Part I: the intro here.
Here’s my fact check of Dr Swaminathan’s piece. The article is indented, my comments in purple, flush left.
As global struggle to contain Covid-19 continues and pandemic fatigue sets in, some are advocating for a so-called natural herd immunity strategy, which they argue can be safely achieved through “focused protection”.
PF: “Focused protection” is the term used in the Great Barrington Declaration (GBD). I think using the word “safely” is a bit straw-mannish. The GBD argues that it’s a matter of balancing risk and that lockdowns kill and harm more people than they save.
This concept entails fully reopening societies while shielding the elderly and people with comorbidity to achieve herd immunity in the absence of a vaccine within six months. It sounds simple, but the facts tell us otherwise.
PF: The “facts” such as they are, consist of the differences between those counties or states that have locked down stringently and those that haven’t. In the latter the poster-nation is Sweden, where figures of deaths per capita suggest precisely this, namely that they have achieved, or are close to achieving, herd immunity. There is also evidence from US States, where the poster-State is Florida, with death rates dramatically lower than strict lockdown states like New York.
First, herd immunity is achieved by protecting people from a virus with the use of a vaccine, not by exposing them to it. For example, herd immunity against measles requires about 95 per cent of people to be vaccinated.
PF: Dr Swaminathan is lecturing the GBD authors in the meaning of “herd immunity”! I’m sure they are very clear on how it is achieved. They are, after all, renowned epidemiologists at Harvard, Oxford and Stanford medical schools. Look up of “herd immunity” gives the screenshot below. Decide for yourself whether Dr Swaminathan’s statement is correct or not (strictly, it is not). Click to enlarge and clarify.
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| Note the last sentence “the level of vaccination varies by disease” |
Once immunised against measles, they act as a protective buffer preventing the virus from circulating and infecting the remaining 5 per cent of the population who are unvaccinated.
Second, we are nowhere close to the levels of immunity required to stop this disease transmitting. We know from seroepidemiology studies that less than 10 per cent of the global population has shown evidence of infection. That means the vast majority of people are still susceptible to the Sars-CoV-2 virus.
To achieve herd immunity for Sars-CoV-2, it is estimated that at least 60 to 70 per cent of the global population – more than 5 billion people – would need to have had the infection, which, in the absence of a vaccine, may take years.
PF: Some epidemiologists believe the immunity for Covid-19 may be as low as 20% of the population. There is no settled science to support her statement that “60 to 70 per cent” need to have been infected to reach herd immunity, or that “the vast majority of people are still susceptible…”.
Furthermore, as with other coronaviruses, reinfection cannot be ruled out, exposing people to disease again and again. Cases of reinfection have already been reported.
PF: Yes “cases [of reinfection] have already been reported”. The question is how many and what do they mean. So far, they are so few that each one warrants a report in the press. A few individual reinfections in 38 million cases is — according to epidemiologists — not unusual and happens with many viral diseases. Lancet: What reinfections mean
Third, letting the virus spread through populations unchecked would have devastating consequences for communities and health systems.
Far too many people would develop severe disease and die, hospitals would be overwhelmed with the influx of patients – particularly as flu season takes off in the northern hemisphere – and communities would be ravaged by the sheer number of people in need of care.
PF: Straw-man argument: the GBD is not talking of letting the virus spread unchecked. “Letting it rip” as Boris says. The GBD talks of checking it most closely amongst the most vulnerable. And suggesting to the rest they mask, disinfect, and distance, while they go about business as usual. (It’s also an ipse dixit statement, esp the second para).
We also have no idea how many people will suffer the debilitating impacts of post-Covid syndrome or for how long. Many people describe suffering from months of persistent fatigue, headaches, “brain fog” and trouble breathing.
PF: I suffer ‘persistent fatigue, headaches, “brain fog”’ from jet lag….seriously, though, the question again is how many and for how long?
Other serious conditions from being sick with Covid-19 – such as physical and cognitive limitations, psychiatric problems and issues with the lungs, heart and brain – are being reported.
Fourth, it is a mistake to believe the virus only severely affects older people and those with underlying conditions. Research has shown that mortality increases significantly with age, but many young people with no underlying health conditions have developed severe disease and died. At the peak of Italy’s outbreak, up to 15 per cent of all people in intensive care were under 50.
PF: This is a flat out distortion. A most unhelpful one as it only adds to the panic and paranoia. The fact remains that since the beginning, in China, this has been a disease that kills old people. They are between 1,000 times (70+) and 10,000 times (80+) more likely to die than young people. The fact that some young people are seriously ill, and some die, is to be expected. But the vast majority dying were, and are, the elderly.
Finally, how would this theoretical “focused protection” play out in the real world? Governments are already encouraged to protect high-risk groups as part of a raft of public health measures that are only effective when applied together. Choosing a single intervention with disregard for the realities of local transmission would be unwise, ineffective and deadly.
PF: Another straw man that misrepresents the GMD position. They do not discount multiple measures to control the virus, but urge focus so that the whole economy and health of the younger cohort is not damaged, perhaps irreparably, and certainly long term.
As WHO director-general Tedros Adhanom Ghebreyesus has said, it is not a choice between letting the virus run free and shutting down our societies. This virus transmits mainly between close contacts and causes outbreaks that can be controlled by implementing targeted measures.
Rather than wasting precious resources discriminating against high-risk groups, we should focus on going after the virus. Through robust testing and contact tracing, we can know precisely where the virus is circulating and clamp down on it with the tried and tested public health measures we are all now familiar with, including isolation of cases and quarantine of contacts.
PF: Why say “discriminating” again the high-risk group? This seem unnecessarily pejorative. The act of offering protection to the elderly (not mandatory) and shielding the front-line staff, with frequent testing, seems to make perfect sense. It does to the highly credentialed authors of the GBD. And it does to me. It’s not “discrimination” for goodness sake, but simply putting in place the “tailored intervention” that she argues for in the very next para....
By tailoring interventions to local contexts and targeting disease clusters, we can avoid punishing national lockdowns that are blind to variations in community transmission.
By informing individuals about how they might protect themselves and their loved ones, we can reduce the disease burden. We have seen this approach succeed in many countries.
It is hard work, but we have new and better tools than we did nine months ago. For example, we have better-trained and equipped health workers in many countries, better diagnostics and treatment options and digital applications which help with contact tracing and patient information.
Governments everywhere must take decisive action to suppress transmission, reduce mortality and empower communities to take the action they need to protect themselves.
Public health authorities must connect with the communities they serve to understand the barriers they face and try to resolve them.
PF: Agree. This is pretty much what the GBD advocates with its “focused protection”. Yet this very statement is at odds with the tenor of the rest of the article, which argues for “a raft of public health measures” and calls for more “hard work” “isolations” and “quarantines”. Not hard to see that to a government keen on being seen to “do something” this reads as a call to lockdown.
Governments need to shore up their health systems to enable them to respond to all health needs, and they must invest in developing the diagnostics, therapeutics and vaccines that can help us bring this pandemic to a close. There are currently more than 200 vaccine candidates, with several in the final stage of clinical trials.
We could have limited supplies of an efficacious Sars-CoV-2 vaccine available as early as next year. When that happens, we can realistically and safely strive for herd immunity. Until then, we have to outsmart this virus by understanding where and how it spreads and not giving it a chance to do so.
~ Dr Soumya Swaminathan is chief scientist of the World Health Organisation
PF: Overall, I don’t think there is all that much difference between the GBD proposals and at leas some of what’s said by Dr Shaminathan. So why does she need to attack them, as expert a group of people on the virus as one could find? She ought to be trying to find common ground with them. Writing like this does nothing for the WHO.
