POST 53. October 20, 2020. CORONAVIRUS. “a…“herd-immunity strategy” is a contradiction in terms, in that herd immunity is the absence of a strategy.”

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“Letting the coronavirus rip through the U.S. population unchecked to infect as many people as possible to achieve so-called herd immunity would cause a lot of unnecessary deaths and the idea is “nonsense” and “dangerous,”…. (Dr. Anthony Fauci)

With “herd immunity” being introduced into the Coronavirus discussion I recalled that as a student in Epidemiology 101 at the UNC School of Public Health back in 1970 this was a descriptive term, and not used operationally.

“Herd immunity” was, and still is, an outcome where enough of the population gains immunity to a virus by vaccination that the viral threat burns itself out by lack of am easily available residual target population.

Now, as the third wave seems to be underway some are suggesting “herd immunity” as a  tamping down strategy – let the young get it, while protecting those at risk, e.g., the elderly and those with pre-existing conditions.

But it doesn’t work that way. The young may get it asymptomatically but will still bring it home to those at risk who will get symptoms requiring treatment, leading to hospitals reaching their limits, not because of unavailability of beds and equipment, but due to staff shortages (health care workers get sick too!)

 So it’s back to basics until there is a vaccine and advanced therapeutics – wearing masks, social distancing, hand hygiene and now “indoor safety”.

Here’s why!

but first….

to read POSTS 1-53 in chronological order, highlight and click on

POST 52. October 18, 2020. ZIKA/ EBOLA/ CANDIDA AURIS/ SEVERE FLU/ Tracking. “… if there was a severe flu pandemic, more than 33 million people could be killed across the world in 250 days… Boy, do we not have our act together.” —”- Bill Gates. July 1, 2018

to read POST 52 highlight and click on

“But “herd-immunity strategy” is a contradiction in terms, in that herd immunity is the absence of a strategy. Herd immunity is an important public-health concept, developed and used to guide vaccination policy. It involves a calculation of the percentage of people in a population who would need to achieve immunity in order to prevent an outbreak. The same concept offers little such guidance during an ongoing pandemic without a vaccine. If it were a military strategy, it would mean letting the enemy tear through you until they stop because there’s no one left to attack.” (L)

“In late September, a Nobel Prize-winning economist emailed Dr. Scott W. Atlas, a White House coronavirus adviser, in what he saw as a last-ditch effort to persuade the Trump administration to embrace a dramatic increase in testing and isolating infected patients. The plan was designed to appeal to President Trump, who has complained that positive tests make his administration look bad and would not “generate any new confirmed cases.”

Dr. Atlas, a radiologist, told the economist, Paul Romer of New York University, that there was no need to do the sort of testing he was proposing.

“That’s not appropriate health care policy,” Dr. Atlas wrote.

Dr. Atlas went on to reference a theory that the virus can be arrested once a small percentage of the United States population contracts it. He said there was a “likelihood that only 25 or 20 percent of people need the infection,” an apparent reference to a threshold for so-called “herd immunity” that has been widely disputed by epidemiologists.

The call for more widespread testing and isolation, Dr. Atlas wrote, “is grossly misguided.”

The exchange highlights the resistance within the White House toward adopting a significantly expanded federal testing program, including efforts to isolate infected patients and track the people they have been in contact with, even as infections and deaths continue to rise nationwide. That resistance has become a sticking point in negotiations over a new economic stimulus package, with the administration and top Democrats disagreeing over the scope and setup of an expanded testing plan.

Many public health experts, and some economists like Mr. Romer, say that a far more sweeping testing program would save lives and boost the economy by helping as many Americans as possible learn quickly if they are sick — and then take steps to avoid spreading the virus.

Dr. Atlas and other administration officials playing influential roles in the government’s virus response effectively say the opposite: that more widespread testing would infringe on Americans’ privacy and hurt the economy, by keeping potentially infected workers who show no symptoms of the virus from reporting to their jobs.” (A)

“In an interview on Thursday, …..Dr Atlas said that the United States had a “massive” testing program over all, but that it should be used strategically to protect vulnerable populations, like nursing home residents — not young, healthy individuals who he said were at low risk of contracting the disease. He said that large-scale government test and isolate programs infringed on civil liberties, and that new research had persuaded him that herd immunity might be achieved once 20 or 40 percent of Americans are infected.

“The overwhelming majority of people who get this infection are not at high risk,” Dr. Atlas said in the interview. “And when you start seeking out and testing asymptomatic people, you are destroying the workforce.”…

Experts from a wide range of fields have repeatedly denounced the lack of testing in the United States. Despite Mr. Trump’s repeated affirmations that the country has done more testing than any other nation, researchers have noted that 991,000 or so tests done each day were still not enough to keep in check a virus that has infected more than eight million people nationwide. Tests can individually diagnose people who might unknowingly carrying the virus. At the population level, they can also help health officials monitor any spread and pinpoint and quash outbreaks before they spin out of control.

Others have cautioned against an overreliance on testing as a preventive measure, noting that, in the absence of standards like physical distancing and mask wearing, testing alone cannot fully contain a virus that spreads wherever people tend to gather, regardless of whether those infected are exhibiting symptoms.

“No testing scheme, no test is perfect. There will always be people who go undetected,” said Dr. David Dowdy, an infectious disease epidemiologist at Johns Hopkins University who has researched and written about herd immunity. “The best way to protect the most vulnerable is to reduce the amount of virus that’s in the population that can get through all of those testing schemes and cause destruction.”

Dr. Atlas’s position has been challenged by medical advisers around him who have backgrounds in infectious disease response, revealing a significant rift in the White House over the right approach. Dr. Deborah L. Birx, the White House’s coronavirus response coordinator, has pushed for aggressive, broad testing even among young and healthy people, often clashing with Dr. Atlas in meetings.

“I would always be happy if we had 100 percent of students tested weekly,” Dr. Birx said on Wednesday in an appearance at Penn State University, “because I think testing changes behavior.”

Dr. Atlas at one point influenced the administration’s efforts to install new Centers for Disease Control and Prevention guidance that said it was not necessary to test people without symptoms of Covid-19 even if they had been exposed to the virus, upsetting Dr. Birx and Dr. Robert R. Redfield, the C.D.C. director….

In his email, sent to Dr. Atlas’s personal account, Mr. Romer proposed additional testing and isolation efforts that could allow far more Americans to return to work and shopping, generating economic activity that would be 10 or 100 times larger than the cost of the testing program itself.” (B)

“The Great Barrington Declaration – As infectious disease epidemiologists and public health scientists we have grave concerns about the damaging physical and mental health impacts of the prevailing COVID-19 policies, and recommend an approach we call Focused Protection.

Coming from both the left and right, and around the world, we have devoted our careers to protecting people. Current lockdown policies are producing devastating effects on short and long-term public health. The results (to name a few) include lower childhood vaccination rates, worsening cardiovascular disease outcomes, fewer cancer screenings and deteriorating mental health – leading to greater excess mortality in years to come, with the working class and younger members of society carrying the heaviest burden. Keeping students out of school is a grave injustice.

Keeping these measures in place until a vaccine is available will cause irreparable damage, with the underprivileged disproportionately harmed.

Fortunately, our understanding of the virus is growing. We know that vulnerability to death from COVID-19 is more than a thousand-fold higher in the old and infirm than the young. Indeed, for children, COVID-19 is less dangerous than many other harms, including influenza.

As immunity builds in the population, the risk of infection to all – including the vulnerable – falls. We know that all populations will eventually reach herd immunity – i.e.  the point at which the rate of new infections is stable – and that this can be assisted by (but is not dependent upon) a vaccine. Our goal should therefore be to minimize mortality and social harm until we reach herd immunity.

The most compassionate approach that balances the risks and benefits of reaching herd immunity, is to allow those who are at minimal risk of death to live their lives normally to build up immunity to the virus through natural infection, while better protecting those who are at highest risk. We call this Focused Protection.

Adopting measures to protect the vulnerable should be the central aim of public health responses to COVID-19. By way of example, nursing homes should use staff with acquired immunity and perform frequent PCR testing of other staff and all visitors. Staff rotation should be minimized. Retired people living at home should have groceries and other essentials delivered to their home. When possible, they should meet family members outside rather than inside. A comprehensive and detailed list of measures, including approaches to multi-generational households, can be implemented, and is well within the scope and capability of public health professionals.

Those who are not vulnerable should immediately be allowed to resume life as normal. Simple hygiene measures, such as hand washing and staying home when sick should be practiced by everyone to reduce the herd immunity threshold. Schools and universities should be open for in-person teaching. Extracurricular activities, such as sports, should be resumed. Young low-risk adults should work normally, rather than from home. Restaurants and other businesses should open. Arts, music, sport and other cultural activities should resume. People who are more at risk may participate if they wish, while society as a whole enjoys the protection conferred upon the vulnerable by those who have built up herd immunity.” (C)

“Letting the coronavirus rip through the U.S. population unchecked to infect as many people as possible to achieve so-called herd immunity would cause a lot of unnecessary deaths and the idea is “nonsense” and “dangerous,” the nation’s top infectious disease expert said Thursday.

“I’ll tell you exactly how I feel about that,” Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said when asked about whether herd immunity is a viable strategy for the U.S. to adopt. “If you let infections rip as it were and say, ‘Let everybody get infected that’s going to be able to get infected and then we’ll have herd immunity.’ Quite frankly that is nonsense, and anybody who knows anything about epidemiology will tell you that that is nonsense and very dangerous,” Fauci told Yahoo News.

Herd immunity happens when enough of the population is immune to a disease, making it unlikely to spread and protecting the rest of the community, the Mayo Clinic says. It can be achieved through natural infection — when enough people are exposed to the disease and develop antibodies against it — and through vaccinations.

Most scientists think 60% to 80% of the population needs to be vaccinated or have natural antibodies to achieve herd immunity, global health experts say. However, the nation’s top health experts have said a majority of Americans remain susceptible to a coronavirus infection.

“With this idea of herd immunity, this is a phrase that’s used when you use vaccination. When you vaccinate a certain amount of the population to be able to protect the rest of the population that isn’t able to get that vaccine,” Maria Van Kerkhove, head of the World Health Organization’s emerging diseases and zoonosis unit, told CNN’s “New Day” on Thursday.

“Herd immunity as an approach by letting the virus circulate is dangerous, it leads to unnecessary cases and it leads to unnecessary deaths,” she said.

Despite those concerns, a senior White House official briefing reporters on a call Monday mentioned an online movement called the “Great Barrington Declaration,” which favors herd immunity, NBC News reported. Health and Human Services Secretary Alex Azar has previously said that herd immunity “is not the strategy of the U.S. government with regard to coronavirus.”..

“By the time you get to herd immunity you will have killed a lot of people that would’ve been avoidable,” he said.”  (D)

“If you just let things rip and let the infection go — no masks, crowd, it doesn’t make any difference — that quite frankly,… is ridiculous because what that will do is that there will be so many people in the community that you can’t shelter, that you can’t protect, who are going to get sick and get serious consequences,” Fauci said. “So this idea that we have the power to protect the vulnerable is total nonsense, because history has shown that that’s not the case. And if you talk to anybody who has any experience in epidemiology and infectious diseases, they will tell you that that is risky and you’ll wind up with many more infections of vulnerable people, which will lead to hospitalizations and deaths. So I think that we just got to look that square in the eye and say it’s nonsense.”

During a briefing Monday, World Health Organization director-general Tedros Adhanom Ghebreyesus called herd immunity “scientifically and ethically problematic.

“Never in the history of public health has herd immunity been used as a strategy for responding to an outbreak, let alone a pandemic,” Tedros said.” (E)

“The authors of the Declaration — a trio of scientists from Harvard, Stanford, and Oxford, whose views, we should say, are outside the mainstream — call their approach “focused prevention.” The big idea is that we could let the virus spread among younger, healthier people, all the while making sure we protect older, more vulnerable people…

And yet there are ample reasons to fear that this “focused prevention” strategy of allowing the young and healthy to get sick to build population immunity to the virus would never work. And it could cause devastating unintended consequences….

Let’s count the reasons why.

1) Even if we could limit exposure to the people least likely to die of Covid-19, this group still can suffer immense consequences from the infection — like hospitalization, long-term symptoms, organ damage, missed work, and high medical bills. The long-term health consequences of the virus have barely been studied. When we expose younger, healthier people to the virus (on purpose!), we don’t know what the consequence of that will be down the road.

2) We have a lonnnnnngggggg way to go. There’s no one, perfect estimate of what percentage of the US population has already been infected by the virus. But, by all accounts, it’s nowhere near the figures needed for herd immunity to kick in. Overall, a new Lancet study — which drew its data from a sample of dialysis patients — suggests that fewer than 10 percent of people nationwide have been exposed to the virus. No one knows the exact threshold percentage for herd immunity to kick in for a meaningful way to help end the pandemic. But common estimates hover around 60 percent.

So far, there have been more than 200,000 deaths in the United States. There’s so much more potential for death if the virus spreads to true herd immunity levels. “The cost of herd immunity [through natural infection] is extraordinarily high,” Hanage says…

3) Scientists don’t know how long naturally acquired immunity to the virus lasts or how common reinfections might be. If immunity wanes and reinfections are common, then it will be all the more difficult to build up herd immunity in the country. In the spring, epidemiologists at Harvard sketched out the scenarios. If immunity lasts a couple of years or more, Covid-19 could fade in a few years’ time, per their analysis published in Science (much too long a time to begin with, if you ask me). If immunity wanes within a year, Covid-19 could make fierce annual comebacks until an effective vaccine is widely available.

At the same time, we don’t know how long immunity delivered via a vaccine would last. But, at least a vaccine would come without the cost of increased illnesses, hospitalizations, and long-term complications.

If immunity doesn’t last, “such a [focused prevention] strategy would not end the COVID-19 pandemic but result in recurrent epidemics, as was the case with numerous infectious diseases before the advent of vaccination,” the John Snow Memorandum says.

4) By letting the pandemic rage, we risk overshooting the herd immunity threshold. Once you hit the herd immunity threshold, it doesn’t mean the pandemic is over. After the threshold is reached, “all it means is that, on average, each infection causes less than one ongoing infection,” Hanage says. “That’s of limited use if you’ve already got a million people infected.” If each infection causes, on average, 0.8 new infections, the epidemic will slow. But 0.8 isn’t zero. If a million people are infected at the time herd immunity is reached, per Hanage’s example, those already infected people may infect 800,000 more.

There are a lot of other unknowns here, too. One is the type of immunity conferred by natural infection. “Immunity” is a catchall term that means many different things. It could mean true protection from getting infected with the virus a second time. Or it could mean reinfections are possible but less severe. You could, potentially, get infected a second time, never feel sick at all (thanks to a quick immune response), and still pass on the virus to another person.” (F)

“Experts from a wide range of fields have repeatedly denounced the lack of testing in the United States. Despite Mr. Trump’s repeated affirmations that the country has done more testing than any other nation, researchers have noted that 991,000 or so tests done each day were still not enough to keep in check a virus that has infected more than eight million people nationwide. Tests can individually diagnose people who might unknowingly carrying the virus. At the population level, they can also help health officials monitor any spread and pinpoint and quash outbreaks before they spin out of control.

Others have cautioned against an overreliance on testing as a preventive measure, noting that, in the absence of standards like physical distancing and mask wearing, testing alone cannot fully contain a virus that spreads wherever people tend to gather, regardless of whether those infected are exhibiting symptoms.

“No testing scheme, no test is perfect. There will always be people who go undetected,” said Dr. David Dowdy, an infectious disease epidemiologist at Johns Hopkins University who has researched and written about herd immunity. “The best way to protect the most vulnerable is to reduce the amount of virus that’s in the population that can get through all of those testing schemes and cause destruction.”

Dr. Atlas’s position has been challenged by medical advisers around him who have backgrounds in infectious disease response, revealing a significant rift in the White House over the right approach. Dr. Deborah L. Birx, the White House’s coronavirus response coordinator, has pushed for aggressive, broad testing even among young and healthy people, often clashing with Dr. Atlas in meetings.

“I would always be happy if we had 100 percent of students tested weekly,” Dr. Birx said on Wednesday in an appearance at Penn State University, “because I think testing changes behavior.”

Dr. Atlas at one point influenced the administration’s efforts to install new Centers for Disease Control and Prevention guidance that said it was not necessary to test people without symptoms of Covid-19 even if they had been exposed to the virus, upsetting Dr. Birx and Dr. Robert R. Redfield, the C.D.C. director….

Mr. Romer said… “Atlas just responded in a way that just honestly made it seem like he was in over his head,” … (G)

“A group of 80 researchers warn that a so-called herd immunity approach to managing COVID-19 by allowing immunity to develop in low-risk populations while protecting the most vulnerable is “a dangerous fallacy unsupported by the scientific evidence”…

The open letter, referred to by its authors as the John Snow Memorandum, is published today by The Lancet. It is signed by 80 international researchers (as of publication) with expertise spanning public health, epidemiology, medicine, paediatrics, sociology, virology, infectious disease, health systems, psychology, psychiatry, health policy, and mathematical modelling [1]. The letter will also be launched during the 16th World Congress on Public Health programme 2020.

They state: “It is critical to act decisively and urgently. Effective measures that suppress and control transmission need to be implemented widely, and they must be supported by financial and social programmes that encourage community responses and address the inequities that have been amplified by the pandemic.”

“Continuing restrictions will probably be required in the short term, to reduce transmission and fix ineffective pandemic response systems, in order to prevent future lockdowns. The purpose of these restrictions is to effectively suppress SARS-CoV-2 infections to low levels that allow rapid detection of localised outbreaks and rapid response through efficient and comprehensive find, test, trace, isolate, and support systems so life can return to near-normal without the need for generalised restrictions. Protecting our economies is inextricably tied to controlling COVID-19. We must protect our workforce and avoid long-term uncertainty.”…

They explain that uncontrolled transmission in younger people risks significant ill-health and death across the whole population – with real-world evidence from many countries showing that it is not possible to restrict uncontrolled outbreaks to certain sections of society, and it being practically impossible and highly unethical to isolate large swathes of the population. Instead, they say that special efforts to protect the most vulnerable are essential, but must go hand-in-hand with multi-pronged population-level strategies…

The authors also warn that natural infection-based herd immunity approaches risk impacting the workforce as a whole and overwhelming the ability of healthcare systems to provide acute and routine care. They note that we still do not understand who might suffer from ‘long COVID’, and that herd immunity approaches place an unacceptable burden on healthcare workers, many of whom have died from COVID-19 or experienced trauma as a result of having to practise disaster medicine.

The letter concludes: “The evidence is very clear: controlling community spread of COVID-19 is the best way to protect our societies and economies until safe and effective vaccines and therapeutics arrive within the coming months. We cannot afford distractions that undermine an effective response; it is essential that we act urgently based on the evidence.” (H)

“THE JOHN SNOW MEMORANDUM

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected more than 35 million people globally, with more than 1 million deaths recorded by the World Health Organization as of Oct 12, 2020. As a second wave of COVID-19 affects Europe, and with winter approaching, we need clear communication about the risks posed by COVID-19 and effective strategies to combat them. Here, we share our view of the current evidence-based consensus on COVID-19….

In the initial phase of the pandemic, many countries instituted lockdowns (general population restrictions, including orders to stay at home and work from home) to slow the rapid spread of the virus. This was essential to reduce mortality(6),(7) prevent health-care services from being overwhelmed, and buy time to set up pandemic response systems to suppress transmission following lockdown. Although lockdowns have been disruptive, substantially affecting mental and physical health, and harming the economy, these effects have often been worse in countries that were not able to use the time during and after lockdown to establish effective pandemic control systems. In the absence of adequate provisions to manage the pandemic and its societal impacts, these countries have faced continuing restrictions.

This has understandably led to widespread demoralisation and diminishing trust. The arrival of a second wave and the realisation of the challenges ahead has led to renewed interest in a so-called herd immunity approach, which suggests allowing a large uncontrolled outbreak in the low-risk population while protecting the vulnerable. Proponents suggest this would lead to the development of infection-acquired population immunity in the low-risk population, which will eventually protect the vulnerable. This is a dangerous fallacy unsupported by scientific evidence….

We cannot afford distractions that undermine an effective response; it is essential that we act urgently based on the evidence.” (I)

Showdown: Great Barrington Declaration v John Snow Memorandum (J)

“The United States came into this crisis with enormous advantages. Along with tremendous manufacturing capacity, we have a biomedical research system that is the envy of the world. We have enormous expertise in public health, health policy, and basic biology and have consistently been able to turn that expertise into new therapies and preventive measures. And much of that national expertise resides in government institutions. Yet our leaders have largely chosen to ignore and even denigrate experts.

The response of our nation’s leaders has been consistently inadequate. The federal government has largely abandoned disease control to the states. Governors have varied in their responses, not so much by party as by competence. But whatever their competence, governors do not have the tools that Washington controls. Instead of using those tools, the federal government has undermined them. The Centers for Disease Control and Prevention, which was the world’s leading disease response organization, has been eviscerated and has suffered dramatic testing and policy failures. The National Institutes of Health have played a key role in vaccine development but have been excluded from much crucial government decision making. And the Food and Drug Administration has been shamefully politicized,3 appearing to respond to pressure from the administration rather than scientific evidence. Our current leaders have undercut trust in science and in government,4 causing damage that will certainly outlast them. Instead of relying on expertise, the administration has turned to uninformed “opinion leaders” and charlatans who obscure the truth and facilitate the promulgation of outright lies.” (K)

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  5. Лариса

    So long as we were protecting the truly vulnerable, a sense of calm could be restored to society. Just as important, society as a whole could develop natural herd immunity to the virus. The vast majority of people would develop mild coronavirus infections, while medical resources could focus on those who fell critically ill. Once the wider population had been exposed and, if infected, had recovered and gained natural immunity, the risk to the most vulnerable would fall dramatically.

  6. Алла

    So long as we were protecting the truly vulnerable, a sense of calm could be restored to society. Just as important, society as a whole could develop natural herd immunity to the virus. The vast majority of people would develop mild coronavirus infections, while medical resources could focus on those who fell critically ill. Once the wider population had been exposed and, if infected, had recovered and gained natural immunity, the risk to the most vulnerable would fall dramatically.

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