Developing Herd Immunity:
A Modest Proposal August 11, 2020 Updated September 1, 2020 |
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Globally, the COVID-19 pandemic continues to spread. Some 250,000 new cases are confirmed each day; and counting unreported cases, the daily total may well reach into the millions. Worldwide, death toll estimates from the virus approach 750,000.
Some countries, such as Laos, have been quite successful in avoiding the pandemic so far. In others, most notably, the United States, the pandemic has ravaged through the population for months. Many, such as China, where the pandemic was first noted, have brought the pandemic under control and kept it under control. In other countries, such as Japan, the pandemic is resurging after having been previously brought under control. In still others, such as India, the pandemic arrived late, but when it did arrive, it spread like wildfire. Second waves of COVID-19 cases are definitely in vogue now. Here are some examples: Folks in places where new cases have peaked and then fallen drastically, worn out from beating back the initial wave, are living in fear of a resurgence of COVID-19 — hoping science will give them a vaccine before it's too late.Spain peaked with an average of 7,800 new cases reported daily during the week ending April 1. New cases fell to an average of 279 over the week ending June 10, but then surged to an average of 2,704 new cases over the week ending August 10. Here, I have a modest proposal to make. It's a low-tech solution. It doesn't require a vaccine that may not be available for a long time and may not work particularly well, even after it is available. In fact, this proposal doesn't require anything that we don't already have, except the will to implement it. First thing is to estimate how many active infections can be handled without overwhelming one's healthcare infrastructure. Here, we must not lose sight of the fact that people still need medical attention for other reasons as well. Second let's estimate how many active infections we can handle without sending our economy into a tailspin. These estimates need to be fine-tuned. If infected people are not aged or immuno-compromised, our healthcare infrastructure can tolerate a lot more infections than if the infected are among the most vulnerable in society. If the infected people are from non-critical professions, we can handle far more infections than if the infected are frontline healthcare workers. Then, we want to build in a safety factor; and when all is said and done, we have a number, let's call it our Maximum Comfortable Active Infection Load or MCAIL for short. Note this number should change over time as we strive to build a more robust healthcare infrastructure and fine-tune the proposal. Now, estimate our current active infection load. If its above the MCAIL threshold, first thing to do is to bring it down, using known techniques such as isolation, contact tracing, social distancing etc. It's not my purpose here to review these techniques that we have all heard about over and over again. When our active infection load falls below the MCAIL threshold; we ask for volunteers; who agree to be deliberately infected with COVID-19. Our purpose here is to arrive at herd-immunity as quickly and painlessly as possible, without overwhelming our healthcare infrastructure or destroying our economic livelihood. Herd-immunity is attained when the immune portion of the population is large enough that the virus cannot easily spread through the portion that lacks immunity. I've seen estimates of herd immunity that vary from requiring 20% of the population to be immune to requiring 80% of the population to be immune. Clearly, the details need to be worked out in real time. Immunity derived from having recovered from a disease is the real McCoy — much more effective in general than vaccine-induced immunity, particularly new untried vaccines that have been rushed to market by for-profit corporations, hoping to make a killing (literally) off the pandemic. So far, there have been no confirmed instances of a fully recovered individual getting sick with COVID-19 a second time (although there are plenty of rumors). As volunteers recover, new volunteers are accepted, keeping the active infection load as close as possible to the MCAIL threshold. Once a volunteer has recovered and acquired immunity, he returns to the general population, perhaps a month or so after being selected. Once we reach herd-immunity, we can pat ourselves on the back and say, “Job Well Done.” Certainly, volunteers should be offered something for agreeing to be human guinea pigs. What should be offered? Whatever it takes to get enough volunteers. The infection fatality rate, the portion of those infected who can be expected to die from the infection, is low — less than 1% — and even lower if healthy volunteers are chosen. Lasting complications are certainly possible, but seem to be rare among healthy individuals. Volunteers should be isolated and checked daily until they are coronavirus free. If needed, they should receive the best medical care available. Most will likely experience at worst mild symptoms. Volunteers might well be less likely to die of COVID-19 then the general population, because of the constant medical care and attention they would receive while infected. In addition, volunteers should certainly receive a salary commensurate with their earning abilities. Their salary should also include hazardous duty pay. Afterwards, being virtually immune, their services should be in great demand in hospitals, nursing homes and other places where workers must be around folks who are likely to be infected or those who are most at risk from infections. What we are striving for here is far more than flattening the curve. Indeed, if this works as planned; we no longer have a curve at all; Instead we have a level straight line. Before 1963, it was common knowledge that most children would eventually get measles. Many parents would deliberately expose their children to measles at opportune times in order to get the inevitable over with, in spite of the risk involved. It is likely that, short of an effective vaccine, most people will eventually contract COVID-19. With this proposal, we are simulating the situation that existed with measles prior to 1963 when the first measles vaccine was developed. And what happens if an effective COVID-19 vaccine is developed? We can always switch horses (as we did with measles) if desired. But let's not put all our money on the vaccine horse; especially since there is no guarantee that it will ever reach the finish line. Indeed, many think that a COVID-19 vaccine that comes even close to the efficacy of our measles vaccine (97% effective) is highly unlikely. And let's not forget that decades into the HIV/AIDS pandemic, science has failed miserably in producing a vaccine. Actually, this proposal increases the likelihood of eventually developing an effective vaccine for COVID-19. It allows vaccine developers the time necessary to do the job right. “Warp-speed” is no longer necessary since we have another, perhaps even better, method of fighting the pandemic. Haste makes waste. Personally, I would not want to take a vaccine produced under the conditions now envisioned. There are certainly a lot of unknowns here; and I am not in a position to fill in all the blanks. However, I believe the idea is sound; and certainly beats doing nothing while living in fear and waiting for a vaccine. You might ask: where's the money going to come from? How about from the almost $2 trillion that the world spends each year on war and preparations for war. A minuscule percentage of the world's war budget should easily cover implementing this proposal worldwide. Not only would we conquer the pandemic; but we would also render war, potentially a much greater killer than COVID-19, far less likely.
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