It’s a coronavirus strategy gaining traction among some Republicans: In lieu of waiting for a vaccine, let the virus run its course among younger, healthy people to create herd immunity.
Last week, state Senate Majority Leader Mike Shirkey, R-Clark Lake, said he believes “an element of herd immunity” needs to happen in the state.
“Nobody should be misled here or of the opinion that you can keep it from spreading – it’s going to spread, so we just do the best we can,” Shirkey said. “I’m also a big believer that there’s an element of herd immunity that needs to take place.”
President Donald Trump also appears to have aligned himself with the concept, in which officials would allow natural spread of the virus through the population, while keeping vulnerable people such as the elderly protected. The idea is if enough people get sick and become immune, eventually transmission of the virus would sputter.
But it’s a strategy strongly opposed by most of the medical and scientific establishment, including Dr. Anthony Fauci, the federal government’s top expert in infectious disease.
And Shirkey’s comments drew a forceful rebuke in the form of a letter signed by five nationally prominent medical experts, who said that prevention is a very more viable strategy.
MLive talked to a number of experts around the state about the concept of herd immunity, all of whom expressed the strong opposition to the strategy. Below is a list of the reasons they say it’s a bad idea.
1. It would take too long to work.
It’s estimated that herd immunity would require about at least 65% and maybe as high as 80% to 90% of the population to acquire the virus.
“We’re so far away from that, that it’s not a realistic strategy at this point in time,” said Dr. Josh Kooistra, chief medical officer for Spectrum Health in Grand Rapids. “If you look at the antibody testing across our community, we’re at 3.6% showing an antibody response. So if you extrapolate that, we’re so far away from meaningful herd immunity.”
Dr. Trini Mathew, an infectious disease specialist for Beaumont Health in metro Detroit, agreed.
“We should not bank on herd immunity because it would take us months to years, if you think about it,” she said. “How many decades of efforts of public health measures did it take for us to build that herd immunity for measles?”
2. It risks high number of hospitalizations and deaths.
This is probably the single biggest argument against herd immunity: Letting the virus run its natural course risks overwhelming hospitals and a high number of deaths.
“If ‘herd immunity’ were to begin after about 80% of the state’s population has been infected, as some believe, then 6.5 million more Michiganders would still need to contract COVID-19,” said the letter sent by national medical experts to Shirkey. “At the current mortality rate, this would mean more than 30,000 additional deaths — more than four times the number of deaths to date.”
Mathew echoes that point. “How many more deaths are we willing to have?” she said. “And I think that is non-negotiable.”
Deaths aren’t the only issue, said Linda Vail, who heads the Ingham County Health Department. Metro Detroit already has experienced what happens when many people become ill at the same time and overwhelm hospitals.
“When hospitals get overwhelmed, they’re not able to properly care for people” regardless if their health issue is coronavirus or something else, she said. “Then people unnecessarily die because of capacity issues.”
Marcus Cheatham, who heads the Mid-Michigan Health Department, which serves Clinton, Gratiot and Montcalm counties, makes the same point.
“The main thing I’m concerned about is hospitalizations,” he said. If hospitals get overwhelmed, “you not only have mortality from people who have COVID and can’t get in to the hospital, but you have other people — heart attacks, car crashes, drug overdoses, all of that stuff — who can’t get care.”
3. It’s simply impossible to protect vulnerable populations once community spread gets too high.
“I think the proponents of natural infection-based herd immunity have not thought through the consequences of that strategy or even the feasibility of that strategy,” said Ryan Malosh, a University of Michigan epidemiologist.
That’s particularly true of the concept that vulnerable people could be protected if the virus is allowed to spread freely. Malosh pointed to his own situation: He is a cancer survivor who received a bone marrow transplant two years ago, which makes him extremely vulnerable if he were to catch COVID-19.
“I’m an extremely high risk person,” he said. “But I live with three kids less than 7 years old, and my wife is 34, and completely healthy. How do you protect me from them? Do I have to move away from my family until the vaccine is available?”
As another example, Malosh pointed to the issue of coronavirus outbreaks in nursing homes, which are typically started by asymptomatic staff who unintentionally bring the virus into the facility. Those outbreaks increase in frequency as community spread rises and staff members are more likely to acquire the virus.
So herd immunity proponents have suggested that nursing homes should only use staff members with proven immunity — a wildly impractical idea considering the current shortage of nursing home staff and the outcry that would result from firing staffers who have taken pains to stay healthy.
“The devil is in the details for this herd immunity strategy, and I haven’t seen any reasonable details that can suggest that you can actually protect” people who would be vulnerable, Malosh said.
4. Herd immunity hasn’t worked well elsewhere.
“Sweden did that little experiment, and it didn’t work out so well for them,” Vail said.
Unlike most other European countries, Sweden eschewed a lockdown last spring, with the idea that they would minimize steps to control the virus among young and healthy people while protecting the elderly. They found it difficult to achieve the latter, and Sweden’s death rate of 585 people per million residents is many times higher than its Scandinavian neighbors, including Denmark (death rate of 117 per million), Finland (63 deaths per million) and Norway (51 deaths per million).
Several Republican governors, such as Florida Gov. Ron DeSantis, also said in the spring that they weren’t worried when their coronavirus case numbers started increasing among younger adults. But what state after state has discovered is that the virus takes a predictable pattern: It starts with exponential growth among young adults, who generally have mild cases; then cases rise among older, more vulnerable populations, followed by a big increase in hospitalizations and then in deaths.
“For a virus that’s been quite unpredictable in a lot of ways, this is one predictable pattern,” Malosh said.
That’s played out with deadly consequences in numerous states. As an example, almost 12,200 in Florida have died of coronavirus since July 1 compared to 3,075 deaths in Michigan. And more 4,600 of those Florida deaths involved nursing home residents, compared to about 200 nursing-home deaths in Michigan during the same time frame.
5. We don’t know enough about coronavirus immunity.
Yet another big argument against herd immunity: It’s unclear how long naturally produced antibodies provide protection from re-infection.
“What is really sort of irresponsible about the strategy is we don’t even know how long immunity lasts,” Malosh said.
“The whole strategy is built around the assumption that if you’re infected, you are then immune from subsequent infections,” he said, but it’s unclear for how long that is true.
“We’ve seen a handful of of people who’ve gotten reinfected; I don’t think it’s particularly common,” Malosh said. “But we don’t really know what it’s going look like when a large number of people are getting exposed to the virus a second time after they’ve already been infected.”
The letter from medical experts to Shirkey underscores that point.
“Even if herd immunity is achieved, the coronavirus can still infect people. This means that even after a tremendous loss of life, there would still be an ongoing risk, leaving many understandably wary about returning to their previous levels of activity,” the letter said.
6. We don’t know enough about long-term effects of having COVID.
Doctors also say we don’t know a lot yet about how the virus could impact individual’s health over the long term, even if the patients aren’t sick enough to require hospitalization.
Nine in ten coronavirus patients reported experiencing side-effects such as fatigue, psychological after-effects and loss of smell and taste after they recovered from the disease, according to a preliminary study by South Korea released last month.
An Irish study found more than half of coronavirus patients studied suffered persistent fatigue in the aftermath of the initial disease.
“There are a number of studies now starting to look at the people who are recovering from coronavirus,” said Dr. Matthew Sims, an infectious disease specialist for Beaumont Health in metro Detroit. “One that just came out said when they looked at all their patients an average of 60 days out, only about 13% of them had no symptoms at all.”
A future pivot?
In the statement to MLive, Shirkey’s office said the majority leader “thinks heard immunity should be part of the discussion moving forward on policies regarding COVID in the state. He is not a medical expert and therefore is open to the research and expertise of professionals who are willing to weigh in on the topic.”
Cheatham said he is “stunned” by Shirkey’s push for herd immunity.
“Shirkey has been good for public health in so many ways,” Cheatham said. “So when he says something like that, I’m just really thrown back on my heels because I feel like he knows that the mortality and hospitalization consequences of trying to do herd immunity. I’m just stunned by that comment.”
That said, Cheatham said it’s important to keep an eye on mortality and hospitalization data.
“If it reaches a point where the cost to society is not very high, then I think it’s absolutely reasonable to pivot and say OK, the worst is past us,” he said. “Reasonable people have to have that conversation.
“At this point in time, in my judgment, this is still a killer disease,” he said. “But my team is exhausted. If it becomes benign, I’ll be the first one to say OK, it’s all right now. We can relax.”
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