Today, Explained - The truth about herd immunity

Episode Date: September 9, 2020

Some people think it’s the only way out of the pandemic. Those people are very wrong. Transcript at vox.com/todayexplained Learn more about your ad choices. Visit podcastchoices.com/adchoices

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Visit connectsontario.ca. There's a new kid on the block of 1600 Pennsylvania Avenue. His name is Dr. Scott Atlas, and he's recently become one of President Trump's top pandemic advisors. So, like, he's an infectious disease expert like Fauci, right? Nope, nope, nope, nope, nope. Oh, but he's obviously an epidemiologist. Nope, nope, nope, nope, nope. Oh, okay. All right. But Atlas is probably a physician with loads of experience advising politicians, yeah?

Nope, nope, nope, nope, nope. Okay, well, tell me he's not just some guy who the president saw on Fox News a bunch. Bingo. Those who are not at risk to die or have a serious hospital-requiring illness, we should be fine with letting them get infected. The policy of total isolation is actually destructive and is literally killing people. By having total population isolation, we are preventing natural immunity from developing. Great. After six months of various states of lockdown, quarantine, social distancing, and mask wearing, 200,000 deaths, and some 6 million cases, President Trump has brought in Fox News' neuroradiologist-in-chief to advise him on COVID-19.

And the worst part is, according to reports from the Washington Post, he's kind of into herd immunity as a path forward for the United States. When you get immunity and low-risk groups infect each other, there's a blockage of sort of the pathways to the vulnerable. This is called herd immunity. I don't think herd immunity is the way out for any place. I don't think any place is even close to herd immunity. And as a strategy, it's dangerous. This is Dr. Howard Foreman. He's a professor of public health at Yale University. And as you just heard, he's less into herd immunity, but he also knows a lot about it. So we asked him to explain. I think about 50

years ago or 60 years ago is when herd immunity was first talked about, that if you got to a certain level of immunity in the community from vaccination, that you could no longer have epidemic outbreaks. You would no longer have an outbreak develop in the community, even if somebody from outside the community came in with an infection, let's say measles, that they could not then cause an outbreak to happen in the community. Even if there were hundreds or even thousands of people that were not vaccinated, it would not take off again as long as you were above a certain percent threshold. Well, since we don't have a vaccine yet, how many Americans would have to get

COVID-19 for herd immunity to be plausible in the United States? So first things first, we don't even know that having had COVID-19 gives you true immunity. You know, there's several different things that may be the outcome of having prior COVID-19. One is that you cannot be infected anymore. That would be full immunity. The other is that you could be infected, but you wouldn't get the disease again. A third is that you might get infected, can't get the disease, but you could shed the virus,

but at a much lower level, let's say, so that you're not spreading it nearly as much. So we don't have answers to those questions yet. As you know, in the last few weeks, we've learned of at least four cases around the world where reinfection has occurred. In Hong Kong, a patient is believed to be the first person to become reinfected with COVID-19, and other cases in Europe are being investigated. This as health officials prepare for a full flu season lurking

just around the corner. But let's assume for the moment that anybody who gets COVID-19 has full immunity and can no longer spread it. Under those circumstances, the estimates for what level of infection we'd need to have to have herd immunity vary between sort of reasonably estimates of 47% to as high as maybe 70%. So we're talking about hundreds of millions of Americans, potentially. Correct. You would need to have hundreds of millions. And by the way, the other issue about that is that they'd have to be homogeneously across the country infected. So if you had,

for instance, 100 million people infected in the great northeast area, and that got them to 95% prior infection, that would do nothing to protect people in, let's say, the midsection of the country if their prior infection rate was 20%. How many Americans would we expect to perish from the disease if we had that level of infection? Right. So let's say that you had 150 million Americans infected. And let's imagine that the infection fatality rate across the entire population ends up being around 0.4 or 0.5%, you're starting to talk about anywhere between 600 and a million people, depending on where the numbers fall out. What would that look like for American cities, American states,

not to mention families, friends destroyed, lives destroyed. Yeah, look, I think when we just count the deaths, and I say just in a very sort of facetious manner, we're underestimating all the harm from this. The deaths are the tip of the iceberg. A small fraction of people that have serious illness and then death, a lot of people are becoming sick from this and are still in recovery now. We have no idea what outcomes look like for this. So when I'm looking and thinking that in order to get to, let's say, minimum herd immunity in every community

across the country, you might need to have 200 million or more people infected and you're starting to talk about 800,000 or a million deaths, you're also talking about at least 10 times that with very serious illnesses and recovery associated with it. So I think that's a catastrophic proposition, particularly when we're only talking about the subacute effects, we have no idea about long-term effects. And has something like this ever happened before in the known history of mankind? To get herd immunity from infection?

Yeah. Not on any large scale. There's, I think, one community or one city where people have said it happened with Zika, but I don't even think that officially would qualify as herd immunity. That would probably, you know, be more characterized as, you know, reduced spread and endemic spread, but not to this degree. But there have been countries that have publicly talked about this as a potential strategy, right? I mean, Sweden, maybe? England? Is that right? Right. So England briefly contemplated it. But after models showed how badly UK hospitals would be overwhelmed in such a scenario

and the potentially hundreds of thousands of deaths it would cause, priorities have shifted. Sweden briefly contemplated it and then really has not pursued that strategy. Sweden took a different tack, not shutting down, trusting citizens to follow social distancing on their own, and putting a priority on so-called herd immunity. The results were mixed. And right now, in fact, there's a letter signed by a lot of scientists urging Israel to pursue, you know, the Sweden approach slash herd immunity. So they do use this term, but I just don't, you know, when I read what they're actually saying, either they don't know what's going on in Sweden or they are trying to misuse this term.

So the long and short of it is herd immunity is not a solution for this country or really any other to consider unless they're ready to see a significant portion of their population die, a much more significant portion of their population come down with serious long-term health consequences, and to face whatever it is, catastrophic oversaturation of hospitals and infrastructure. Is that fair? Potentially. I think we can manage the infrastructure of the hospitals and so on.

I think the deaths are not manageable. And when you're sitting there and trying to make a calculation today of do you actively encourage the infection of a large part of society and by the way infecting younger people and giving them this infection may even be more consequential than some older people because they have more years to suffer potential consequences so we just don't know, but actively doing that. And then on the flip side of that, we're talking about having a vaccine in potentially two, four, five months.

We have therapeutics coming out all the time. We're learning more about this. It just seems like a failed strategy that doesn't even have an upside to it. Okay, so herd immunity is out. Even the White House is now denying it's considering herd immunity as a potential path forward. So what can the United States do in the meantime? More with Dr. Foreman after a break on Today Explained. Thank you. Ramp says they give finance teams unprecedented control and insight into company spend. With Ramp, you're able to issue cards to every employee with limits and restrictions and automate expense reporting so you can stop wasting time at the end of every month. And now you can get $250 when you join Ramp.

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please contact Connex Ontario at 1-866-531-2600 to speak to an advisor free of charge. BetMGM operates pursuant to an operating agreement with iGaming Ontario. Okay, Dr. Foreman, we've established that herd immunity is certainly an option, albeit one where a ton of people die or get sick for the rest of their lives, so not a great one. Then there's the vaccine. What do we have in the meantime? We're not doing great on contact tracing.

Is it testing? Is testing our one way to stave off even more of a disaster? Yeah, there's just no question that testing works. Like we've seen it work in so many places with and without contact tracing. We know that if you can test and isolate early enough, if you can remove people from circulation when they're at their highest likelihood of spreading this, we can effectively reduce spread in the same way that herd immunity is supposed to allow us to reduce spread so that outbreaks can no longer occur. It's not to say that nobody gets infected anymore. It's to say that we hold the numbers down dramatically because we're no longer allowing it to spread so quickly. And we could stand to get a lot better at testing,

yeah? I've only, you know, gone and gotten the nasal swab test once and it took several days to get results. What's the promise of rapid testing looking like? The rapid tests that we're talking about are things that for very, very low cost will have perhaps a slightly reduced sensitivity, perhaps a significantly reduced sensitivity so that they'll have a lot of false negatives, meaning that people will be told they're negative when in fact they're infected, but that those tests will give you results in 15 to 45 minutes typically. And there's all different types of tests out there right now. And they're still being evaluated.

But I believe over the next eight weeks, we're going to start to see more and more of these. Abbott Labs will double its main workforce by starting to produce a rapid and inexpensive coronavirus test. Obviously, the Abbott announcement was probably the biggest know, the biggest signal that this is happening. Now, the company will produce a $5 test that purports to give you

results in 15 minutes. So when you hear about, you know, rapid testing being available at some party in the Hamptons or at the White House or at the NBA bubble in Disney World, it isn't the kind of rapid testing that we're talking about with Abbott, and that's going to be coming soon. Yeah, no, these are typically much quicker. They're on a single swab. They're more akin to what pregnancy tests look like than they are to the nasal swab that you and I have had as a COVID or coronavirus test. And how do they differ in terms of accuracy, if at all? So the word on the street is that their sensitivity is much lower, but their specificity is still very high, meaning that we'd have a lot of false negatives. I know of some manufacturers

that are claiming that their sensitivity is on par with PCR tests, the typical nasal swab, which we consider to be sort of the gold standard at this point. But even if they're much less sensitive, remember that the goal here is not to be 100% certain that someone's not infected as they might want to be around the president. The goal here is to take as many people as possible out of circulation before they can infect people. So if out of five people who are currently infected and potentially spreading, I can take three of them out of circulation, I've had an enormous impact on the spread of this disease. And it looks like we'll have rapid testing that works to at least a high level before we have anything resembling a vaccine? That's right. And certainly we could have done it even faster if we would have made this a priority. But we didn't?

You know, to the best of my knowledge, there has been some funding for the development of testing, but certainly not on the scale of, you know, quote, operation warp speed, and certainly not with the same intensity. So I think most of the entrepreneurs that have moved into this market have done so on their own without necessarily the type of support that could have made this happen much more quickly. And that was a real missed opportunity, it sounds like. Yeah, look, I think that the lack of attention to testing from the beginning has been probably the biggest fatal mistake. From day one, we didn't set up testing properly. We made mistakes on that scale. Then when we could have scaled up traditional testing, we weren't able to. And then when it comes to this type of rapid testing, it has not been the highest priority of our leaders. For all the people who can't wait to return to whatever version of normalcy they've sacrificed,

I wonder, do you think rapid testing will be enough, at least in the United States, to get them to that place once we have enough of it available? That's my hope. I mean, I don't, you know, I think every step along the way, anytime we're talking about loosening our current restrictions, we need to figure out how do you counterbalance that?

How do you prevent it from leading to greater spread? So testing has always been, from the first time I wrote about this in February to now, has always been the way out of this because if you can ramp up testing, you can also relax other things. You may be able to allow people to go

into a less crowded but still movie theater. You may be able to allow people to be in a less crowded but still filled indoor restaurant. You might be able to do sporting events again. There's so many things that you could imagine doing if you have something to counterbalance it. I would say that of all the things that I've failed at in the last six or seven months, the one that I think is my biggest failing is how naive I've been. I was absolutely certain when Vice President Pence said

that we're going to have those test kits out, that we were going to have them. I was absolutely certain, even though I don't necessarily believe him on other things, that when the president said, if you want a test, you'll be able to have a test. So I think it's unfair for me to continue to be naive and say, I believe this,

but I've been optimistic because talking to people in this field about what they're doing and what they're innovating with. I have optimism in entrepreneurs and I think entrepreneurs are telling me that by November we're going to have more rapid testing available. I hope it scales up as fast as I'm saying, but I'm pretty sure we're going to have substantially more than we do today. Dr. Howard Foreman is a professor of public health at Yale University. I'm Sean Ramos-Firm. This is Today Explained.