Flocking Toward Herd Immunity

“Achieving herd immunity without a vaccine is a recipe for carnage.”

-Gregg Gonsalves, Epidemiologist, Yale School of Public Health.

Governments are anxious to avoid returning to economically damaging lock-downs and mass quarantines, so getting ready for winter should mean the U.S. works to get COVID infection numbers as low as possible. Instead, it is exploring a dangerous path to herd immunity—unmitigated viral spread that has young, non-disabled workers resuming their daily lives as usual while vulnerable populations continue their isolation.

Indeed, U.S. public officials redefine "herd immunity," which is only a byproduct and not a health strategy. Herd immunity requires either a vaccine (not currently available) or allowing the virus to spread throughout the population until a sufficient number of the community has antibodies. Any good pandemic mitigation strategy would minimize the number of persons infected, slowing viral transmission to allow hospitals to provide care to everyone who needs it.

The U.S. administration is conflating "herd immunity" and "unmitigated spread." Instead, it will abandon the principle of "crush the curve," meant to prevent large numbers of COVID patients from overwhelming the health systems and increasing the mortality rate to near 10%. When localities run out of hospital beds, any patient that requires immediate treatment in an ICU will die.

All of this as COVID cases across the U.S. are surging right now — from Wyoming to Virginia. Forty-one states report record numbers of new cases just as we approach the colder, in climate months of fall and winter.

There is little doubt that the lack of any federal leadership is substantively responsible for our current state.

Herd Immunity as a Strategy

Herd immunity, as it is traditionally understood, is an outcome, not a national strategy. It refers to the point at which enough people are resistant to a disease that is unlikely to spread in a community. Populations attain herd immunity two ways: 1) through a vaccination; 2) through an infection. Herd immunity to COVID-19 acquired through an infection would necessarily result in millions of dead Americans and hundreds of millions of people sick and infected, possibly facing long-term health consequences.


Dr. Scott Atlas, a radiologist by training, promoted 'herd immunity' as a means to deal with the pandemic on Fox News, was quickly plucked as principal COVID-19 pandemic advisor to the President. Atlas, who has no expertise in infectious disease or epidemiology, suggests the virus should spread through the population. Hence, people build up immunity rather than trying to contain it through shutdown measures. For highly-infections diseases like Measles, nearly 95% of the population needs to be immunized to control the disease. Scientists estimate that number for COVID falls between 50% and 70%. So, it's pretty easy to do the math. If, say, 60% of the U.S. population (329 million) would need to acquire COVID-19 to achieve the potential of herd immunity, that would mean 197 million of us would need to test positive for the coronavirus. How many would die from it? The U.S. stands at around 3.7% across all demographic, racial, ethnic, and gender components. Approximately 7.3 million Americans could lose their lives before we reach so-called herd immunity.


Dr. Anthony Fauci, an outspoken opponent of a herd immunity "plan," has rebuked public officials who favor the strategy, blasting the proposal as "total nonsense," and pointing out that only 22% of New York City residents have antibodies. Last spring, we learned that health outcomes decline when the virus spreads unmitigated in communities that lack available ICU beds and medical supplies.

Case Study: Sweden

“Not only did these lack of measures likely result in more infections and deaths, but it didn’t even help the economy: Sweden fared worse economically than other Nordic countries throughout the pandemic.

The Swedish way has yielded little but death and misery. And, this situation has not been honestly portrayed to the Swedish people or to the rest of the world.”

-Time Magazine editorial (10/14/20)

Proponents of a herd immunity strategy point to Sweden as a model for what could happen in the U.S., so what happened in Sweden?

As of this writing, Sweden has a higher death rate per million than any of its neighbors. Sweden has experienced 584 deaths per million people, the 12 highest in the world. Compare this figure with 116 in Denmark, 63 in Finland, and 51 in Norway, and it's clear that failure to mitigate the disease led to worse health outcomes than its neighbors. The U.K.'s is 635. Swedes also have universal healthcare. While the country never entered a lockdown, it did restrict in-person gatherings, requested that businesses allow employees to work from home, and restricted visits to retirement homes. Public officials maintain consistent public health messaging that individuals have a personal responsibility to avoid transmitting the virus.

Sweden has not experienced another major outbreak of the virus since May. However, it is also not testing enough of the population to know for sure. It never instituted a mass testing or contact-tracing program, and Sweden's test rates are among the lowest in Europe.

Clear, consistent messaging to a homogenous and compliant populace avoided the confusion and fatigue over public health measures seen in other countries. However, their health outcomes were as bad as—if not worse than—other states per capita. At the pandemic's peak, Sweden had to triage patients, treating elderly COVID victims with morphine and leaving them to die.

Sweden never locked down to prevent COVID spread, and it is suffering among the highest infection and death rates in the region.

Outcome Analysis

While it may be tempting to point to Sweden and wonder whether they have the right idea, their citizens aren't facing hundreds-of-thousands of dollars in medical bills. The population remains compliant with public health measures—a trait that Americans don't share. Additionally, the Swedish strategy is almost sure to fail.

Why?

Betting against a COVID outbreak is a losing strategy in the long-run, as the virus is now endemic worldwide. A COVID infection only confers antibodies for a few weeks to a few months, and the population is vulnerable to emerging strains or the same one recirculating in the society. The reality is that Sweden remains scientifically vulnerable to another outbreak, as only an estimated 7% of Sweden has COVID antibodies, and the magic number for herd immunity is somewhere above 50%. Their success at containing COVID is more than likely somewhat attributable to freeloading off their neighbors' responsible policies and other EU members.

Not only is Sweden's policy an abject failure in overselling the approach to the outside world, but Sweden also revealed that they are obscuring the truth from their citizens.