The great COVID-19 response debate

"Achieving herd immunity is not simple."

What started as a proposal called the Great Barrington Declaration advocating a “focused protection” approach as opposed to blanket lockdowns in response to the Covid 19 epidemic has ignited what is now turning out to be The Great COVID-19 Response Debate.

The open letter written and signed by a group of public health advocates, epidemiologists and academics of various disciplines led by Sunetra Gupta of the University of Oxford, Jay Bhattacharya of Stanford University and Martin Kulldorf of Harvard University has attracted widespread attention worldwide.

The authors invited anyone with access to the internet to add their name to the growing list of advocates including scientists, experts in various fields and even, as the London based Sky News network found out, fake experts and homeopaths.

That open letter has provided a platform for all concerned, individuals and governments included, to inquire into alternative responses to the WHO-sponsored protocols which are essentially anchored on restrictions on movements of people, especially those belonging to the vulnerable segments of the population – young children, the elderly and those with health conditions.

In the authors’ view, such restrictions have attendant adverse effects on “public physical and mental health..manifesting an especial burden for the underprivileged.”

Instead of such measures, they recommend “focused protection” involving the “shielding of those most at risk,” with less stringent restrictions on the remainder of the population in order to “reduce the herd immunity threshold.”

Combining social justice with individual (freedom of movement) rights, the declaration has provided populist leaders like US President Trump with the kind of ammunition needed to promote a new way out of the global lockdown. Reports have it that many of those in Trump’s inner circle such as Health and Human Services Secretary Alex Azar, the new White House coronavirus advisor, Dr. Scott Altas, and even Florida Governor Ron DeSantis, all of whom have been at odds with Dr. Anthony Fauci, the government’s Infectious Disease Director, and have actually advocated against social distancing measures and other WHO-advised protocols during the pandemic.

They have taken the declaration to heart, to the point of arranging a possible meeting for the group with the US President before he contracted the virus.

But no matter how attractive this approach has been to a number of highly placed individuals, it has yet to gain major adherents within the scientific and medical community. Critics have inundated the group’s website, some cautiously sympathetic, most openly disdainful. Yale University epidemiologist Gregg Gonsalves noted that their colleagues in the medical community were “aghast” at the authors’ embrace of what he called a “gussled up version of herd immunity…which can be a recipe for disaster.”

Noted epidemiologist and Dean of the Rutgers University School of Public Health Perry Hatkins emphasized that herd immunity as a concept may seem like an appealing idea, but the “approach demands that we sacrifice lives in order to get to our goal of jumpstarting the economy” and returning to “normal lives.” Atkins said the “focused protection” approach “doesn’t account for the fact that the more you engage people in auditoriums or stadiums and work places,” the more you will expose the people you intend to protect, the working class people and their families, to the disease.

The chief executive of NHS England, Sir Simon Stevens, has said asking all over-65s to shield to slow the transmission of the second wave of coronavirus would be "age-based apartheid."  A number of experts echoed Stevens’ view noting that herd immunity as a pandemic response in reality has “profound ethical, logistical and scientific flaws.”

Oxford University Professor and Director of the Rosalind Franklin Institute James Naismith was more cautiously sympathetic. Noting that the main signatories include many accomplished scientists and that a number of the assertions in the declaration, such as the vulnerability of the elderly and those with health conditions, have scientific basis and, equally important, the disruption in the economy, education and social life have been very hard for most people, the critical question remains will the “herd immunity approach” result in lesser mishaps and hardships from here and accelerate our return to what many governments have called the “new normal”.

The declaration, Naismith noted, “omits some rather critical scientific information that would help better inform policy makers.” He mentioned that achieving herd immunity is not simple, noting that up to now such is not even possible in the case of common cold or the seasonal influenza even as vaccines and medicines for these diseases have been in use for years.

Professor Naismith also suggested that the authors come out with a working assignment, a kind of probability measure, of the vulnerabilities which may occur to at least advise governments and the readers whether the fall out is something more acceptable than what we have been enduring over the past ten months of global lockdown. What happens if indeed we initiate a “focused protection” approach and return those outside the vulnerable groups to normal activities? How many deaths and how many life changing events will result if we are just 80 percent or 60 percent successful as a 100-percent success rate is impossible to achieve? These questions need to be answered if we are to do away with the existing protocols.

Finally, Professor Jeremy Rossman, Honorary Senior Lecturer in Virology, University of Kent, listed three critical aspects which have significant impacts to health and lives which the declaration somewhat ignored.

First, whether herd immunity is achievable given the transmissibility and virulent behavior of COVID-19. Rossman noted that herd immunity relies on lasting immunological protection from re-infection which, in the case of COVID-19, has been happening in most states where a series of re-starts were allowed.

Second, the declaration did not consider the impact of what scientists have come to describe as long-haul COVID cases where “many healthy young adults with ‘mild’ COVID-19 infections are experiencing protracted symptoms and long-term disability.”

Thus, it is not just the fatality rate which should be taken into consideration but the long-term impact on health before one experiments with the herd immunity approach.

Finally, the Swedish experience of foregoing lockdown restrictions in favor of personal responsibility and focused protection of the elderly did not result in the successful protection of the vulnerable population. 

Given these divergent views and the continuing global struggle to come out with a vaccine and the cocktail of COVID 19 medically acceptable cures, it will take a while before we can readily accept this somehow more radical COVID-19 response approach. What needs to be done at this point is to clean the edges, so to speak, to ensure that the cautious approach we have taken will not be implemented in a haphazard or, worse, over-acting way.