Author’s Note: This post presents what I believe to be logical extensions of claims made by the epidemiologists, virologists, and statisticians herein cited. They appear to me to be very authoritative. Not having expertise in those fields, I cannot certify their accuracy, and my interpretation of what they said could be faulty. Nevertheless, if those experts and my interpretations and analysis are correct, the following discussion is critical in our efforts to protect the vulnerable and minimize economic damage from COVID-19. Spoiler alert, it is very different from the mainstream narrative.
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Let’s sort out some of the problems concerning the mainstream messaging about COVID-19 that causes the public to believe that rising numbers of infection is bad and that a steady or falling number of infections will lower the number of people who eventually die from COVID-19. That messaging is non-scientific and is slowing the rate at which the country can get back to business, which is counterproductive. Let’s call it “The Herd Immunity Messaging Problem.”
Society should do what can reasonably be done to protect the people who are likely to be seriously harmed or killed by COVID-19. As discussed in earlier posts and below, no countries are doing a good job of protecting those people. New York Governor Cuomo presented a chart of data collected over the most recent several days showing from where hospitalized people came.
As you can see, 66% of people had come from home and 12% came from nursing homes and assisted living facilities. Clearly, lockdowns are not foolproof and people are not safe at home. Yet the “STAY AT HOME” messaging that was devised based on what was feared about a virus the designers knew little. The designers who constantly say, “we need more data” are simultaneously confessing that their plan was not based on the needed data. Let’s sort out the problems with staying on message after contradicting data has been collected.
THE ULTIMATE GOAL OF NONPHARMACUTICAL INTERVENTIONS (“NPI”)
When no one in a population has been infected, the vast majority of people on whom the virus lands are vulnerable to infection. NPI (stay at home, protective gear, washing hands, etc.) lowers the odds of infection some, but far from completely. In the early stages of a pandemic, anyone infected will likely pass the virus on to multiple other people, each of whom will likely infect multiple other people. That process creates exponential growth of infection (“the wave”), a normal feature of pandemics. Not long after becoming infected, almost everyone becomes immune to the virus or dies.[i] However, as the immune share of a population increases, paths to vulnerable people become more blocked by immune people who will kill the virus instead of passing it on. If enough people get infected,[1] the odds the virus can find a path through the multiple blocked paths to a vulnerable person becomes slim that the virus can no longer find enough new victims to sustain itself. That level of infection in a population is called “herd immunity.”
“With all respiratory diseases, the only thing that stops the disease is herd immunity.”[ii] Consequently, achieving herd immunity should be the ultimate goal in the battle against COVID-19.[iii] The virus will continue to infect more people until herd immunity stops it. Perforce, any location that has not yet achieved herd immunity needs more infections. Yet the public has been led to believe that more infections are bad. Houston, We have a Herd Immunity Messaging Problem!
“Flattening the curve” has been a big part of the mainstream narrative. However, flattening the curve is not a tool to achieve herd immunity. On the contrary, it slows progress toward that ultimate goal. In theory, flattening the cure can save a few lives, but it also causes many problems, including serious illness and deaths. (See Part I, Part II, and PART III.) We are told to “listen to the experts,” but some epidemiologists say NPI will have little effect on the total COVID-19 deaths any country is destined to have,[iv] while others say the NPI in most places turned out to have been a huge mistake.[v]
Flattening the curve can help prevent hospitals from being overwhelmed. Otherwise, as Knut Wittkowski, previously the longtime head of the Department of Biostatistics, Epidemiology, and Research Design at the Rockefeller University in New York City, put it:
“[W]hat people are trying to do is flatten the curve. I don’t really know why. But, what happens is if you flatten the curve, you also prolong, to widen it, and it takes more time. And I don’t see a good reason for a respiratory disease to stay in the population longer than necessary…”[vi]
Stated differently: Flattening the curve with NPI when and where hospitals are not at risk of being overwhelmed is putting off the inevitable and putting the vulnerable more at risk. As it turned out,[2] flattening the curve in most places wasted the opportunity to achieve herd immunity sooner. (For example, Sweden, which had relatively mild NPI, appears to be closer to herd immunity than other industrialized countries.[vii]) Social distancing by young healthy people has similar effects, but its tradeoffs are not quite as negative. For very old people and people with problematic preexisting conditions, social distancing likely remains a prudent course.
Mainstream messaging has been illogical concerning herd immunity. For example, when the mainstream media asks, “Sweden And Herd Immunity: Simple Math Or Plain Madness?” it does not provide an answer. It merely mentions a large number of deaths that might ensue and says something like:
Set aside the fact that, based on recent studies and models, the 1% estimate is wildly too high. Focus on how the 60,000 deaths say nothing about the effectiveness of Sweden’s approach. The real issue concerning total deaths is: Will the ultimate death toll at the end of the pandemic be higher or lower with aggressive this NPI, that NPI, or no NPI? The above media “argument” for aggressive NPI ignores the possibility that Sweden’s ultimate COVID-19 mortality rate could be among the lowest in the world. Why? NPI is designed to manage the wave, not the ultimate number of deaths. Judging a country’s NPI regime when less than 10% of the country’s population has been infected is like taking a snapshot of a horse race before the first turn is reached. Well-respected epidemiologists believe that all the “horses” will “cross the finish line” in a fairly tight pack, i.e., differences in aggressiveness of NPI will have little impact on the ultimate number of deaths in a country.[viii] Worse, comparing the death rates of countries with very different percentages of immune people is either fear-mongering or ridiculous.
Easing NPI in a way that facilitates the invulnerable ninety-plus percent of the population contracting the virus would not be a perfect approach to the problem. No approach to COVID-19 damage mitigation will be. But no one knows that such a policy is not the best available and many epidemiologists believe that it is. Moreover, it is not as reckless as many believe. For the tiny fraction of young and healthy people who have severe symptoms, aggressive NPI will not necessarily save them and it will hurt them.[ix] If people are to get infected, it is likely best to get those problems behind them while the economy is relatively shut down than after they are back at work. In addition, those young and healthy people who are ultra-vulnerable to COVID-19 are extra susceptible to being adversely affected by the virus in any event.
Having the presence of mind to know at every instant what you must do to follow NPI (e.g., never absent-mindedly touch your face between hand washing) is nearly impossible. Can everyone stay 6’ apart from others everywhere and always? They will need eyes in the back of their heads and be quick. We must touch things that may be infected with COVID-9. For example, are you sure no one touched or coughed on your car door handle while you were in the store? Over an extended period of attempts to disinfect, spots teeming with COVID-19 will inevitably be missed. In short, the odds that people can avoid contact with COVID-19, are practically zero. (Cuomo’s chart bears this out.)
We are serious when we say “we must protect the vulnerable.” But, between now and when a vaccine can be deployed, vulnerable people in nursing homes and elsewhere will need multiple shifts of attendants, and contact with nurses, doctors, food and supply vendors, administrators, security people, maintenance people, repairmen, and others frequently entering the complex. If any of them are infected, the virus is on the inside. People inside will receive food, mail, supplies, and other items that may have COVID-19 on the outside of the package or on its contents. The odds that all of those people and materials will be 100% COVID-19-free 100% of the time is zero. Proof of this is born out by the statics that is coming in from around the world showing that nursing homes are often not able to keep the virus out. As Professor Johan Giesecke, MD, Ph.D. said about nursing homes, “We all fail…everywhere in Europe.”[x]
As illustrated in Cuomo’s chart above, a similar, if not worse story applies to people “sheltering” at home. In short, time is not on the side of vulnerable people. The longer we go without herd immunity, the greater the odds that COVID-19 will find its way to venerable people. As more and more people become infected, the more those odds favor the vulnerable. With herd immunity being the only way to stop the virus, the sooner herd immunity is reached, the better.
The mainstream messaging on infections is that more infections are bad. That bad messaging is a huge problem as states start easing NPI. Easing will cause COVID-19 infections to rise for a while. The mainstream response that the rising infection rate is proof that the NPI easing was a mistake is the opposite of the truth and highly counterproductive. So long as hotspots are managed so as to prevent overwhelmed hospitals, many benefits will flow from a rising infection rate. Among the benefits are increasing protection for the sheltered vulnerable and, if the messaging is done correctly, faster economic improvement. Serendipitously, human health concerning non-COVID ailments and human flourishing will improve as well.
The herd immunity messaging problem is that the mainstream media can, and probably will unnecessarily and tragically continue to misinform, confuse, and scare people with negligible risk of harm from the virus into staying at home. Let’s do what we can to help the vulnerable by changing that narrative.
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Caveat Emptor. I feel compelled to repeat, the above observations and claims are not made by an epidemiologist, virologist, or statistician. Therefore, they may be wrong. However, if they are wrong, it is incumbent on those who are “informing” the public to explain why these logical extensions of what is being said are wrong. Otherwise, we will all reap the calamitous harvest of the confusion they are sowing.
UPDATE: During an interview with Mark Levin, Yale’s Dr. Katz captured susinctly the essential point of this post: “The Fauci and Birx practice of flattening the curve doesn’t stop people from dying, it simply changes the date of their death.”
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[1] Generally, viruses require between 50% and 80% of the population to be infected, but no one can know the percentage necessary for COVID-19 to fade away to insignificance.
[2] I’m not faulting lockdown decisions made in a panic with little information, much of which was bad. All decisions are made without all the knowledge one would like.
[i] With COVID-19, the death rate is heartbreakingly large and statistically very small. Most who die of COVID-19 had deadly diseases before they were infected. “Nearly All Patients Hospitalized With Covid-19 Had Chronic Health Issues, Study Finds:” “Only 6 percent of patients at one New York area health system had no chronic conditions… [and] and most — 88 percent — had at least two.”
https://21stcenturywire.com/2020/05/01/coronavirus-epidemiologist-dr-knut-wittkowski-lockdown-has-no-benefit-only-negative-effects/[ii] “Epidemiologist Dr Knut Wittkowski: ‘Lockdown Has No Benefit, Only Negative Effects’”
[iii] “Nobel prize winning scientist Prof Michael Levitt: lockdown is a ‘huge mistake’” @11:56 and id.
[iv] “Why lockdowns are the wrong policy – Swedish expert Prof. Johan Giesecke.” @12:11
[v] “Swedish Epidemiologist Johan Giesecke: Why Lockdowns Are The Wrong Policy”
[vi] “Epidemiologist: Ending lockdown is quickest way to ‘exterminate’ coronavirus.”
[vii] “Swedish Ambassador Says Stockholm Expected To Reach ‘Herd Immunity’ In May.”
[viii] See link in endnote i. Q: “So you don’t think the severity of these intervening measures are going to make that much difference?” A: “No. I don’t think so.”
[ix] “The Real Issues Concerning COVID-19—Part III” and its endnotes.
[x] “Failure to count COVID-19 nursing home deaths could dramatically skew US numbers” and “Webinar: Weekly COVID-19 Pandemic Briefing – The Swedish Approach.” @9:46
Well stated, Harvey. I think you are absolutely correct on this. Unfortunately, it means that those of us in the “vulnerable” population will have to take a Russian roulette approach to life over the next 6-12 months. Even the simple act of going out to eat at a restaurant becomes an exercise in risk-reward decision making!