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Let’s take a different approach.
One of Donald Trump’s top new medical advisers is urging the White House to embrace a “herd immunity” strategy to combat the coronavirus pandemic. Herd-immunity strategies entail allowing disease to spread through much of the population, thereby building natural immunity to the deadly, highly contagious virus. Basing its reporting on “five people familiar with the discussions,” The Washington Post says the Trump White House has already begun to implement some policies along these lines.
One tiny issue here (along with others) – from what I’ve seen it’s looking as if there is no natural immunity to this virus. People have been getting it again, after recovering the first time.
The approach’s chief proponent is Scott Atlas, a neuroradiologist with no background in infectious diseases or epidemiology from Stanford’s conservative Hoover Institution. Atlas has advocated that the United States adopt the Swedish model, which relies on lifting restrictions so that healthy people can build up immunity to the disease rather than limiting social and business interactions to prevent the virus from spreading.
And unhealthy people can die off. Where’s the downside?
There’s been reporting on this for a couple of weeks, but apparently the new bit is “The Washington Post says the Trump White House has already begun to implement some policies along these lines.” It’s also worth repeating though – that Trump’s go-to guy on this does not have the relevant training.
The timeline of the observed re-infections have been along the lines of March-June or March-July, which suggests an immunity period of 3-5 months. Given the percentage of cases that emerged after late March, the population that could be re-infected has been relatively small until recently – particularly when you consider that some would be living in areas still observing extensive restrictions. The absolute number of cases that occurred in April and onward, combined with the fact that much of that population is in areas not living with strong restrictions, would suggest that within a few weeks, we will see sufficient re-infections that that will no longer be notable.
This has scary implications for vaccines, which is bad news for the US. A good outcome for a vaccine at this point is 6 months of immunity, and 4 months is a possibility. That is not a magic bullet that makes it go away. That is a tool that can be used as a powerful element of a coordinated effort to suppress, augmenting testing and tracing.
Yes, the implications for vaccines are deeply depressing.
The Washington Post article estimated that achieving herd immunity without a vaccine would entail about 2.13 million deaths. A doctor friend of mine used somewhat more conservative estimates (an R0 of 2.5, which would require about a 67% infection rate for herd immunity, a 1% mortality rate, a current infection rate of 7%), and still came up with just under 2 million deaths.
If immunity is sufficiently short, ‘herd immunity’ becomes essentially impossible – a closed population might be able to achieve it for some amount of time, but it would simply fade leaving that population vulnerable to outside introduction just a few months later.
Herd immunity. For a pandemic. Fuck.
Herd immunity is a population specific term. Herd immunity is used in humans for very specific reasons. Calculating the vaccination rate required to reduce infections in a population. In a retrospective manner, looking at historical data. Projecting into the future in worse case scenarios and measuring against interventions and their efficacy.
By the time you’re working with populations, they’ve stopped being people and have become mere numbers. Epidemiologists have to remind themselves from time to time that there are people behind the number, but not think about it too often because that way madness lies.
Herd immunity is the worst case scenario in a population that could become immune to the disease over time. This occurs not because people change or the virus changes but because the makeup of the population changes. Most of the people unable to become immune die, those left restrict the virus’ ability to find a human host. Here’s the problem – this virus is zoonotic. It can infect other animals, much in the way that flu does. So achieving extinction is impossible. It can sit there happily mutating in a bird or a mammal of any species – (probably but not exclusively) chickens and pigs, respectively.
Dr Atlas is proposing an attempt to achieve herd immunity through natural selection. Yes, good old fashioned eugenics. Consider the Black Death. That epidemic killed between one and two thirds of the population of Europe. It signaled the end of feudalism and severely limited the genetic pool in people of European ancestry. (We white people are like clones compared with the rest of humanity).
Diseases like the Black Death change societies. I don’t know if Dr Atlas will like the result. Nor will the white supremacists. Battling a disease that can literally almost wipe out a continent’s worth of people is easier the more genetic variation you have. People of African ancestry have the most (it’s the oldest population, older = more time to recombine and mutate DNA). White people have the least. Not because of age exclusively, but because of one epidemic effect 670 years ago. Evolutionarily a blink but in terms of historical impact, it was huge.
Herd immunity assumes the possibility of immunity either natural or through vaccination. If long term immunity cannot be achieved, modern civilization is heading for the biggest transformation since the fall of the Roman empire which plunged European civilization into the Dark Ages or the Great Flood of Gun-Yu which heralded the beginning of dynastic succession in what later became China.
And if long term immunity isn’t possible? We may see the greatest transformation of a civilization you’ve ever seen. A global transformation. The biggest, most beautiful, in history.
The herd immunity idea just won’t die. It looked incredibly questionable in March, and virtually every discovery since has pointed to how disastrously ill-founded such a strategy would be. Yet here we are in August, with an Administration doing what the ratlickers advocate.
@Naif Not enough people get the vaccine against this idiocy. And nobody thinks they’ll be in the proportion that dies or left horribly damaged.
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Except me. I’m thoroughly convinced it will happen. If I died every time I thought I was going to be one of the dead, I wouldn’t have made it to teenage years, let alone be six weeks from my 60th birthday, but I still believe it with every thing.
I fear this…I fear it more than almost anything I’ve ever feared.
This certainly adds context to the ‘Everybody’s going to get this thing eventually’ comment by the unidentified WH official to Jim Acosta, as quoted in Ophelia’s recent Everybody Eventually post. I was thinking it may have been a concealed dig at Trump’s lack of a plan to deal with the virus, but it’s now clear that this hair-brained, murderous notion is the plan and the official was actually being honest, not sarcastic.[ http://www.butterfliesandwheels.org/2020/everybody-eventually/
@iknklast
When I heard about the potential loss of taste and smell my fear factor went through the roof. I love cooking and experimenting with food, it’s one of my hopeful career paths* from the hell that IT has become. Without that hope I almost prefer being dead.
* the other one is music, I apparently have no interest in making money :)
I don’t know. We have a culinary school at our college, and the graduates of that make more with a two year degree than I make with my Ph.D. They end up in hotel/restaurant management, or working for high quality restaurants, places where there is a huge demand, i guess. I was shocked when I heard what they make. I debated going for the degree myself; I too love cooking and experimenting with food…and my husband loves eating, so that’s a match made in heaven (or whatever us atheists might believe in…serendipity?).
Mike @11, I remember a year or so ago listening to a NY based food critic being interviewed. Food had been her life, professionally and personally. After being hit by a car she suffered total loss of smell and taste. She described going to a very dark place as a result. Apparently after intense experimentation and training she started to get back the faintest traces of those senses. She described the rebuilding of limited ability to taste and smell and how that led to her developing a renewed interest in food – and a purpose. Apparently what she now senses (and enjoys) is completely different to pre-accident. I believe she has written a book about her experience and includes recipes of her new favorites. The porridge with peanut butter and chilli oil sounded interesting.