While I agree that it is time to take continuous steps toward reopening, there are several aspects in Rob Williams’ article promoting to end the assault to herd immunity that deserve comment. In my opinion, the whole analysis misses the crucial point that the whole problem from a public health policy perspective is not stopping the spread of the virus but how to effectively slow down its spread to avoid the crippling of our hospitals during the epidemic.
Putting for a moment the deadliness of the virus aside, different from the flu, COVID-19 has a capacity of spreading at a significant higher rate through the population (also because lots of people are vaccinated against the flu). And if it is true that most of the people contracting the virus may be totally asymptomatic or lightly affected, there are many of those falling sick that need important medical attention. Even if the absolute numbers were identical with flu (and they aren’t!), the problem with COVID-19 is that these may occur in a very short period of time sending the hospitals under water.
There are several measures that can be taken to slow down the speed of the spread so that hospitals can cope. Lockdown is one of them and I agree that it may not be the most effective one. However, it is a “broad-spectrum medicine” when you still do not know very well several aspects of the virus’s capabilities, allowing to reduce the rate of contagion, and buying time to better figure things out. I would argue that Vermont is an example of its effectiveness. By locking down early, especially closing the ski stations that attract so many tourists here in Vermont during the winter months, the hospitals have not gone under stress at any time. As of June 1, 2020, Vermont has no hospitalizations related to COVID-19.
Other successful examples are Greece and Portugal that, compared to other nations with similar populations, have had significantly less hospitalizations and deaths by choosing to lock down before the wildfires started. Other measures are the ones taken by Taiwan or South Korea, such as early border control, proactive case finding and containment, resource allocation and reassurance and education of the public, but they prepared as soon as the first cases were announced in China. The U.S. was totally unprepared.
Then there is the example of Sweden that is letting the virus spread around by maintaining social distancing but with no lockdown, trying to reach herd immunity. While this could be an effective policy, it should be also clear that there may be important costs to pay. From the data available as of today, while it may be true that in populations under 65 years old COVID may have similar effects of the flu, on older populations it is significantly more severe. It is estimated that the rate of mortality of COVID is between 1 and 2% of the population affected. Is this affordable? To put things in perspective, in Vermont that is a possible 4,000 to 8,000 deaths until we reach herd immunity (approximately two-thirds of the population need to be contaminated). For reference, as of June 1, 2020, 55 people have died in Vermont due to COVID. So, we either risk having a significant number of deaths toward herd immunity or we keep isolated all the elderly and other categories at risk until that day. But how do we deal with them in the long run? Is it acceptable to lock down some people in order for some of us to run free?
I am not necessarily an advocate for lockdown, and for my family, and probably it would be easier to get it and get it over with (but again, what if we need hospitalization and hospitals are under pressure?). When I decided to vaccinate my kids it was not only to protect them from various diseases but also to guarantee the herd immunity to protect those who do not have a choice to get vaccinated due to their medical conditions.
Similarly, I feel that respecting keep-the-distance measures and wearing a mask are actually very altruistic actions (even if maybe not that effective) toward protecting our health care system (which needs it) and those who are more susceptible until we figure things out. Vermont is carefully loosening these measures one step at the time. Let us continue to show that we care for one another.
Propato lives in Warren, Vermont.
