Protecting the vulnerable is not impossible

It’s not a herd immunity strategy, but the way we have dealt with health dangers for centuries

The Great Barrington Declaration has been the focus of intense debate by scientists and policymakers worldwide. The plan itself calls for focused protection – a return to standard public health practice – in addressing the Covid-19 epidemic. My co-signatories and I call for devoting overwhelming resources to the aim of protecting the vulnerable, while lifting lockdowns on the rest of the population, who face greater health dangers from lockdowns than they do from the virus itself.

We have heard several common counter-arguments. Prominent critics, including Dr Anthony Fauci, director of the US National Institute on Allergy and Infectious Diseases, have mischaracterised the plan as actively promoting Covid infection among the non-vulnerable – colourfully but incorrectly describing the strategy as “let[ting] things rip”.

This is a false characterisation. Focused protection is a central tenet – we must not let vulnerable people be exposed to the virus. We do not encourage intentionally exposing the non-vulnerable. Those who choose to continue to restrict their activities will be free to do so. The focused protection strategy is the standard way that societies have dealt successfully with previous epidemics.

While it is true that permitting the non-vulnerable to live their lives normally may lead to a rise in cases, they face a very low risk of mortality from Covid. It is in the order of five deaths per 10,000 infections – similar to the risk of a deadly traffic accident from driving to work every day. Though some may fear long-term harm from infection, evidence has not established that this is common or permanent.

Similarly, it is inaccurate to characterise the focused protection plan as a “herd immunity strategy”. Herd immunity is the natural end point with many infectious diseases and will occur with Covid-19 eventually, regardless of the policies adopted. A policy of lockdown while waiting for a vaccine, for instance, depends on the establishment of herd immunity.

Matt Hancock, the Health Secretary, argued in the House of Commons that achieving population immunity to Covid-19 is impossible. This is flatly incorrect. The development of immunity through natural infection is a common feature of many pathogens. It is reasonable to assume that Covid-19 does not have any tricks up its sleeve to prevent this from happening – it would pose a very serious problem for the development of a vaccine if it did. Even if infection does not provide lifelong personal immunity, it is a biological fact that herd immunity is the inevitable outcome of this epidemic, regardless of the strategy we adopt.

Is it genuinely possible to shield the vulnerable from infection without limiting the number of cases among the non-vulnerable? Well, lockdown policies have done a poor job of protecting the vulnerable so far. Failures include requiring “essential” workers to be put in situations where they may be exposed to the virus, failing to protect nursing home residents from exposure to the virus, and making no provision for elderly people living in multi-generational homes to be shielded, should a family member be exposed to the virus.

The declaration provides some concrete ideas to fix those problems. They include a stringent testing programme in nursing homes, the provision of free N95 masks for the vulnerable who cannot avoid potential exposure, the sequestering of care home residents who have Covid-19, the application of workplace disability laws to require employers to protect vulnerable workers, providing food delivery for vulnerable people isolating at home, and the provision of rapid testing and temporary alternative living arrangements for elderly people in multi-generational homes. It is within the capacity of creative public health officials to innovate. That the lockdown status quo has not done so is not evidence that it is impossible.

Lockdowns delay the time until herd immunity occurs and will result in unnecessary suffering and death for vulnerable and non-vulnerable alike. A focused protection approach will save lives in both the short and long term. My declaration co-signers and I urge governments worldwide to adopt it.