There have been recent reports that Trump appointee Paul Alexander, Health and Human Services aide to Assistant Press Secretary Michael Caputo, advocated for herd immunity over the summer, even as cases were rising and people were dying. He wrote in an email “Allow the nation to develop antibodies. Infants, kids, teens, young people, young adults, middle aged with no conditions etc. have zero to little risk… So we use them to develop herd… we want them infected.” (1)
Normally, I would not discuss the ramblings of an unqualified person with no training in the area under discussion. In this case it matters because that person was involved at the federal level, and apparently, many others felt the same way. I have also heard from several patients in my office who stated that they would prefer “natural” or herd immunity without the vaccine.
Herd immunity occurs when a high proportion of the population has had either prior infection or vaccination. The 1918 influenza pandemic, which killed at least 50 million people is an example of “natural” herd immunity. There was no vaccine. The Black Death, which killed up to half of Europe over a three year period of the 14th century is another example. (2)
Another reason to discuss this is that outgoing POTUS as late as September signaled positively about “herd mentality” (misnomer, he likely meant herd immunity). (3) Whatever he meant by that, the lack of CDC protocol at White House meetings and the massive in-person campaign rallies (including a “surprise” rally in Maine) (4) we saw before the presidential election, and his other misstatements about herd immunity and how to gain it fit into the playbook of intentional infection. It appears that has been the plan. The problems with this, and Alexander’s thoughts are several.
First, young adults and children are not immune to COVID-19. They may be less likely to develop serious illness, but some do get very ill, and some have died from the illness. (5) People under 30 have represented over 20% of COVID-19 cases in the U.S., and may spread the virus more easily than people in older age groups. In one study of over 3000 people between the ages of 18-34 who had COVID-19, 21% wound up in intensive care, 10% on a ventilator, and nearly 3% died. (6) There are also many reports of young children with severe cases. (7) It is not a no-risk situation. And don’t we care about young people (or any people for that matter) with underlying conditions making them at very high risk? Making everyone around them sick and infectious is a dangerous thing to do. The virus that causes COVID-19 is an invisible threat that spreads very effectively from asymptomatic and pre-symptomatic carriers. (8)
Second, anyone with the virus can spread it. Alexander’s proposed strategy to infect as many young people as possible in order to develop herd immunity shows how little he understood about viral infection. Having young people infected would not stop those young people from spreading COVID-19 to parents, grandparents, coworkers, neighbors, and so-on. Mass infection of young people would kill more people overall, and it would overwhelm hospitals, with predictable dire consequences. Allowing an epidemic to spread unfettered is a recipe for disaster, and a foolish thing to suggest.
Finally there is a lot more to say about this, but let’s part with this thought. Viruses mutate when they reproduce (known as replication). They can only reproduce, or copy themselves, in our bodies. In fact, that is the purpose of infecting us: to hijack our cells and make copies of the virus, a staggering number of copies. The problem is that errors occur at a predicable rate when making these copies. In other words, you expect mutations. Thus, the more people are infected, the more viruses copy themselves, the more mutations will occur. It also means it becomes more likely that some horrible mutation will develop that makes the virus a more effective killer, more contagious, or some other awful outcome. We don’t want those results, and we certainly don’t want to push the situation. Giving the virus to more people intentionally means asking for mutations and new strains. It is a roll of the dice, a bad gamble. We are already seeing a new strain in the U.K. (9) that is more contagious than the strain we have already been fighting. (footnote) It is almost certainly here now. Another possibility is a mutation that makes the virus so different that the current vaccines we are finally starting to get become useless. Remember from my last post (10) that a vaccine triggers an immune response to some part of the virus that the body can recognize as foreign. If that part changes, the existing vaccine will not help, because the immune system will not see it. Think of it like this, the police is looking for a man, but they have only a photograph. Like Humphrey Bogart in Dark Passage, the man gets plastic surgery. The police does not recognize him.
It is a lot to think about.
Do your part please. Wear a mask or appropriate facial covering, stay at least 6 feet apart, wash your hands, don’t touch your face unless your hands are clean, don’t congregate in groups, and be COVID-aware. Please be very careful on Christmas and the other holidays. Public health officials are asking people not to travel and not to gather because the epidemic in the U.S. (and in Maine) is worse than it has ever been, even as above – we likely face a more contagious strain from the U.K. circulating around us. If you must see others over the holidays, remember risk is compounded by time and exposure. (11) The more exposure, and the longer the time, the more likely you are to catch the virus. Be smart. Even writing this I know that it hurts not to see the ones we love, but isn’t avoiding risk a way of saying “I love you”? And for that matter, isn’t getting the vaccine the same? Herd immunity without a vaccine is a bad choice. Make a good choice.
Stay tuned to the Maine CDC for a schedule of vaccinations, or check with your doctor.
footnote: for a discussion of the contagiousness of COVID-19 and the reproduction number, see COVID-19 questions in MPDN, March 2020 https://mainepdnews.org/2020/03/28/covid-19-questions/
REFERENCES (as of 12/23/20)
4. https://mainepdnews.org/2020/12/06/covid-19-on-the-rise-what-to-do/
6. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2770542
7. https://mainepdnews.org/2020/07/16/covid-19-update-in-and-out-of-maine/
8. https://mainepdnews.org/2020/05/29/risk-and-the-asymptomatic-carrier-of-covid-19/
9. https://time.com/5923758/new-covid-strain-uk/
10. https://mainepdnews.org/2020/12/17/are-you-planning-to-get-a-covid-19-vaccine/
11. https://www.erinbromage.com/post/the-risks-know-them-avoid-them
