POST 24. May 7, 2020. CORONAVIRUS. Former New Jersey governor Chris Christie said: “there are going to be deaths no matter what”… but that people needed to get back to work.

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“In a podcast interview with CNN’s Dana Bash, former New Jersey Gov. Chris Christie conceded that there would be deaths if states begin to ease their lockdown restrictions, but that people need to accept these deaths because the economic impact would be more dangerous.

Bash began by asking Christie about New York Times reporting that showed White House modeling projected 3,000 deaths a day from the coronavirus by June 1.

Christie acknowledged that “it’s absolutely true,” but believed the country could not sustain its current economic course.

“If we leave this purely up to the physicians’ and the epidemiologists’ data we will be locked in our houses for another year because they don’t want us to be doing anything other than staying in our homes until there’s a vaccine,” Christie said.

“Of course, everybody wants to save every life they can — but the question is, towards what end, ultimately?” Christie later said. “Are there ways that we can thread the middle here to allow that there are going to be deaths, and there are going to be deaths no matter what?”

Christie said it was important to “let some of these folks get back to work, because if we don’t, we’re going to destroy the American way of life in these families — and it will be years and years before we can recover.” (A)

What is herd immunity?

Exposure to a disease-causing organism triggers the body to produce antibodies, disease-specific proteins that fight off the infection. On first exposure, it can take the body a while to develop the right antibody. However, in many cases, the human immune system retains knowledge of that infectious agent, and if it comes across it again, is able to rapidly deploy these antibodies to fight it off.

When a person develops this sort of antibody-based immunity to a given infectious agent, the likelihood that they will pass it on falls significantly says D’Souza. When 70-80% of a given population develops this antibody protection, herd immunity is achieved, indirectly providing protection to those who are not yet immune.

“It’s enough people being immune that over time the number of infections goes down rather than up,” says David Dowdy, associate professor of epidemiology also at Johns Hopkins University. “There are really only two ways to achieve this level of immunity. One is through development and mass distribution of a vaccine, and the other is through a massive increase in the number of people who get sick.” (B)

“How have we achieved herd immunity for other infectious diseases?

Measles, mumps, polio, and chickenpox are examples of infectious diseases that were once very common but are now rare in the U.S. because vaccines helped to establish herd immunity. We sometimes see outbreaks of vaccine-preventable diseases in communities with lower vaccine coverage because they don’t have herd protection. (The 2019 measles outbreak at Disneyland is an example.)

For infections without a vaccine, even if many adults have developed immunity because of prior infection, the disease can still circulate among children and can still infect those with weakened immune systems. This was seen for many of the aforementioned diseases before vaccines were developed.

Other viruses (like the flu) mutate over time, so antibodies from a previous infection provide protection for only a short period of time. For the flu, this is less than a year. If SARS-CoV-2, the virus that causes COVID-19, is like other coronaviruses that currently infect humans, we can expect that people who get infected will be immune for months to years, but probably not their entire lives.

What will it take to achieve herd immunity with SARS-CoV-2?

As with any other infection, there are two ways to achieve herd immunity: A large proportion of the population either gets infected or gets a protective vaccine. Based on early estimates of this virus’s infectiousness, we will likely need at least 70% of the population to be immune to have herd protection.

In the worst case (for example, if we do not perform physical distancing or enact other measures to slow the spread of SARS-CoV-2), the virus can infect this many people in a matter of a few months. This would overwhelm our hospitals and lead to high death rates.

In the best case, we maintain current levels of infection—or even reduce these levels—until a vaccine becomes available. This will take concerted effort on the part of the entire population, with some level of continued physical distancing for an extended period, likely a year or longer, before a highly effective vaccine can be developed, tested, and mass produced.

The most likely case is somewhere in the middle, where infection rates rise and fall over time; we may relax social distancing measures when numbers of infections fall, and then may need to re-implement these measures as numbers increase again. Prolonged effort will be required to prevent major outbreaks until a vaccine is developed. Even then, SARS-CoV-2 could still infect children before they can be vaccinated or adults after their immunity wanes. But it is unlikely in the long term to have the explosive spread that we are seeing right now because much of the population will be immune in the future.” (C)

“There’s a consensus that the key to ending the coronavirus pandemic is establishing herd immunity. But there are many unknowns. One is whether researchers can develop a safe and effective vaccine. Another is how long people who’ve recovered have immunity; reinfection after months or years is common with other human coronaviruses. Finally, it’s not clear what percentage of people must be immune to protect the “herd.” That depends on the contagiousness of the virus. (D)

“Herd immunity is disease-specific and is influenced by the ease with which the disease spreads from person to person, or the level of contagiousness. The specifics about coronavirus and herd immunity are not yet characterized. Regardless of the specifics, achieving herd immunity by the repeated process of infection of one person, recovery and immunity will take a long time – many, many months or even years.

It will take a long time to achieve worldwide herd immunity. It may take less time in some cities or countries, but it will take time. Those individuals who are immune will be able to get back to work and be protected from reinfection and, probably, not transmit the virus or disease.” (E)

“The point at which we reach herd immunity is mathematically related to the germ’s propensity to spread, expressed as its reproduction number, or R0. The R0 for the coronavirus is between 2 and 2.5, scientists estimate (pdf), meaning each infected person passes it to about two other people, absent measures to contain the contagion.

To imagine how herd immunity works, think of coronavirus cases multiplying in a susceptible population this way: 1, 2, 4, 8, 16, and so on. But if half the people are immune, half of those infections won’t ever happen, and so the spreading speed is effectively cut in two. Then, according to the Science Media Centre, the outbreak simmers along like this instead: 1, 1, 1, 1 … The outbreak is snuffed out once the infection rate is less than 1.

The current germ’s rate of spread is higher than that of the ordinary flu, but similar to that of novel emergent influenzas that have occasionally swept the globe before. “That is similar to pandemic flu of 1918, and it implies that the end of this epidemic is going to require nearly 50% of the population to be immune, either from a vaccine, which is not on the immediate horizon, or from natural infection,” Harvard University epidemiologist Marc Lipsitch told a gathering of experts on a video call this weekend.

The more infectious a virus is, the more people need to be immune for us to achieve herd immunity. Measles, one of the most easily transmitted diseases with an R0 over 12, requires about 90% of people to be resistant for unprotected people to get a free ride from the herd. That’s why new outbreaks can start when even small numbers of people opt out of the measles vaccine.

Similarly, if the coronavirus spreads more easily than the experts think, more people will need to get it before herd immunity is reached. For an R0 of 3, for example, 66% of the population has to be immune before the effect kicks in, according to the simplest model.

Whether it’s 50% or 60% or 80%, those figures imply billions infected and millions killed around the world, although the more slowly the pandemic unfolds, the greater the chance for new treatments or vaccines to help.

The newest epidemiological models developed in the UK now recommend aggressive “suppression” of the virus. The basic tactics being urged would be to isolate sick people, try to reduce social contacts by 75%, and close schools. Those economically costly measures could continue for many months.

“Suppressing transmission means that we won’t build up herd immunity,” says Azra Ghani, the lead epidemiologist on the new model of the outbreak from Imperial College London. The trade-off of success is “that we are driving it down to such a low level that we have to keep those [measures] in place.” “ (F)

“Which brings us to why herd immunity could never be considered a preventative measure.

If 70 percent of your population is infected with a disease, it is by definition not prevention. How can it be? Most of the people in your country are sick! And the hopeful nonsense that you can reach that 70 percent by just infecting young people is simply absurd. If only young people are immune, you’d have clusters of older people with no immunity at all, making it incredibly risky for anyone over a certain age to leave their house lest they get infected, forever.

It’s also worth thinking about the repercussions of this disastrous scenario – the best estimates put COVID-19 infection fatality rate at around 0.5-1 percent. If 70 percent of an entire population gets sick, that means that between 0.35-0.7 percent of everyone in a country could die, which is a catastrophic outcome.

With something like 10 percent of all infections needing to be hospitalised, you’d also see an enormous number of people very sick, which has huge implications for the country as well.

The sad fact is that herd immunity just isn’t a solution to our pandemic woes. Yes, it may eventually happen anyway, but hoping that it will save us all is just not realistic. The time to discuss herd immunity is when we have a vaccine developed, and not one second earlier, because at that point we will be able to really stop the epidemic in its tracks.

Until we have a vaccine, anyone talking about herd immunity as a preventative strategy for COVID-19 is simply wrong. Fortunately, there are other ways of preventing infections from spreading, which all boil down to avoiding people who are sick.

So stay home, stay safe, and practice physical distancing as much as possible.” (G)

“But even assuming that immunity is long-lasting, a very large number of people must be infected to reach the herd immunity threshold required. Given that current estimates suggest roughly 0.5 percent to 1 percent of all infections are fatal, that means a lot of deaths.

Perhaps most important to understand, the virus doesn’t magically disappear when the herd immunity threshold is reached. That’s not when things stop — it’s only when they start to slow down.

Once enough immunity has been built in the population, each person will infect fewer than one other person, so a new epidemic cannot start afresh. But an epidemic that is already underway will continue to spread. If 100,000 people are infectious at the peak and they each infect 0.9 people, that’s still 90,000 new infections, and more after that. A runaway train doesn’t stop the instant the track begins to slope uphill, and a rapidly spreading virus doesn’t stop right when herd immunity is attained.

If the pandemic went uncontrolled in the United States, it could continue for months after herd immunity was reached, infecting many more millions in the process.

By the time the epidemic ended, a very large proportion of the population would have been infected — far above our expected herd immunity threshold of around two-thirds. These additional infections are what epidemiologists refer to as “overshoot.”

Herd immunity doesn’t stop a virus in its tracks. The number of infections continues to climb after herd immunity is reached.

Some countries are attempting strategies intended to “safely” build up population immunity to the coronavirus without a vaccine. Sweden, for instance, is asking older people and those with underlying health issues to self-quarantine but is keeping many schools, restaurants and bars open. Many commentators have suggested that this would also be a good policy for poorer countries like India. But given the fatality rate, there is no way to do this without huge numbers of casualties — and indeed, Sweden has already seen far more deaths than its neighbors.

As we see it, now is far too early to throw up our hands and proceed as if a vast majority of the world’s population will inevitably become infected before a vaccine becomes available.

Moreover, we should not be overconfident about our ability to conduct a “controlled burn” with a pandemic that exploded across the globe in a matter of weeks despite extraordinary efforts to contain it.

Since the early days of the pandemic, we have been using social distancing to flatten its curve. This decreases strain on the health care system. It buys the scientific community time to develop treatments and vaccines, as well as build up capacity for testing and tracing. While this is an extraordinarily difficult virus to manage, countries such as New Zealand and Taiwan have had early success, challenging the narrative that control is impossible. We must learn from their successes.

There would be nothing quick or painless about reaching herd immunity without a vaccine.” (H)

“While much of Europe has gone into lockdown, one country has bucked the trend: Sweden.

Restaurants, schools and playgrounds in the Scandinavian country are open. Sweden’s Foreign Minister Ann Linde has said it’s not following the herd immunity theory, but rather relying on its citizens to voluntarily be responsible to prevent the spread of the coronavirus.

But Sweden’s state epidemiologist, Anders Tegnell, claimed herd immunity could be reached in the nation’s capital, Stockholm, within weeks.

“In major parts of Sweden, around Stockholm, we have reached a plateau (in new cases) and we’re already seein the effect of herd immunity and in a few weeks’ time we’ll see even more of the effects of that,” Tegnell said in an interview with CNBC.

The strategy hasn’t come without costs.

WHO has said it’s “imperative” that Sweden take stronger measures to control the spread of the virus.

Compared to other European nations that haven taken stricter measures, Sweden’s “curve” — the rate of infections and deaths caused by the coronavirus — is steeper. As of Wednesday, Sweden has at least 1,937 reported coronavirus-related deaths, compared to Norway’s 185 and Finland’s 149 deaths, according to data from Johns Hopkins University.” (I)

“Sweden’s ambassador to the U.S. has said the country’s capital Stockholm could reach herd immunity from the coronavirus within a few weeks, despite questions over whether people who have recovered from COVID-19 are actually protected from a second infection.

Herd immunity means the majority of a population have become immune to an infectious disease, either by recovering from it or by being vaccinated.

Karin Ulrika Olofsdotter, Swedish ambassador to the United States, told NPR: “About 30 percent of people in Stockholm have reached a level of immunity. We could reach herd immunity in the capital as early as next month.”

How much of the population needs to have been infected to achieve herd immunity depends on the disease. With COVID-19, the figure is unclear, but it is estimated at least 50 to 60 percent of the population would need to have been infected.

There is no official lockdown in Sweden and schools, restaurants and stores have stayed open during the pandemic. The government has issued social distancing guidelines and told citizens to avoid unnecessary travel. Gatherings of more than 50 people and visits to care homes have been banned.

Officials forced five bars and restaurants in Stockholm to close after they failed to respect social distancing guidelines.

Olofsdotter said that additional research and testing is necessary to understand more about immunity to COVID-19. She said the Swedish government would change its approach to tackling the coronavirus if necessary.” (J)

“Governments everywhere are facing a stark “jobs vs. deaths” Hobbesian choice.

How long will the public tolerate lockdowns that paralyze the economy and limit essential social mobility?

In response, many countries are seemingly lining up behind two unproven strategies based on contradictory hypotheses of virus behavior. This with similar hopes that they can thread the needle by limiting the human toll to “acceptable” levels, keep hospitals from being overwhelmed, and maintain vital economic activity.

The first “elimination hypothesis” has been implemented on physical or virtual islands such as Singapore, Taiwan, South Korea, Iceland, and New Zealand. It is based on the presumption that the virus can be eliminated via a two-pronged strategy: stop importation at borders and ports of entry and reduce domestic outbreaks by stringent containment procedures.

In countries such as the U.K., the U.S., Italy, and Spain, where the virus has long ago escaped containment and mitigation phase, a variant of the elimination model is being deployed. Cycles of suppression lockdowns alternating with the relaxation of social distancing interventions accompanied by aggressive containment measures are anticipated.

Significant second and further resurgent waves of infection are likely if the importation of virus or domestic foci re-emerge. Armies of virus hunter tracking teams would need to be deployed in ongoing containment firefights.

The public messaging accompanying the elimination model is for absolute safety to avoid exposure at all costs. Acquired immunity is thwarted, and an effective vaccine features prominently as the end-game.

The second “herd immunity hypothesis“ is actively or implicitly practiced in Sweden, Mexico, and Belarus. It assumes a virus that cannot be sealed off or contained. It is presumed to be best controlled through managed spread through the population, leading to progressively greater levels of acquired immunity. Since the virus cannot be indefinitely evaded, it is accommodated and gently accepted. It was initially slowing then ultimately halting the spread through herd immunity….

As these grand experiments play out, it would be a tragic missed opportunity not to take full global advantage. Each country should make explicit the assumptions and presumed scientific basis of its strategy clear. To allow valid national comparisons, there should be a cooperative global “Big Data” acquisition and analysis framework set up to measure the impact of each strategy.

This race is more marathon than a sprint. Long-term health winners will be judged on the cumulative “area under the epidemic curve” measured in total infections, severe cases, and deaths. Also, when measures of effective immunity are eventually determined, population immunity rates will be critical. If the herd-immunity hypothesis is correct, the early numerical lead of the elimination countries will dissipate over time.” (K)

“Social distancing and frequent handwashing are currently the only ways to help prevent you and those around you from contracting and potentially spreading SARS-CoV-2, the virus that causes COVID-19.

There are several reasons why herd immunity isn’t the answer to stopping the spread of the new coronavirus:

-There isn’t yet a vaccine for SARS-CoV-2. Vaccinations are the safest way to practice herd immunity in a population.

-The research for antivirals and other medications to treat COVID-19 is ongoing.

-Scientists don’t know if you can contract SARS-CoV-2 and develop COVID-19 more than once.

-People who contract SARS-CoV-2 and develop COVID-19 can experience serious side effects. Severe cases can lead to death.

-Doctors don’t yet know exactly why some people who contract SARS-CoV-2 develop severe COVID-19, while others do not.

-Vulnerable members of society, such as older adults and people with some chronic health conditions, could get very sick if they’re exposed to this virus.

-Otherwise healthy and younger people may become very ill with COVID-19.

-Hospitals and healthcare systems may be overburdened if many people develop COVID-19 at the same time.”  (L)

“President Trump on Sunday night said that the government would reassess the recommended period for keeping businesses shut and millions of workers at home after this week, amid millions of job losses caused by the efforts to contain the spread of the novel coronavirus.

“WE CANNOT LET THE CURE BE WORSE THAN THE PROBLEM ITSELF,” Mr. Trump tweeted in all capital letters shortly before midnight. “AT THE END OF THE 15 DAY PERIOD, WE WILL MAKE A DECISION AS TO WHICH WAY WE WANT TO GO!”” (M)

“We won’t get to herd immunity in the near future. A miracle drug is not in sight. The only way to restart the economy, then, is to put a highly effective system in place to test millions of people, trace their movements, and quickly quarantine those who might have been infected.

But even as the past few days have brought bad news about the science of the pandemic, they have brought terrifying news about its politics: It now seems less likely than ever that the United States will do what is necessary to reopen the economy without causing a second wave of deadly infections.

America is still behind on testing for COVID-19. Although Trump promised almost two months ago that anyone who wanted a test could get one, the U.S. has still conducted only about 5.4 million. The country needs to increase its testing rate at least threefold to reopen safely.

America is also behind on test and trace. Some countries, such as South Korea, now have robust systems in place to inform people that they have been exposed to the coronavirus, and need to self-isolate. But implementing such a system requires two things the United States sorely lacks: widespread trust in the government and a coordinated response from the White House.

In the absence of a federal strategy, some states, such as New York and Massachusetts, are trying to develop their own test-and-trace systems. But without help from Washington, they will likely lack both the resources to build a comprehensive system and the ability to persuade a large majority of their residents to sign up for an app that tracks their movements. Even if, against the odds, they should succeed in both these tasks, they face another obvious obstacle: Viruses don’t respect state lines.

If he were truly interested in limiting the damage to America’s economy, and opening up the country, Trump would be laser-focused on remedying these problems. Instead, the president has doubled down on culture wars and quack cures.

Early last week, Trump fanned the flames of the irresponsible protests against stay-at-home orders that are now being staged in cities across the country. A few days later, he vowed to “suspend immigration” to the United States. Then he suggested that scientists look into the possibility of injecting patients with bleach.

For all his blustering demands to get the country back to normal, the president is failing to take the steps that are required to reopen the economy without a horrific death toll. And for all the ingenuity shown by individual governors, the absence of a coordinated federal strategy may prove impossible to overcome.

Ihaven’t written much about the pandemic recently. The reason is, quite simply, that I didn’t feel there was much to say. Though every day brought a ton of news, a lot of it was contradictory; for long, painful weeks, I felt as though my overall understanding of the situation was barely improving.

Now I finally feel on firmer ground. Some of what we have learned over the past few weeks has been positive. The fatality rate from COVID-19 is likely to be significantly lower than early estimates suggested. Americans have followed social-distancing guidelines to an impressive degree. So far, we have succeeded in flattening the curve, and have not had to turn thousands of people in desperate need of medical treatment away from the emergency room. Even in New York City, the American epicenter of the pandemic, the number of new infections and new fatalities is ebbing.

We are not in the worst of all possible timelines. And yet, our hopes for the pandemic’s quick resolution should clearly be shelved. Taken together, the three major developments of the past few days paint a bleak picture of the months that lie ahead: COVID-19 is too deadly to let it rip through the population. An effective cure is not in sight. And the federal government is incapable of formulating a coherent pandemic response.” (N)

“You’re tired of Zoom cocktail hours, the never-ending pile of dishes, Netflix.

You miss your friends. You want to hug your parents. You want to see people’s faces, no masks please.

And if you are among the more than 30 million Americans who filed for unemployment since mid-March, you are probably freaking out about your finances too.

Perhaps you are beginning to wonder if the people protesting stay-at-home orders around the state and across the country have a point: Maybe this extended physical distancing is doing more harm to our collective health than good.

Just how bad would it be to let everyone struggling to pay their bills go back to work? To eat at a restaurant again? To go to the beach on a hot day without being scolded by your governor?

After all, doesn’t this pandemic end with either a vaccine, herd immunity or some combination of the two? If everything reopened and a few more people got sick, might that be a reasonable price to pay?

If only it were that simple….

“The hospitals are really the bottleneck here,” she said.

Shelter-in-place orders have effectively kept many hospital systems across the country from becoming overburdened by COVID-19 patients, but that could change quickly as restrictions are eased.

“Because of confinement, there is an appearance that we can manage this,” Bourouiba said.”

But if those measures were suddenly lifted with nothing to replace them, we would overwhelm the healthcare system and doctors would start having to choose who lives and who dies, she said.

“That’s the ethical question people in our society need to be thinking about,” Bourouiba added.

So, what will it take to ease the stay-at-home measures with minimal risk to society? Public health experts agree on the essentials: the capacity to rapidly test people who may be infected, isolate those who test positive, and track and quarantine their close contacts.

And unfortunately, communities must be willing to go back into lockdown if there is an explosion of cases in their midst….” (O)

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4 Comments

  1. BennyH

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