors of Sweden therefore report far fewer deaths. Denmark has a mortality rate of 11 deaths per 100,000 inhabitants; Norway has five deaths per 100,000 inhabitants.
And Sweden appears to be nowhere near herd immunity, with only 7% of the population testing positive for antibodies to the coronavirus, “leaving them far from achieving natural herd immunity in the population,” according to a comment from two virologists in Switzerland, published in the journal Lancet. “Most of the population does not seem to have stayed [the coronavirus], even in areas with widespread viral circulation.
“In light of these findings, any proposed approach to achieve herd immunity through natural infection is not only highly unethical, but also unattainable,” said the commentary, written by Isabella Eckerle and Benjamin Meyer.
The CDC estimates that perhaps only 23% of New York City’s population has a coronavirus infection. New York City could easily fall into a second wave of severe pandemic conditions for coronavirus, Rutherford said.
Other data show how it is possible for much larger sections of the population to become infected.
Under three slums in Mumbai, India, 57% of the people tested were exposed to the coronavirus, according to the BBC, citing a survey conducted by government officials. On a cruise ship with 217 passengers that left Argentina for Antarctica in March, 59% tested positive for the virus, according to a study published in the journal Thorax.
Even peoples who were previously seen as hard hit still have many sensitive people to thank for a second wave of illness.
Spain was hit hard in its first rise of the pandemic, and had an experience as bad as Italy and New York City, Rutherford said. But a study in the journal Lancet said that only about 5% of the population had anti-antibody test results that indicated exposure to the virus.
Recently, Spain began to experience a second wave of cases.
What all this means is that a vaccine will be essential for controlling the pandemic.
Although officials and experts are cautiously optimistic that California as a whole seems to be recovering from the current rise in disease, they are already warning the public to expect a new rise in cases in the coming months – perhaps if disease levels fall low enough that more schools fall can start again.
Gov. Gavin Newsom said last week that he is anticipating a new wave of disease in the fall – and hopes that transmission of coronavirus disease will fall before the flu season arrives. Newsom’s secretary of health and human services agency, Dr Mark Ghaly, also spoke last week about second and third waves of illness.
In the last global pandemic comparable to this, in 1918-19, there were three distinct waves of influenza in the US, with levels of disease returning to baseline after the first wave .
But Rutherford warned that it is possible that California may not be able to get its disease below a similar baseline level, given that the disease is extremely widespread.
“I think it’s almost impossible for us to go back to basics, seeing how many people are infected and how widely the infection is distributed,” Rutherford said. “That we’ll see it go … a little after it starts going up again,” rise up as officials think it’s OK to let teenagers go back to school.
“It simply came to our notice then. Make no mistake about it, ”said Rutherford. “The solution is immunization.”
Fauci, at a forum hosted by the Harvard TH Chan School of Public Health on Wednesday, said he thinks officials will know by the end of this year or early next year, based on initial data from early studies, “or we a “Safe and effective vaccination. I am very optimistic that we will succeed.”
Fauci’s optimistic timeline is based on the assumption that everything will go well, said Dr. Joel Ernst, head of UC San Francisco’s Department of Experimental Medicine.
But it is also plausible that we may not get an answer on a safe and effective vaccine until 2022, Ernst said, citing a more pessimistic timeframe offered by the scientists who designed the clinical trials for the vaccine. “That’s very conservative,” he said.
“It’s difficult to predict exactly on what date things will be ready,” Ernst said.
It will also take time to figure out a way to immunize Americans. There will not be enough faxes to impose on everyone in the nation immediately. “There will be a period where vaccines prove safe and effective that you will not immediately have 300 million doses. So you have to prioritize who gets it first, ”Fauci said.
Contrary to President Trump who said the coronavirus would simply “go away”, some California officials are supporting the public to point out the reality that the coronavirus will be with us for some time to come.
We need to “get everyone involved in shifting their mind-set after a long game,” said Santa Clara County health officer Dr. Sara Cody. “We have to change our behavior for a very, very long time.”
“If we see cases increase and they go up sharply, then we may need to put in place stricter controls, as we did in March,” Cody said.
Dr. Christina Ghaly, director of health care in LA County, said the virus is just as capable of spreading as it was several weeks ago. “And it will continue to spread if we give it a chance to do so.”
Lin reported from San Francisco, Christensen from Southern California.
