The path to ‘herd immunity’ would be lined with half a million dead Americans

A discarded mask lies on the ground in the streets of Munich. (Christof Stache/AFP/Getty Images)

Tom Frieden, a physician, is president and CEO of Resolve to Save Lives, an initiative of the global public health organization Vital Strategies, and former director of the Centers for Disease Control and Prevention (2009-2017).

As the covid-19 pandemic continues in the United States and many parts of the world, millions of Americans are increasingly impatient for the economy and society to regain a more normal footing. Some “maverick scientists” with “an audience inside the White House,” as The Post reported last week, argue for “allowing the coronavirus to spread freely at ‘natural’ rates among healthy young people while keeping most aspects of the economy up and running.”

Their aim is to achieve “herd immunity,” the concept that if enough people are immune, those without immunity can be protected. Usually this refers to immunity gained from vaccination; the goal of herd immunity has typically not been applied to a disease for which there is no vaccine.

WHO Director General Tedros Adhanom Ghebreyesus said on Oct. 12 that allowing the coronavirus to spread to reach herd immunity is "ethically problematic.” (Video: WHO)

There is a saying that for every complicated problem, a solution exists that is quick, simple — and wrong. That applies here: Pursuing herd immunity is the wrong, dead wrong, solution for the pandemic. Discussing such a reckless approach shouldn’t be necessary, except that it echoes the misguided ideas of neuroradiologist Scott Atlas, who in recent months has become an influential medical adviser to President Trump.

Atlas, The Post reported, has relied on similar-minded scientists “to bolster his in-house arguments.”

Less than 15 percent of Americans have been infected by the virus that causes covid-19. If immunity among those who have been infected and survived is strong and long-lasting (and it may well be neither), and if herd immunity kicks in at 60 percent infection of the population (and it might be higher), with a fatality rate of 0.5 percent among those infected, then at least another half-million Americans — in addition to the 220,000 who have already died — would have to die for the country to achieve herd immunity. And that’s the best-case scenario. The number of deaths to get there could be twice as high.

The route to herd immunity would run through graveyards filled with Americans who did not have to die, because what starts in young adults doesn’t stay in young adults. “Protecting the vulnerable,” however appealing it may sound, isn’t plausible if the virus is allowed to freely spread among younger people. We’ve seen this in families, communities and entire regions of the country. First come cases in young adults. Then the virus spreads to older adults and medically vulnerable people. Hospitalizations increase. And then deaths increase.

Without federal intervention, experts warn of an unprecedented wave of evictions in the coming months, more devastating than the 2008 foreclosure crisis. (Video: The Washington Post)

The vulnerable are not just a sliver of society. The 65-and-over population of the United States in 2018 was 52 million. As many as 60 percent of adults have a medical condition that increases their risk of death from covid-19 — with many unaware of their condition, which can include undiagnosed kidney disease, diabetes or cancer. The plain truth is that we cannot protect the vulnerable without protecting all of us.

A one-two punch is needed to knock out the virus — a combination approach, just as multiple drugs are used to treat infections such as HIV and tuberculosis. That in turn will allow the accelerated resumption of economic and social activity.

First, knock down the spread of the virus. The best way to do this is — as the country has been trying to do, with uneven success — to reduce close contact with others, especially in crowded indoor spaces with poor ventilation. Increase adherence to the Three W’s: wear a mask, watch your distance and wash your hands (or use sanitizer). Where restrictions have been loosened, track early-warning triggers and activate strategic closures to prevent an explosive spread.

Second, box the virus in to stop cases from becoming clusters and clusters from becoming outbreaks. Rapid testing should focus on those at greatest risk of having been exposed. The sooner people who are infectious get isolated, the fewer secondary cases there will be. That means rapid testing and rapid action when tests are positive. Close contacts need to be quarantined so that if they develop infection, the chain of transmission will stop with them.

A safe and effective vaccine may become available in the coming months — or it may not. Yet even if it were widely administered (a big if), it wouldn’t end the pandemic. Even if a vaccine that’s 70 percent effective is taken by 70 percent of people — optimistic estimates — that leaves half of the population unprotected. For the foreseeable future, masks will be in, at least indoors, and handshakes will be out.

Although there’s no quick fix, this pandemic will end one day. In the interim, there are actions individuals, families and communities across the country can take to reduce risk. The sooner the virus is under control, the quicker and more complete the recovery will be.

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