A compassionate covid strategy
The following is adapted from a panel presentation on Oct. 9 in Omaha, Neb., at a Hillsdale College Free Market Forum.
My goals are to present facts about: 1. how deadly covid-19 actually is; 2. who is at risk from covid; 3. how deadly widespread lockdowns have been, and 4. a shift in public policy. 1. The covid-19 fatality rate We need to distinguish covid cases from covid infections. A lot of fear and confusion has resulted from failing to understand the difference.
In early March, the case fatality rate in the U.S. was roughly 3 percent—nearly 3 out of every 100 people who were identified as “cases” of covid in early March died from it. Compare that to today, when the fatality rate of covid is known to be less than ½ of 1 percent.
When the World Health Organization said back then that 3 percent of people who get covid die from it, they were wrong. The fatality
rate is much closer to 0.2 or 0.3 percent. The reason for the inaccurate early estimates is simple: In early March, we were not identifying most of the people who had been infected by covid.
“Case fatality rate” is computed by dividing the number of deaths by the total number of confirmed cases. But to obtain an accurate fatality rate, the number in the denominator should be the number of people who have been infected—who actually had the disease—rather than the number of confirmed cases.
In March, only the small fraction of infected people who got sick and went to the hospital were identified as cases. But the majority who are infected have very mild symptoms or none at all. These people weren’t identified in the early days, which resulted in a misleading fatality rate. And that is what drove public policy.
It continues to sow fear and panic, because the perception is frozen in the misleading data from March.
So how do we get an accurate fatality rate? We test for seroprevalence to find out how many people have evidence in their bloodstream of having had covid.
This is easy with some viruses. Anyone who has had chickenpox, for instance, still has that virus living in them—it stays in the body forever. But covid, like other coronaviruses, doesn’t stay in the body. Someone who is infected with covid and then clears it will be immune from it, but it won’t still be living in them.
What we need to test for are antibodies or other evidence that someone has had covid. And even antibodies fade over time, so testing for them still results in an underestimate of total infections.
In April, I ran a series of studies using antibody tests to see how many people in California’s Santa Clara County, where I live, had been infected.
At the time, there were about 1,000 covid cases that had been identified in the county, but our antibody tests found that 50,000 people had been infected—there were 50 times more infections than identified cases. This was important because it meant that the fatality rate was not 3 percent, but closer to 0.2 percent; not 3 in 100, but 2 in 1,000.
The way science tests controversial studies is to see if they can be replicated. And there are now 82 similar seroprevalence studies from around the world, and the median result is a fatality rate of about 0.2 percent— exactly what we found in Santa Clara County.
In some places the fatality rate was higher: in New York City it was more like 0.5 percent. In other places it was lower: Idaho was 0.13 percent. What this variation shows is that the fatality rate is not simply a function of how deadly a virus is. It is also a function of who gets infected and of the quality of the health-care system.
In the early days of the virus, our health-care systems managed covid poorly. We pursued aggressive treatments, such as the use of ventilators, that in retrospect might have been counter-productive.
And in some places we needlessly allowed a lot of people in nursing homes to get infected.
But the bottom line is that the covid fatality rate is in the neighborhood of 0.2 percent.
2. Who is at risk?
The most important fact about the pandemic is that it is not equally dangerous for everybody. This became clear very early on, but for some reason public health messaging failed to get this fact out.
There is a thousand-fold difference between the mortality rate in older people, 70 and up, and the mortality rate in children. This year, in the United States, more children have died from the seasonal flu than from covid by a factor of two or three.
The covid fatality rate for people 70 and up is about 4 percent—4 in 100 among those 70 and older, as opposed to 2 in 1,000 in the overall population. 3. Deadliness of the lockdowns Lockdowns have never before been tried as a method of disease control. Nor were lockdowns part of the original plan. The initial rationale for lockdowns was that slowing the spread of the disease would prevent hospitals from being overwhelmed. It became clear before long that this was not a worry; in the U.S. and in most of the world, hospitals were never at risk of being overwhelmed. Yet the lockdowns were kept in place, and this is turning out to have deadly effects.
The U.N. has estimated that 130 million additional people will starve this year as a result of the economic damage resulting from the lockdowns.
In the last 20 years we’ve lifted one billion people worldwide out of poverty. This year we are reversing that progress.
Another result of the lockdowns is that people stopped bringing their children in for immunizations against diseases like diphtheria, pertussis (whooping cough), and polio, because they had been led to fear covid more than they feared these more deadly diseases. Eighty million children worldwide are now at risk of these diseases. We had made substantial progress in slowing them down, but now they are going to come back.
Large numbers of Americans, even though they had cancer and needed chemotherapy, didn’t come in for treatment. Others have skipped recommended cancer screenings. We’re going to see a rise in cancer and cancer death rates as a consequence. We’re also going to see a higher number of deaths from diabetes due to people missing diabetic monitoring.
In June, a CDC survey found that one in four young adults between 18 and 24 had seriously considered suicide. Human beings are not designed to live alone. We’re meant to be in company with one another. It is unsurprising that the lockdowns have had the psychological effects that they’ve had, especially among young adults and children, who have been denied much-needed socialization.
What we’ve been doing is requiring young people to bear the burden of controlling a disease from which they face little to no risk. This is entirely backward from the right approach.
4. Where to go from here Recently I met with two other epidemiologists—Dr. Sunetra Gupta of Oxford University and Dr. Martin Kulldorff of Harvard University—in Great Barrington, Mass. We come from very different disciplinary backgrounds and from very different parts of the political spectrum. Yet we arrived at the same view: The widespread lockdown policy has been a devastating public health mistake.
In response, we wrote and issued the Great Barrington Declaration, which can be viewed—along with explanatory videos, answers to frequently asked questions, a list of co-signers, etc.—online at www.gbdeclaration.org.
The Declaration in part reads: 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.
Current lockdown policies are producing devastating effects on short and long-term public health. The results 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.
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—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. 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. 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, sports, 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. ★ ★ ★ Herd immunity is not a strategy. It is a biological fact that applies to most infectious diseases. Even when we come up with a vaccine, we will be relying on herd immunity as an end point for this epidemic. We know the people who are vulnerable, and we know the people who are not vulnerable. To continue to act as if we do not know these things makes no sense.
When scientists have spoken up against the lockdown policy, there has been enormous pushback: “You’re endangering lives.” Science cannot operate in an environment like that. I don’t know all the answers to covid; no one does. But science can’t do its job in an environment where anyone who challenges the status quo gets shut down or canceled.
To date, the Great Barrington Declaration has been signed by over 43,000 medical and public health scientists and medical practitioners. The Declaration thus does not represent a fringe view within the scientific community. This is a central part of the scientific debate, and it belongs in the debate. Members of the general public can also sign the Declaration.
Together, I think we can get on the other side of this pandemic. But we have to fight back. We should respond to the covid virus rationally: Protect the vulnerable, treat the people who get infected compassionately, develop a vaccine.
And while doing these things, we should bring back the civilization that we had so that the cure does not end up being worse than the disease.
Jay Bhattacharya is a Professor of Medicine at Stanford University, a research associate at the National Bureau of Economics Research, and a senior fellow at the Stanford Institute for Economic Policy Research and at the Stanford Freeman Spogli Institute.
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