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What you need to know about COVID-19 today
Dr. David Naylor understands COVID-19 fatigue. “We had a taste of freedom as the summer wore on,” said Naylor, co-chair of Canada’s COVID-19 immunity task force, and now a “pretty dismal” winter looms, with on-again, off-again restrictions.
It all makes the idea of quick fixes appealing, says Naylor, which is why he and others worry a new campaign that argues against lockdowns in favour of “shielding” the elderly and vulnerable while allowing everyone else to get on with their normal lives is bound to resonate in all the wrong places.
“Obviously, the Great Barrington fix will excite the minimizers who pretend COVID-19 is not much worse than the flu and enliven the libertarians who object to public health measures on principle,” Naylor wrote in an email to the National Post . “So be it: they’ve been offside all along.”
Thousands have signed the so-called “ Great Barrington Declaration ,” a 510-word pronouncement authored by three academics from Harvard, Stanford and Oxford universities who are advocating an age-targeted, “focused protection” approach to managing the global COVID-19 crisis.
On Monday, the trio met with U.S. Health and Human Services Secretary Alex Azar and White House pandemic adviser Scott Atlas, who has faced scrutiny for his reported views on herd immunity — permitting “controlled spread” among the population, particularly the young and healthy who are less likely to die from COVID-19, so that enough people get infected, recover and develop immunity in order to effectively stop the disease from spreading.
The declaration’s authors argue that the most “compassionate approach” to reaching herd immunity “is to allow those who are at minimal risk of death to live their lives normally to build up immunity to the virus through natural infection, while protecting those who are at highest risk.”
“By way of example, nursing homes should use staff with acquired immunity and perform frequent PCR testing of other staff and all visitors,” the declaration reads. Groceries and other essential goods should be delivered to retirees living at home, while those who are not vulnerable “should immediately be allowed to resume life as normal.” Schools and universities should be open for in-person teaching, extracurricular activities like sports should resume, young “low-risk” adults should work normally, rather than from home; arts, music, and cultural events should resume.
Those who are not vulnerable 'should immediately be allowed to resume life as normal'
“People who are more at risk may participate if they wish, while society as a whole enjoys the protection conferred upon the vulnerable by those who have built up herd immunity,” the statement reads.
The collateral damage from lockdowns has had devastating effects on public health, the authors argue, including lower childhood vaccination rates, fewer cancer screenings, a deterioration in mental health — “leading to greater excess mortality in years to come, with the working class and younger members of society carrying the heaviest burden.”
The vulnerable would include the elderly as well as anyone at high risk of death because of an underlying health condition, should they become infected with SARS-CoV-2, said co-author Dr. Jayanta Bhattacharya, a physician, epidemiologist and health economist at Stanford University Medical School.
“We all feel that the scientific and public discussion has excluded pertinent evidence (about the harms of the lockdown, for instance) and the possibility of a superior approach to the epidemic that would save lives relative to the current approach,” Bhattacharya wrote to National Post in an email.
The declaration itself, observers note, is bereft of supporting evidence, containing not a single reference to any published data to support their strategy. “I mean, honestly, if a medical student submitted this as a paper they would get a failing grade,” said Dr. Irfan Dhalla, a general internist and a vice-president at Unity Health, which operates two hospitals in Toronto.
We cannot reach herd immunity without a massive loss of life or a vaccine. It’s that simple
Critics say it’s all a massive distraction. In the United States, hospitalizations are rising. Confirmed case numbers are soaring in Ontario and Quebec. Across Canada, average daily case counts have jumped 40 per cent in one week.
But the declaration also arrives as young people grow tired of living, as Naylor described it, in “COVID-19 limbo,” as people working in small businesses lose livelihoods, as U.S. President Donald Trump, fresh from a three-night hospital stay for COVID-19, encourages Americans “don’t fear COVID.”
All of it could give the herd-immunity movement some momentum. And while it’s a fringe view, “it’s not as much of a fringe view as I would like it to be,” Dhalla said. “But it’s the wrong view.”
“We cannot reach herd immunity without a massive loss of life or a vaccine. It’s that simple. Honestly, it boggles my mind that intelligent people are signing on to this statement.”
The declaration is named after Barrington, MA, home of the American Institute for Economic Research which, according to its most recently available tax form filed with the IRS and obtained by the Berkshire Edge, conducts “independent, scientific, economic research to educate individuals, thereby advancing their personal interests and those of the nation.” It was signed following a private weekend summit.
In an interview with the National Post , co-author Martin Kulldorff, a professor at Harvard Medical School, said society should do its utmost to shield people over 60, but that people under 50 “should live their normal lives unless they have some known risk factor.” The 50s to 60s fall in a grey zone.
“Anybody above 60, whether teacher or bus driver or janitor I think should not be working — if those in their 60s can’t work from home they should be able to take a sabbatical (supported by social security) for three, four or whatever months it takes before there is immunity in the community that will protect everybody,” Kulldorff said.
Kulldorff isn’t suggesting people go out and get deliberately infected. “That should never happen. And everybody should wash their hands and stay home when sick.”
The declaration is silent on masking and physical distancing, as well as testing and contact tracing.
However, on a promotional video, his co-author, Oxford University epidemiologist Dr. Sunetra Gupta, said it’s possible to shield the high-risk while allowing others to “to get out there and get infected and build up herd immunity.”
It would be a temporary measure, she said, and not a “permanent state of affairs.” “We’re saying, let’s just do this for the three months that it takes for the pathogen to sweep through the population,” Gupta said.
Kulldorff said any argument that the price would be massive loss of life is “nonsense.” “Fewer older people — not zero, but fewer old people — would be infected. But you’ll have more young people infected, and that’s going to reduce the mortality.” Vulnerability to death from COVID-19, the group said, is 1,000-fold higher in the old and infirm than the young.
Others have pointed out that countries that are managing well, including South Korea, have adopted strategies that don’t include “letting the virus run wild whilst hoping that the asthmatic community and the elderly can find somewhere to hide for 12 months,” said Dr. Michael Head, senior research fellow in global health at the University of Southampton.
Britain flirted with herd immunity and then retreated as the COVID-19 toll rose rapidly, Naylor noted. Sweden gambled, and ended up with higher rates of hospitalizations and deaths compared to neighbouring countries. Its no-lockdown policy also didn’t create herd immunity, according to a paper published in August in the Journal of the Royal Society of Medicine.
Any herd immunity strategy focused on the young and healthy is never going to be the “controlled demographic burn that some zealots imagine,” Naylor said. “Case growth will be exponential,” there are not watertight ways to seal the old away from the young, no one knows how long it would take to achieve the necessary threshold of immunity — or how long immunity from an infection would last and, “with masses of people sick in their 40s and 50s hospitals will be over-run and deaths will skyrocket as they did in Italy and New York,” Naylor said.
Younger people also aren’t immune to severe COVID-19: A new study by researchers at Brigham and Women’s Hospital found that, of 3,222 people aged 18 to 35 admitted to U.S. hospitals in April and June, 21 per cent required intensive care, 10 per cent needed mechanical ventilation and 2.7 per cent died.
Naylor said we know now how to contain the surge “without going all the way to an economy-killing and morale-crushing full lockdown” by using a more targeted, regional approach.
There’s also hope a vaccine will be available by March. Given the prospects, “why on earth should we rush to embrace a reckless prescription for a demographically-selective national ‘chickenpox party’ involving a dangerous pathogen?” Naylor said.
Copyright Postmedia Network Inc., 2020