Best estimates show that COVID-19 has infected about 10 per cent of the global population to date and killed more than one million people. Records on excess mortalities in various nations suggest the true toll of the pandemic is likely half again greater than official tallies. The virus is clearly on a determined roll. And the vast majority of us are still being hunted.
Meanwhile, no one knows how many of the millions infected will suffer from long-term heart, lung or neurological complications — factors probably more important than a case fatality rate of one to three per cent.
But to some whose political views hew to the libertarian right, the virus has held the global economy hostage for far too long and grandiosely expanded the reach of governments.
They argue the human herd must liberate itself by getting infected, and they downplay the consequences.
Their laissez-faire prescriptions are trumpeted in the “Great Barrington Declaration.” It came about earlier this month when the American Institute for Economic Research, one of many groups funded by the libertarian billionaire Charles Koch, hosted a select group of academics concerned about the impacts of pandemic lockdowns in Barrington, Massachusetts. In a nutshell, the group suggests it would be better to encourage the healthy to eat, drink and be merry while letting the virus burn through their ranks, because 80 per cent of them will be largely symptom free.
During this viral fire, they added, authorities should isolate the vulnerable (the old, infirm, the poor, immigrants, the obese, diabetics, etc.) in their homes, long-term care residences and other refuges. The Great Barrington signers describe this approach as “Focused Protection.”
Then, once the healthy part of the herd has been so thoroughly exposed to the virus to have developed antibodies, transmission should stop, and life will resume as normal. The vulnerable might then leave their cloisters of Focused Protection and rejoice.
This declaration was soon followed by another announcement from the White House.
President Donald Trump’s new health expert, Scott Atlas, a radiologist, proclaimed: “We just had a declaration written, and the thrust of the declaration is exactly aligned with the president — that is, opening schools, opening society, and protecting the high-risk people, the seniors.”
On first glance, it’s an inviting scenario in how it seems to promise a return to “normal” for the majority and offer concern and support for those most vulnerable, many already electing to live locked-down lives to protect themselves.
But some of the world’s best epidemiologists and viral experts have responded to the Great Barrington Declaration with an eloquent rebuttal called the John Snow Memorandum. (Snow was the disease mapper that stomped out cholera in 19th-century London.)
Signers of the Snow Memo called herd immunity a grand fallacy, if not a murderous idea for at least five reasons. Here they are:
1. There aren’t enough ‘strong’ ones to constitute a herd.
For starters, the math on herd immunity just doesn’t add up. About 60 to 70 per cent of the population probably needs to get infected to produce herd immunity, if such a thing even exists for a cold virus. Not many countries have that many young or healthy people to spare for a biological experiment. Nearly 20 per cent of Europe’s population, for example, is over 65, and in the United States nearly 40 per cent of the population is obese — another risk factor for COVID-19 complications.
And how does “Focused Protection” address the finding that people of colour in the United States have “age-adjusted COVID-19 death rates triple that of white Americans”?
Science offers a further related challenge to herd immunity. The virus can and does make young and healthy people very ill. The Economist recently reported: “At the peak of the COVID-19 epidemic in England and Wales, deaths among people aged 45 to 64 years were 80 per cent higher than usual,” despite admonitions to stay at home.
2. Given this is a respiratory virus, immunity likely won’t last.
Herd immunity for respiratory viruses, whether the flu or a cold, is wishful thinking. The infectious disease expert William Haseltine has repeatedly noted that studies on “cold-causing coronaviruses show that they can infect a person more than once — and even as many as three or four times.” In addition, recent studies have shown that individuals can be re-infected with the coronavirus. The second time around appears to be markedly worse.
Trust in herd immunity rests on the idea that getting COVID-19 bestows on the survivor strong, lasting antibodies. But a nationwide study from Spain, which included 61,000 patients, found that people who tested positive for antibodies one week no longer had those antibodies two weeks later.
So, herd immunity may be unachievable, and pursuing it could result in recurrent waves of epidemics. One group of researchers put it this way in the medical journal The Lancet: “In light of these findings, any proposed approach to achieve herd immunity through natural infection is not only highly unethical, but also unachievable.”
3. Lockdown is not the only alternative to seeking herd immunity.
The Barrington Declaration presents a straw man argument: lockdown or herd immunity. That’s not the issue. Much of East Asia has successfully battled the virus and reduced death rates without brutal lockdowns or herd immunity. How? Thanks to previous battles with SARS, they learned about the importance of acting quickly and respecting the precautionary principle.
As a result, Japan, Taiwan, South Korea and Vietnam strategically employed mass testing, rigorous contact tracing, travel bans, isolation hotels for the infected, and ubiquitous masking. These combined strategies have kept deaths to a minimum and allowed East Asian economies to function. Canada’s Atlantic bubble is another fine success story.
At the same time, it is important to remember that short, hard and quick economic interruptions remain a historic response to galloping pandemics because they stop exponential growth. Merchants came up with the idea of constraining mobility in the medieval plague years when they realized dead people don’t buy or sell things.
But even lockdowns can fail and do fail, especially when political leaders don’t take advantage of the restrictions to secure the testing, contract tracing and housing for the infected necessary to dampen viral spread.
4. First tries at achieving COVID-19 herd immunity did not fare well.
Herd immunity repeatedly has been tried and failed. Both the Dutch and the British governments initially wanted to go this route, but hospitalization and death rates quickly changed their thinking. U.K. Prime Minister Boris Johnson got caught in a viral wildfire of his own policy making, and was hospitalized with COVID-19.
Sweden offers a sobering example too. At the beginning of the pandemic, it didn’t lock down. Nor did it later advise people to mask up. Schools and businesses remained open. It didn’t even bother with contract tracing.
As a result, the virus burned through young people and into long-term care homes and immigrant communities. The country witnessed 590 deaths per million — a record almost as bad as the U.S. and Italy. In contrast, Norway acted responsibly and has since breezed through the pandemic with a death rate of 50 per million.
COVID-19 libertarians argue that Sweden never came close “to having a shortage of ICU beds.” But what they fail to add is that Sweden barred anyone over the age of 80 from entering intensive care. Many died at home without even being tested. Nursing homes, short on oxygen, offered morphine instead of ICUs.
And what did Sweden achieve with its laissez-faire experiment? Only 12 per cent of Stockholm’s population and approximately eight per cent of the general population had antibodies to the virus by June. So, a lot of people died, and no herd immunity was achieved. Nor did the economy prosper. In fact, Sweden’s GDP crashed by 8.3 per cent in the second quarter compared to Norway’s 5.1 per cent loss.
La Crosse, Wisconsin offers another telling example of how herd immunity works in real life. When its three universities opened this fall, students returned and partied as students do. COVID-19 spread into the community and then into previously disease-free care homes, killing scores of elders in recent weeks. The virus can and will find a way to move from the healthy part of the unguarded population designated to acquire herd immunity to those who are sequestered and vulnerable.
5. Even a vaccine likely won’t make human herds immune.
Nor can vaccines be counted on to deliver herd immunity. Most flu vaccines offer 50 per cent efficacy or less in older populations. As such, they confer only a temporary and waning immunity. They do not eradicate the virus from human circulation. William Haseltine expects a COVID-19 vaccine won’t be much more reliable. “We all know that flu vaccines do not prevent the annual reoccurrence of the flu,” he notes, “nor should we expect a COVID-19 vaccine to do better.”
Political ideology that clouds epidemiology
The recirculation of the highly political herd immunity thesis is no accident. It provides a cover for caudillos such as Trump, Vladimir Putin and Jair Bolsonaro who have downplayed the virus, and done little or nothing for their people. It is a political script that excuses absent leadership, ignores public health and justifies rising death tolls.
It is noteworthy that herd immunity has never ended a pandemic.
Governments that have flirted with the idea of doing nothing have well demonstrated the results: it overwhelms hospitals, burns out medical workers and increases the death toll. It may even leave thousands of young people with long-term disabilities including heart and lung damage.
But its appeal to certain libertarians is understandable, says the British political economist Richard Murphy. Those willing to accept the risk that a herd immunity approach would breach the walls of “Focused Protection” may not be too upset about it. Murphy says some would see it merely as a method of culling the elderly and unwell. Such “a harvest” would reduce the size of the state by shrinking pension payments and medical care support.
“This is the economics of neoliberalism running riot,” noted Murphy. Its adherents, in other words, dream of capitalism free of troublesome public health edicts, flourishing as mightily as a grave diggers’ guild in the 14th century.
One need not assign such amoral aims to all libertarians, however, to see where their herd immunity enthusiasm goes awry. As the Snow Memorandum notes, advocates misunderstand what science and history has taught us about how pandemics, and this particular coronavirus, work.
There is no quick way out of this pandemic, but there is an assured way forward. It requires competent government, flexible economies and attentive citizens. And as The Tyee has emphasized, it depends on universal masks, timely testing, rigorous contact tracing, support for the poor and the infected, and political leaders who understand that the pandemic is unfortunately but indeed a long emergency.
Nicholas Nassim Taleb and his colleague Yaneer Bar-Yam, both experts on risk and complexity, have summed up the challenge best: “While risk-taking is a business that is left to individuals, collective safety and systemic risk are the business of the state. Failing that mandate of prudence by gambling with the lives of citizens is a professional wrongdoing that extends beyond academic mistake; it is a violation of the ethics of governing.”