Since I started this blog last March, some of the least recognized concerns with the efforts to limit COVID-19 are the inadvertent mental and physical health problems suffered from the mitigations. The total shut down of work places and schools have yielded children not getting routine vaccines, parents losing jobs, people becoming more likely to have substance abuse and an increase in domestic violence. These issues have not received the same media attention as the push for protective measures, but are important and should not be overlooked.
Several alternatives to total shutdowns have been propose. One approach that has gained interest is to isolate and protect those individuals at highest risk while doing more measured precautions to allow reasonable activity by everyone else. This approach has received scrutiny because it has been represented as just a means to achieve “herd immunity,” while the term “at risk” has been construed to include even a mild febrile illness or concerns about “myocarditis” (that has not been definitively shown to exist). At risk should mean those individuals who have the greatest likelihood of becoming seriously ill or dying from COVID-19, period.
While so far there has been little academic and medical support for the protect and normalize approach, that is beginning to change.
On October 4th, three prominent epidemiologists, Dr. Martin Kulldorff, Dr. Sunetra Gupta, and Dr. Jay Bhattacharya wrote what they call the Great Barrington Declaration. This outlines a way forward that exactly involves protecting those at risk while allowing others to live more free and unrestricted lives.
The wording of the Declaration can be found in the accompanying link, and I also pasted it following this paragraph. It has been signed by over 5,000 medical scientists, 10,000 physicians, and 141,000 members of the general public. While it is incredibly thought provoking, I have some disagreement with not having most individuals use simple protective measures (this point is not clear). I feel it is important to consider, however, and wanted you to be aware of their statement.
The Great Barrington Declaration
As infectious disease epidemiologists and public health scientists we have grave concerns about the damaging physical and mental health impacts of the prevailing COVID-19 policies and recommend an approach we call Focused Protection.
Coming from both the left and right, and around the world, we have devoted our careers to protecting people. Current lockdown policies are producing devastating effects on short and long-term public health. The results (to name a few) include lower childhood vaccination rates, worsening cardiovascular disease outcomes, fewer cancer screenings and deteriorating mental health – leading to greater excess mortality in years to come, with the working class and younger members of society carrying the heaviest burden. Keeping students out of school is a grave injustice.
Keeping these measures in place until a vaccine is available will cause irreparable damage, with the underprivileged disproportionately harmed.
Fortunately, our understanding of the virus is growing. We know that vulnerability to death from COVID-19 is more than a thousand-fold higher in the old and infirm than the young. Indeed, for children, COVID-19 is less dangerous than many other harms, including influenza.
As immunity builds in the population, the risk of infection to all – including the vulnerable – falls. We know that all populations will eventually reach herd immunity – i.e. the point at which the rate of new infections is stable – and that this can be assisted by (but is not dependent upon) a vaccine. Our goal should therefore be to minimize mortality and social harm until we reach herd immunity.
The most compassionate approach that balances the risks and benefits of 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 better protecting those who are at highest risk. We call this Focused Protection.
Adopting measures to protect the vulnerable should be the central aim of public health responses to COVID-19. By way of example, nursing homes should use staff with acquired immunity and perform frequent PCR testing of other staff and all visitors. Staff rotation should be minimized. Retired people living at home should have groceries and other essentials delivered to their home. When possible, they should meet family members outside rather than inside. A comprehensive and detailed list of measures, including approaches to multi-generational households, can be implemented, and is well within the scope and capability of public health professionals.
Those who are not vulnerable should immediately be allowed to resume life as normal. Simple hygiene measures, such as hand washing and staying home when sick should be practiced by everyone to reduce the herd immunity threshold. Schools and universities should be open for in-person teaching. Extracurricular activities, such as sports, should be resumed. Young low-risk adults should work normally, rather than from home. Restaurants and other businesses should open. Arts, music, sport and other cultural activities should resume. 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.