Cost much too high for ‘herd immunity’

As the covid-19 pandemic continues, millions of Americans are increasingly impatient for the economy and society to regain a more normal footing. Some “maverick scientists” with “an audience inside the White House,” as The Washington Post reported, argue for “allowing the coronavirus to spread freely at ‘natural’ rates among healthy young people while keeping most aspects of the economy up and running.”

Their aim is to achieve “herd immunity,” the concept that if enough people are immune, those without immunity can be protected. Usually this refers to immunity gained from vaccination; the goal of herd immunity has typically not been applied to a disease for which there is no vaccine.

There is a saying that for every complicated problem, a solution exists that is quick, simple — and wrong. That applies here: Pursuing herd immunity is the wrong, dead wrong, solution for the pandemic. Discussing such a reckless approach shouldn’t be necessary, except that it echoes the misguided ideas of neuroradiologist Scott Atlas, who in recent months has become an influential medical adviser to President Donald Trump.

Less than 15% of Americans have been infected by the virus that causes covid-19. If immunity among those who have been infected and survived is strong and long-lasting (and it may well be neither), and if herd immunity kicks in at 60% infection of the population (it might be higher), then with a fatality rate of 0.5% among those infected, at least another half-million Americans would have to die for the country to achieve herd immunity. And that’s the best-case scenario.

The route to herd immunity would run through graveyards filled with Americans who did not have to die, because what starts in young adults doesn’t stay in young adults. “Protecting the vulnerable,” however appealing it may sound, isn’t plausible if the virus is allowed to freely spread among younger people. We’ve seen this in families, communities and entire regions of the country. First come cases in young adults. Then the virus spreads to older adults and medically vulnerable people. Hospitalizations increase. And then deaths increase.

The vulnerable are not just a sliver of society. The 65-and-over population of the United States in 2018 was 52 million. As many as 60% of adults have a medical condition that increases the risk of death from covid-19 — with many unaware of their conditions. The truth is that we cannot protect the vulnerable without protecting all of us.

A one-two punch is needed to knock out the virus — a combination approach, just as multiple drugs are used to treat infections such as HIV and tuberculosis. That, in turn, will allow the accelerated resumption of economic and social activity.

First, knock down the spread of the virus. The best way to do this is — as the country has been trying to do, with uneven success — to reduce close contact with others, especially in crowded indoor spaces with poor ventilation. Wear a mask, watch your distance and wash your hands (or use sanitizer). Where restrictions have been loosened, track early-warning triggers and activate strategic closures to prevent an explosive spread.

Second, box the virus in to stop cases from becoming clusters and to keep clusters from becoming outbreaks. The sooner people who are infectious get isolated, the fewer secondary cases there will be. That means rapid testing and rapid action when tests are positive. Close contacts need to be quarantined so that if they develop infection, the chain of transmission will stop with them.

A safe and effective vaccine may become available in the coming months — or it may not. Yet even if it were widely administered, it wouldn’t end the pandemic. If a vaccine that’s 70% effective is taken by 70% of people — both optimistic estimates — that leaves half of the population unprotected.

Although there’s no quick fix, this pandemic will end one day. In the interim, there are actions that individuals, families and communities across the country can take to reduce risk. The sooner the virus is under control, the quicker and more complete the recovery will be.

Frieden, a physician, is president and CEO of Resolve to Save Lives, an initiative of the global public health organization Vital Strategies, and former director of the Centers for Disease Control and Prevention.