The Wall Street Journal recently has presented some very assertive pieces on COVID-19 herd immunity, appropriately located in its “Opinion” section. While there are problems with two of these commentaries, looking at them together with a new report on trends in illness in the elderly US population gives a perspective to the current COVID-19 epidemic.
The WSJ seems enamored with Johns Hopkins surgeon, Dr. Marty Makary, who has been given several opportunities to voice his views on “herd immunity.” His primary thesis seems to be “herd immunity” will be present much sooner than predicted by Dr. Fauci or other government representatives. Previously he had made the bold statement that “we would have herd immunity by April”, which, given the current rates of infection (although decreasing), isn’t going to happen.
I wrote that his math was at best “fuzzy,” in his first prediction, but he is back this week doubling down after losing his first bet! He now argues “herd Immunity” will occur sooner than Dr. Fauci thinks because everyone who has been infected with COVID-19 adds to our protected population. Once again, however, Dr. Makary’s math is deficient.
He cites natural infection induced rates of immunity in small areas of urban centers that have been hardest hit by the pandemic. He extrapolates these very high infection numbers to the entire country, which is totally inappropriate. He also overlooks the fact that several of the variant viruses now present in the U.S. appear to be resistant to natural immunity, but fortunately can be blocked by vaccine immunity.
Whether he is correct that we need only 45% of the population immunized, or whether Dr. Fauci is correct that we need close to 80%, is truly irrelevant in this discussion. We will know when we’ve achieved herd immunity because infections in the general population will decrease to a point that we aren’t seeing large outbreaks or extensive numbers of deaths from COVID-19.
In contrast to Dr. Makary’s enthusiasm, a commentary by several NYU public health faculty suggests that we will never be able to achieve herd immunity. They point out that there have been many individuals who are unable to be immunized due to medical conditions and, more importantly, that almost a third of people state in polls that they won’t get the vaccination.
Again, this opinion piece is total conjecture and more importantly overlooks some of the more effective means that are now being used to encourage individuals to be vaccinated. In addition, if the private sector requires vaccination to go to a theme park, a concert, or to travel internationally, then most of the developed world will fight for vaccinations. This also ignores the remarkable achievements in places like Israel where aggressive vaccination has been able to control infections, particularly in their most at risk populations.
The one important point offered by this commentary is that the “entire world” needs to develop immunity to SARS-CoV-2, which will likely take longer than any of us would want. To truly eradicate COVID-19 as a threat, they suggest surveillance methods used to eradicate smallpox. They argue to “immediately begin to supplement the impressive recent rollout of vaccines with a comprehensive rapid-response system, modeled on the ‘surveillance and containment’ strategy that William Foege, former head of the CDC, developed to fight smallpox in the early 1970s.”
Essentially, however, they argue for aggressive contact tracing as a means of identifying and isolating individuals sick with COVID-19. The problem here is that COVID-19 is not spread by physical contact like smallpox, but is a respiratory virus that spreads in clusters. More importantly, most of the individuals who are infected are not symptomatic, so it’s almost impossible to identify everyone who is infected. Contact tracing has already failed for COVID-19, so to again suggest it as the way to solve this pandemic is folly. Give me vaccines for the entire world versus contact tracing with this disease any day!
Good news actually based on facts!
In contrast to the two opinion pieces, there is an article by Jon Kamp in today’s Wall Street Journal that gives a much truer perspective on the state of the pandemic in the United States.
It points out that while “the pandemic is far from over, especially as newly reported U.S. cases plateau after a steep decline and more infectious coronavirus variants spread,” there is increasing evidence that “the Americans who have long faced the highest mortality risk (the elderly) are increasingly protected.”
We have focused on vaccinating the most vulnerable people, and this has finally reached a tipping point. The Centers for Disease Control and Prevention cites vaccinations among people aged 65 and higher. This group has on average represented about four of every five Covid-19 deaths in the U.S. since the pandemic began, according to death-certificate data. By Friday, 71% of this age group had received at least one vaccine dose, compared with 27% of the general population, CDC data show. Nearly 46% of people 65 and over in the US are fully vaccinated.
Death rates and hospitalizations have finally started to fall in elderly individuals over the age of 65, and they are now approaching rates in younger populations that have yet to be vaccinated. This data mimics well what has been observed in Israel, and if vaccinations continue in these populations, to levels achieved in Israel, we can expect hospitalizations and deaths to fall even further.
The clearest signal on this is deaths in nursing homes. These have dropped from 50% of COVID-19 deaths to less than 10%, even at a time when overall deaths have decreased.
While the pandemic is not over, the vaccines do work! We should stop arguing about “herd immunity” and just make sure everyone gets vaccinated! We will achieve herd immunity and we will know it simply by looking at the death statistics!