Again, we have NO evidence that “herd immunity” to the novel coronavirus is even possible. None.
So far, the assumptions in your post appear to be unsupported by anything other than opinion.
Those who want to volunteer for exposure to infection under such conditions are, I suppose, free to do so.
But what you have not provided is one particle of support for the notion that people should be forced–or even merely pressured–to expose themselves to infection, at this time in which there is so little evidence for any of the claims in your post.
Perhaps in some number of months we will have more evidence one way or another, with which to evaluate your claims. But at present we are going solely on opinion. And that’s not a reasonable basis on which to urge people to put themselves in danger.
Please note I am not promoting the specific approach of the article, even though I would be a willing volunteer. I was sharing a model that is a serious consideration of an approach that is independent of American partisanship.
Your belief that the assumptions are unrealistic are duly noted.
We don’t know that exposure and development of antibodies conveys immunity, although experience with exposure to other coronaviruses has been shown to convey at least a significant degree of immunity for several years. However, we do not know this to be the case with related members of the particular genus of betacoronavirus that infect humans (specifically the SARS-CoV(-1) and MERS-CoV viruses) because of how quickly those epidemics were shut down. Once there is more evidence from antibody testing and a better understanding of the virus in viro it should become clear how much protection exposure or inoculation provides although it may be variable among the population, and in order to understand that it will be necessary to study people who are exposed in a controlled way. The big unknown that you highlight is just being able to discriminate high risk members of the population, and a better understanding of how the virus attacks at a cellular level, and how that can be correlated to measurable characteristics is necessary to do that.
I believe what DSeid is proposing (at least with respect to his own participation) is to recruit volunteers from populations with low risk of severe morbidity and mortality AND who are otherwise likely to be exposed anyway (such as medical workers, first responders, and employees in public facing roles such as grocery store clerks). There is nothing particularly unethical about this; it is exactly the same approach taken to vaccine trials, and since it is essentially using the virus as a live unattenuated vaccine, the same methodology can be applied.
There is risk of unexpected consequences, of course, but that is true with any vaccine or drug trial, and so the same controls would be used (double blind, start with a small dose size and go upward, monitor for CRS or other adverse responses) and same type of monitoring protocols. It is clear that the majority of people in all age groups below 60 have very limited or no presentation of symptoms of COVID-19, so the question is really how much risk can be tolerated in that trial and how much of the population are you trying to protect, which dictates the scale of such a trial and what demographics would be covered. I doubt it would be considered to expose people 60 years old and up because of the increased incidence of serious presentation of COVID-19, but again, a lot of people of that age who are actively working in roles in which they may be exposed anyway may be willing to volunteer just so they can continue to do essential work.
We KNOW that herd immunity is possible. We don’t know at what level of infection for what degree of social interaction but every country to city that has current drops in new cases and in death rates is demonstrating that given a specific circumstance of interactions some level of number in the resolved bucket leads to herd immunity. For NYC at the current level of social interactions, according to the preliminary antibody survey, 21% of New Yorkers being immune, is resulting in herd immunity. If not the rates of new cases, of hospitalizations, of ICU admissions, and of deaths, would not be falling like they are. What is the level for herd immunity with any specific release from any specific social distancing measures? To be determined. How complete and lasting is an individual’s protection? Does it correlate with antibody levels? Only best educated guesses and opinions are possible right now. The WHO is very correct to state that it is premature to claim that it is impossible to get reinfected just because one has antibodies. An “immunity passport” should not excuse an individual from exercising caution, especially around the most vulnerable, even as it marks them as being in the lowest risk group possible. It may be possible to be reinfected, even if less likely. there is to date no evidence that however that reinfections DO occur, even at all, let alone to any significant degree. But not proven that it cannot occur, very true.
That the period of infectiousness is limited is in fact quite well established. Even when viruses are detected later on (in those who were felt to have potentially been reinfected) they do not seem to be viable.
The numbers used are likely reasonable estimates of mortality rate for the hypothetical cohort, which would not only be chosen by age but also for the lack of other identifiable risk factors. They used estimates out of Wuhan. We can use the preliminary numbers of NYC infections and the current death rates by age cohort for the city overall: 13.59/100K for those 18 to 44 in NYC. 21% infection rate, so 13.59/21,000 = 0.06% based on that, inclusive of those in that age cohort with comorbidities that would be disallowed under that plan.
Massive assumption are made in every model that exists. These are pretty standard ones.
I don’t see this plan as a practical one, at least for the United States. But every plan that involves any relaxation of social distancing at any point is going to be subjecting some additional population to increased risk. It may be that herd immunity does not come into play with no social distancing required until and if a safe and effective vaccine is widely used, or it may occur before that. But along the way some populations will have increased exposures and risks no matter which changes are implemented. Again, any plan has to include protecting the most vulnerable from being part of that additionally exposed group as much as is possible, balanced against the harms that those protections cause to them.
Stranger - the plan of the article (not my plan) is to get over 80% of the identified lower risk population to participate over the 210 days, which might be possible in Israel. It certainly would make sense to lead with those “who are otherwise likely to be exposed anyway” but the article did not specify such. But yes in regards to my willingness to step up.
Not a hypothesis simply one of many things I can come up with to explain high death rates. Nothing more than something I wondered about and tomorrow I imagine there will be something else I might suspect and want to take a closer look at.
So, for those who want to understand the why the evidence-based approach to medicine is important and why happens when you use other ‘alternative’ approaches, the recent episode of the This Week in Virology podcast (“TWiV 606: Evidence-based science and medicine for COVID-19”) (hosted by Dr. Vincent Racaniello, Higgins Professor in the department of Microbiology and Immunology at the Columbia University College of Physicians and Surgeons) which addresses the most recent observations of COVID-19 observations and discussion of tests of an inactivated virus vaccine. At about 1h15m there is discussion about challenge trials and why the podcast participants (Alan Dove, Rich Condit, and Kathy Spindler) don’t think it is ethically supportable and may not be efficacious in reducing time to a vaccine.
That’s all a hypothesis is. And generating a whole bunch of them in a brainstorming fashion is fine. But then you have to test out your hypothesis by seeing if the known facts falsify it or potentially support it. Otherwise one is more akin to Trump wondering out loud if injecting Lysol is a good thing to try!
The big difference between other such challenge trials and the ones being proposed for COVID-19 is, of course, the lethality:
Not that your post ignored these points, of course. But this quotation highlights them further.
In this discussion of challenge trials we have strayed from the OP’s point, which as I read it, is the argument commonly made on the right that—irrespective of the development and availability of better testing—it is a good thing, in and of itself, for more people to be exposed to the novel coronavirus.
I continue to see this as a cynical and exploitative notion being pushed by people who want others to take risks, with no intention of taking them themselves. I have to say I haven’t read anything in this thread that persuades me that my view of this is mistaken.
Agreed, and that is why I would not advocate for challenge trials myself given the current unknowns about why people without any underlying conditions are dying, often suddenly. But if you had a group of volunteers who were likely to be exposed anyway and knowingly undertook the risks, you’d have to weigh that against the deaths that you statistically know will occur without a vaccine (assuming that social distancing measures aren’t maintained and no level of effective herd immunity is achieved). If you could discriminate between those who are for some reason prone to the atypical blood clotting and cytokine release syndrome effects (which may or may not be related) then you could have good confidence that at least those known effects would be unlikely to occur, but given that we do not have such knowledge I don’t think there would be an ethical way to run such a trial.
Yeah, there are a lot of people who just want this all to be over, and imagine the premise that all the people who are going to die from the contagion are doomed anyway, so why bother locking anything down and hurting the econoymy. This neglects the massive number of casualties that will occur because the health system is overwhelmed (and which are already occurring now with heart attacks, appendicitis, and doubtless other deaths from cancer and other chronic illnesses that are not being treated), and also the fear and anger from just condemning to death those who may potentially be saved by interventions, and all of the effects that would have on economic activity. One might just as well advocate for the policy of euthanizing anyone who starts showing severe symptoms and be done with it. We wouldn’t do that, of course (well, most of us, I’m confident) because it would be inhumane and stupid, but that would essentially be accomplishing the same thing.
If it was an idea yes I would, if it is simply a question I don’t see the need. I am really hoping that the death rate in New York does not turn out to be typical. So I am looking for anything I can come up with that might explain the high death rates. I am still not convinced that New York might have more than it’s share of weakened senior but I haven’t had any luck finding it anywhere.
It’s sobering to realize how little we know about this virus and its effects.
And of course that problem is compounded by the politicization of the pandemic, world-wide, with some nations sharing information and others either declining to share, or even producing false information.
Well, it’s a novel virus so we expect to see unsuspected behavior. But I think physicians were caught off-guard because COVID-19 was originally described as being ‘just’ a respiratory illness based upon the signs and symptoms but now what is apparent is that the virus goes far beyond the respiratory system, and breathing problems are the tip of the iceberg for severe presentations, hence why the measures used to treat ‘normal’ pneumonia-like illness.
The “politicization of the pandemic” is unfortunate but to be expected. A lot of blame has been heaped on the Chinese national government and the Communist Party of China, a good portion of which is probably well-deserved, but it is clear local officials tried to cover up or minimize the outbreak which allowed it to grow to epidemic proportions, and then as it spread to other nations authorities failed to act promptly or report realistic (rather than grossly optimistic estimates bordering on hopeful pleading). This speaks to the need for a transnational authority that has specific powers with regard to surveilling and tracking potential pandemic outbreaks because pathogens do not play politics and do not respect borders. Those nations that played the political cards are now suffering for their lack of honesty and openness, because when you lie to other nations about the state of affairs you can’t help but to lie to your own citizens and medical establishment, too. We have yet to see the political ramifications stemming from this pandemic (and this forum is not the right place to discuss them) but I would not be surprised to see some dramatic changes that come about because of the effects, both medical and economic, from this pandemic.
Hopefully, all nations can cooperate when it comes to distributing treatments and (hopefully) and eventual vaccine rather than play political games but I guess we’ll see what comes.