Sorting Medical Fact from Fiction, Part III: Give Me Liberty AND Give Me Death

Patients have been asking me about “herd mentality,” which they then quickly correct to “herd immunity.” Herd mentality we’ve got plenty of. Herd immunity, not so much. In fact, it’s unclear whether widespread, lasting natural immunity to COVID-19 is even a biological possibility. It may turn out to be only a mirage.

But as the pandemic drags on and we are all getting weary, some of us are worn down enough to entertain some pretty crazy notions– or to take cynical advantage of our weariness.

The Great Barrington Declaration came out on October 4, made a splash, and is still being talked about. This is a letter which calls for letting the virus essentially run wild among the younger and healthier members of the population, in order to bring about a theoretical herd immunity, while in some way protecting those who are at high risk. It’s named for Great Barrington, Massachusetts, where it was written, not because it is actually great in any way.

This declaration amounts to magical thinking. It has irresponsibly injected more confusion into an already uncertain situation. It has made the already impossible jobs of public health workers and health care providers that much harder. And yet, some people have been taken in, even some in my own profession.

Although I wouldn’t usually use Wikipedia as a reference, in this case they have an excellent overview of the document, the responses to it, and the issues involved.
https://en.wikipedia.org/wiki/Great_Barrington_Declaration

If that’s TL;DR, here’s a simpler summary:
https://news.yahoo.com/white-house-backed-great-barrington-142700156.html?guccounter=1

The declaration is such utter balderdash (insert less polite term here) in so many ways that it’s amazing it’s gotten as far as it has. You can read all about the objections to it if you wish. I’ll give you a sketch to save you some time:
— Many younger people are immune-compromised or have conditions like asthma, diabetes or obesity, putting them at higher risk of severe COVID-19. With moderate overweight now added to the list of underlying conditions that matter, it’s been estimated that about 72% of Americans fall into the high-risk category!

— It is unrealistic at best, and likely impossible, to try to separate younger and older people. Even in nursing homes, the staff is largely composed of younger workers, and obviously they must go home to their families and come back. More generally, a great many people live in multigenerational extended families. The latest figures I’ve found, from 2018, put the number at over 20% of the US population, and growing.

— Even if we have sufficient hospital beds to manage out-of-control numbers of cases, we don’t have enough skilled staff to provide care. The avalanche of cases that would be likely to result from the Great Barrington non-strategy would be impossible to care for.

If these points haven’t convinced you, listen to a group of virologists, starting here at about 50 minutes in:

https://www.microbe.tv/twiv/
https://www.youtube.com/watch?v=8IjXzadiNaA&feature=emb_logo

As I write this, New Mexico is reeling from an unprecedented surge in cases, bigger than anything seen last spring at what we thought was the height of the pandemic. Much of the world is in far worse shape than a month ago. No one is sure why this has happened, when only a few short weeks before we seemed well on the way toward beating this thing.

The doctor who was interviewed in the TWiV segment above expressed the theory that having schools open encouraged a premature feeling that everything could go back to normal. He described an 80-year-old woman in his hospital who had caught the virus at her grandson’s birthday party. It was bad enough that 20 kids and their parents got together at all, but then it rained heavily and everyone crowded inside. Without masks.

To the Great Barrington people, that birthday party would have been fine. They wouldn’t have invited Grandma, I suppose, but they would have let the kids and parents infect each other freely. One might wonder what the motivation would be for such shortsighted idiocy. It turns out that the declaration came from a libertarian think tank funded by the Koch brothers. But even if one sympathizes with the libertarian objection to any kind of government control, ending current restrictions makes no practical sense. The longer people go around spreading infection, the longer it will be till the virus is damped down and we can get back to our lives and livelihoods. Which is what libertarians and everyone else would seem to want.

But political philosophies will be moot if it turns out that lasting natural immunity doesn’t happen, and it’s looking like that is the case. Back in the spring, I was thinking more like the libertarians, that it might be ideal to catch a mild case, become immune, and move on. That was before anyone realized the potential for long-term damage— and before we started getting reports of reinfections.

While there are not many known cases so far, there are definitely people who have had COVID-19, recovered, and later been infected with a different strain. We know this because the genomes of various strains have been sequenced, so they can easily be distinguished from each other. Worse, some of the patients became more severely ill the second time, and one died. The previous infection appeared to offer no protection. We don’t know what factors influenced any of this. We aren’t yet sure of the role of innate immunity (not mediated by antibodies). We can’t yet predict how long antibodies to SARS-CoV-2 last. We’re pretty sure it’s not more than a matter of months, though.

This is terrible, vexing news, but it’s not unexpected. The common cold coronaviruses can return to torment us again and again. The same goes for flu. And those are diseases that our bodies already know how to recognize, not a new one that’s hit us out of the blue.

That leaves us in need of a vaccine.

I’m not thrilled to say that, since all vaccines entail some level of risk, and not all are very effective— and a vaccine, even if it’s an especially good one, is not going to solve all our pandemic problems. But I would like to ask you to think clearly about where we are in terms of a potential vaccine and what we are likely to get.

In our current low-trust environment, it’s understandable that a lot of people are leery of accepting a new vaccine that may have God knows what side effects. I don’t want to be among the first to try any kind of medication, myself; I’d rather let some time go by and see if problems crop up. But some people in my profession have been insisting that they aren’t going to take any COVID vaccine, no way no how. Although I’m not gung-ho about vaccines, I don’t see the logic in deciding for or against taking something before one has any information about it. A great many vaccines are in development. They have different characteristics. Some will no doubt prove to be safer than others, and some more effective than others.

More on that next time.