The controversial appointment of a new presidential medical adviser has put a national spotlight on a radical disease management concept to deal with the COVID-19 pandemic.
Its benign name — naturally acquired “herd immunity” — belies the cruelty at the heart of this approach. A better descriptor would be “do nothing and let the virus kill off the weak” plan.
Eventually, COVID-19 would stop spreading because there would be enough survivors of the infection (the herd), and they presumably would have some immune system protection against the pathogen. But this could come at an unacceptable cost: potentially millions of deaths in those with underlying health conditions that make them susceptible to severe infection.
This week, the new White House medical adviser, Dr. Scott Atlas, forcefully pushed back on reports that he is advocating policies rooted in this approach. The neuroradiologist said this is “an overt lie” during a Tuesday CNN interview. That rejection is welcome. While other countries have considered variations of this strategy or even pursued it unsuccessfully, letting the virus run its course is a deeply flawed approach.
It should not be taken seriously by the nation’s policymakers, especially with the rapid strides underway in vaccine development. A safe, effective vaccine would provide population-wide protection. Experts are hopeful one could be widely available in 2021. But if there are setbacks, herd immunity should not be considered a fallback approach.
While herd immunity persists as a social media talking point and was recently mentioned by President Donald Trump in an interview, leading infectious disease doctors in Minnesota and elsewhere do not support the naturally acquired herd immunity approach. Dr. Anthony Fauci, the venerable director of the National Institute of Allergy and Infectious Diseases, told Politico this week that neither he nor White House adviser Dr. Deborah Birx back this strategy.
The Infectious Diseases Society of America (IDSA), which represents over 12,000 physicians and scientists, told an editorial writer this week that “IDSA is not supportive of the herd immunity approach to addressing this pandemic.” Experts at the Mayo Clinic and the University of Minnesota are critical.
One fundamental concern, said Mayo’s Dr. Pritish Tosh, is that it’s not clear how long immune protection lasts in people who have been infected with COVID. Protection from other viruses in the same family isn’t long-lasting, he said, yet assuming otherwise for COVID-19 is at the heart of the naturally acquired herd immunity strategy. “And that’s an assumption I don’t think we can make,’’ he said.
The University of Minnesota’s Dr. Tim Schacker called naturally acquired herd immunity a “terrible strategy,” noting the potentially “huge cost” to human life for an approach that “may or may not work.”
Schacker also rejected one rationale for herd immunity, that the vulnerable could simply isolate. High blood pressure, obesity and other underlying health concerns that increase the risk of severe COVID are common. Putting an indefinite bubble around everyone with these conditions, along with the elderly, isn’t doable.
Both Tosh and Schacker also noted that those who are infected and recover from COVID may have serious long-term complications. One concern: heart damage.
The case against naturally acquired herd immunity is strong. There are those who still may embrace it because they believe it would bolster the economy. But the evidence for this is weak. Sweden, which relied on a voluntary COVID containment with the aim of developing herd immunity, has fared better economically than some European Union countries but has the highest unemployment rate among Nordic nations. Sweden also came in eighth in a recent global ranking of mortality rates per million, further evidence of the high and unacceptable price tag inherent in this herd immunity approach.