Herd immunity will thin the herd

The COVID-19 virus has already infected over 7 million residents in the US and has killed over 204,000, a death rate of 2.9%. The Trump administration response to the pandemic has been characterized by the same pettiness, infighting, bigotry, lying, false hopes, grifting, science denial, and punitive treatment that has characterized the administration in its every action. The President was clearly aware of the seriousness of the pandemic by the time he did his infamous interview with Bob Woodward on February 7, 2020. However, we know he was aware of it earlier than that because Peter Navarro, Trump economic advisor, prepared memos that were circulated throughout the administration warning of the pandemic in January, 2020.

Nevertheless, Trump has steadfastly refused to organize a coherent national response to the pandemic, instead putting that responsibility on the states. As a result, different states have taken radically different approaches to outbreak, ranging from consistent management of the problem (Vermont and Maine), to initial high infection rates and death tolls followed by successful management (New York and New Jersey), to initial low infection rates followed by massive outbreaks (Florida, Texas, and Arizona), to complete unwillingness to address the issue (Iowa and South Dakota). With the coming of cold weather, people will return indoors, and it is highly likely we will have a second wave (we’re still in the first wave due to his inaction) in the next few months.

Among the most egregious aspects of the nonresponse was the failure to provide personal protective equipment (PPE) throughout the early part of the pandemic, resulting in massive shortages of PPE in regions that were most affected. I live in one of the regions, and in late March/early April, it was difficult to find masks, gloves, hand sanitizer, and paper towels, not to mention the nationwide shortage in toilet paper. At that time, the outbreak was raging in New York, but in an extraordinary act of cynicism and cruelty, task-force leader Jared Kushner advised Trump to back off an aggressive testing plan in blue states to cause greater suffering in those states. As a result, we New Yorkers were treated to traumatic and never-ending ambulance sirens, each one representing a severely ill victim being brought to a hospital.

Throughout the spring, Trump, by his own admission, played down the severity of the pandemic in order to “avoid panic” (or more likely because he did not care or froze). There were ludicrous statements that the virus would disappear during the warm weather and that it was like the flu. The latter was directly contradicted by his later remarks to Bob Woodward. He also has consistently refused to wear masks in public except on very rare occasions and has repeatedly mocked those who do.

Then there was the patent medicine phase of the response. In this phase, Trump latched on to small clinical trials suggesting that hydroxychloroquine + zinc would “solve” the pandemic. His administration got emergency use authorization (EUA) from the Food and Drug Agency (FDA). During one of his press conferences, he beseeched people to try it (“what do you have to lose?”). Twenty-nine million dosages were rushed into production. Almost as soon as this ramp-up occurred, larger studies came out showing lack of efficacy, and even some harmful effects. It also turned out that Trump had a small stake in the company that manufactured Plaquenil, the brand-name version of hydroxychloroquine. Trump and Fox news continued to trumpet it as a miracle cure for several weeks after the negative studies came out.

This phase largely ended with the disastrous April 23 press conference at which Trump appeared to advocate injection of light or disinfectant into the body to treat COVID-19. This was widely ridiculed, but nevertheless, the makers of disinfectants such as Lysol had to quickly issue statements that their products were not to be taken internally. Nevertheless, several gullible people were sickened by ingestion of disinfectant. The saving grace was that it marked the end of the press conferences.

Starting in early May, a number of states started opening up. Even this was turned into a political football. States that failed to open fast enough were derided in Trump tweets, and governors who favored slower approaches were assailed by pro-Trump protestors who often showed up with weapons. One such heavily armed group invaded the Michigan Capitol, and a few among their number advocated the beheading of Michigan’s governor.

The ending of the press conferences also marked a phase in which Trump appeared to lose interest in fighting the pandemic. By June, he abortively started to hold indoor campaign rallies, but at his failed Tulsa rally, he said that he had asked his “them to slow the testing down.” The rally was mask-optional (very few wore them), and Trump staff removed stickers on seats advising people to social distance. The rally also had Herman Cain in attendance, who had shortly before the rally derided mask wearing in a tweet. Cain soon developed COVID-19 symptoms and died in late July.

There are many other cases of poor or mendacious policy-making, but one of the most dangerous in the long-term has been the consistent undermining of science. From the statements that COVID was just like the flu, to undermining of mask-wearing and social-distancing guidelines, to the alteration of Centers for Disease Control (CDC) guidance regarding a meat plant in Greeley, CO, to the promotion of inadequate quick-fixes, to the criticism and sidelining of experts in virology and infectious disease, the Trump administration has waged an unending campaign aimed at undermining scientific understanding and treatment of the virus.

During the summer, the Trump administration stance started moving in a very troubling direction. They started making noises about dealing with the pandemic through herd immunity. This approach posits that spread of disease can be avoided by having a large enough portion of the population showing pre-existing immunity by virtue of being vaccinated or having been infected. In order to achieve herd immunity, it typically requires between 83-94% of the public to be vaccinated (in cases when vaccines are available). Despite the dubious likelihood of having a widely disseminated vaccine any time soon, the push for heard immunity has grown. This leaves massive level of infection as the only way to achieve herd immunity.

Recently, Trump has installed radiologist and frequent Fox News guest Scott Atlas as head of the pandemic task force. He has pushed hard to promote herd immunity. He utterly lacks the requisite expertise to be in that role. The herd immunity approach is highly appealing to Trump, who clearly wants to just wish the pandemic away with minimal effort.

At present, there are several serious problems with the herd immunity approach. First, as already noted, there is no vaccine. Second, it is not clear that once people are infected, their immunity is permanent. There are cases of people who show a second phase of the virus. It is not clear that these cases are ones in which the virus had not been entirely eradicated and re-grew, or if they represent novel second infections. If the latter, herd immunity will not work via prior infection. Third, there appear to be numerous long term consequences to COVID infection. These range form rashes to respiratory difficulties, to cardiovascular problems, to inflammatory symptoms.

The biggest problem, absent a vaccine, is the number of deaths such an approach would entail. As noted above, herd immunity typically requires vaccination or prior infection of at least 83% of the population. Assuming a more lenient 80% infection rate, this would mean, in a country of 330 million, 264 million cases. At the current death rate of 2.9%, that would mean 7.6 million deaths. This is a horrific death toll. And again, that does not take into account the healthcare costs of the sequelae of those infections. With the Affordable Care Act (ACA) likely to be struck down in a new Supreme Court, it is unclear how these costs will be paid. In short, herd immunity is, for now, a recipe for a massive death toll and soaring healthcare costs. This will represent a humanitarian crisis. And it will cement Trump’s pandemic response as what Bob Woodward called a “monumental, catastrophic leadership failure.”

There is a darker aspect to this approach that I referenced in my last post (The return of eugenics?). Trump has had a long-standing fascination with eugenics. A mere two days after I published that blog post, in a rally in Minnesota, he told his audience that they had “good genes,” the etymological origin of the word eugenics. The herd immunity fits right into that mindset. Only those with good genes will survive. This may not lead to herd immunity, but it will lead to thinning of our herd.

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