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No, herd immunity is still not a viable strategy -- and the Barrington declaration is unscientific and unethical

This declaration is not about science nor medicine. It's about politics.

Mihai Andrei
October 8, 2020 @ 10:30 pm

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The so-called ‘Barrington Declaration’, calling for a lax approach to COVID-19 and the ‘benefits of herd immunity’, is nothing more than a fringe viewpoint going against all we’ve learned in the past months.

The only thing it’s succeeded in is making it seem that researchers are divided on the topic when in fact, they’re really not, in a fashion that’s reminiscent of climate change denial.

Culling the weak

A libertarian thinktank and three researchers celebrated with champagne as they signed a document offering an ‘alternative’ way of dealing with COVID-19. The declaration, which offers little in the way of scientific evidence, claims that a more hands-off approach in dealing with the pandemic: no lockdowns, no closed schools or universities, and a “Focused Protection” where the younger population is allowed to go about their lives normally. Ultimately, the declaration says, we’ll reach herd immunity and all will be fine.

Except, almost everything about that is wrong.

For starters, the declaration seems to imply that governments want lockdowns and we’re in a constant state of lockdown. But that’s not the case. Very few places have had a full lockdown for more than 1-2 months, and you’d struggle to find any states arguing for a full lockdown. Virtually all governments are pushing different measures, and at most, localized lockdowns — so the Barrington Declaration, as its signatories called it, is arguing against the policies of the past.

Dr Michael Head, Senior Research Fellow in Global Health, University of Southampton, comments:

“The Barrington Declaration is based upon a false premise – that governments and the scientific community wish for extensive lockdowns to continue until a vaccine is available.  Lockdowns are only ever used when transmission is high, and now that we have some knowledge about how best to handle new outbreaks, most national and subnational interventions are much ‘lighter’ than the full suppressions we have seen for example in the UK across the spring of 2020.

Another core argument of the declaration is that if we protect the older groups, we’re basically okay. According to Rupert Beale, a group leader at the Francis Crick Institute in London, that’s nothing more than “wishful thinking”.

For starters, it’s impossible to identify who is vulnerable and who isn’t — because it’s not just the elderly, it’s also people who suffer from obesity or a myriad of other conditions, or people who live in specific environments. Under the Barrington approach, these vulnerable groups would just be abandoned in a ‘cull the weak’ fashion (no word about the non-fatal long-term health effects, either).

“Logistically, how on earth are we to both identify those at risk and effectively separate them from the rest of society?” asks Dr Stephen Griffin, Associate Professor in the School of Medicine, University of Leeds. “Basing risk primarily upon risk of death completely ignores the profound morbidity associated with the pandemic, including what we now term as “long COVID”, plus the criteria by which one or more risk factors might predispose towards severe disease remain both uncertain and incredibly diverse – we have only lived with this virus for ten months, we simply do not understand it well enough to attempt this with any surety.”

Furthermore, infection rates show that as the number of cases grow, they spill over to the elderly. If we allow the virus to run rampant through society, it becomes essentially impossible to protect the elderly. Any reasonable scientist would understand that.

“Individual scientists may reasonably disagree about the relative merits of various interventions, but they must be honest about the feasibility of what they propose,” Beale said.

Beale is far from the only expert to criticize this idea. Speaking to The Guardian, William Hanage, a professor of epidemiology at Harvard, says the strategy is like taking a house fire and fanning the flames, while putting all your valuables in one room and guarding them with a fire extinguisher.

“If the blaze outside the room were adequately controlled then maybe, just maybe, they would be able to stamp out all the embers,” he said. “But this approach is to actively encourage the fire. The risk is that too many sparks make it through and all you’re left with is ashes.”

Another aspect the declaration seems to ignore is that protecting vulnerable groups (and especially the elderly) is already an important part of the coronavirus strategy. But again — protecting the vulnerable sounds fine and well, but doing it as your cases surge is unrealistic.

Jonathan Read, a biostatistician at the University of Lancaster and a member of the Sage modelling subgroup in the UK, explains:

“Shielding of the vulnerable was part of the UK policy since the start of lockdown. The deaths of the elderly, and others at high risk, in care homes and from community infection, even after the imposition of lockdown in March, suggest that a policy that entirely relies on a segregation of society isn’t going to go well,” he said.

In the declaration, there’s no mention of flattening the curve of protective measures

The authors of the declaration don’t even make an attempt to explain how this shielding would happen, or how the vulnerable would be categorized. Even one of the lead signatories (Jay Bhattacharya a professor at Stanford University Medical School), struggled to explain how a grandparent living with a school child could be protected. Researchers at the Max Planck Institute in Germany have published an extensive explanation as to why this just can’t happen.

The Barrington declaration also doesn’t really address what we should be doing to prevent viral transmission. It says nothing of face masks and social distancing, two of our main weapons against the virus.

Without specifically spelling it out, they suggest that the virus should be allowed to spread through the world. But that would be a disaster.

Herd immunity is as unrealistic as ever

Ultimately, the declaration hinges on achieving herd immunity but as has been discussed since the beginning of the pandemic, herd immunity is a disastrous approach.

In order to achieve herd immunity, you’d need a substantial part of the population to be immunized so that the virus can’t readily spread through society. We’re not sure how much of the population would need to be immunized for COVID-19, but it seems to be in the ballpark of 80-90%.

Let’s take the US, the country with the highest number of cases as an example.

For starters, even as it’s suffered a severe outbreak, the US is not even close to achieving herd immunity. A late September study found that in the US, where over 210,000 people have been killed by the virus, just 8% of the population exhibits antibodies. So to achieve herd immunity, we’d need to kill about 2 million people and leave even more with long-lasting damage. But that’s assuming that the infection spreads at the same rate as it has so far — if it accelerates, it will overwhelm medical facilities and cause even more casualties. Again, the declaration provides no detailed plan or structure for how this would be done.

“Scientifically, no evidence from our current understanding of this virus and how we respond to it in any way suggests that herd immunity would be achievable, even if a high proportion of the population were to become infected,” adds Griffin. We know that responses to natural infection wane, and that reinfection occurs and can have more severe consequences than the first. It is hoped that vaccines will provide superior responses, and indeed vaccination remains the only robust means of achieving herd immunity.”

If that’s not argument enough, then it should be said that we don’t even know how long immunity lasts. It’s probably not lifelong. If we’re judging from other coronaviruses, immunity wanes over time in a relatively short time, so without a vaccine, achieving herd immunity might not be possible even if we allow everyone to become infected. We still don’t know that much about how COVID-19 immunity works, but even if it lasts a couple of years, it might not be enough as the pandemic could move in waves. Simply put, there is no natural path towards herd immunity that’s not horrific or unrealistic.

Unscientific and unethical — reminiscent of climate change denial

Given all these severe shortcomings, it’s unsurprising that the reaction from scientists has been vitriolic. Devi Sridhar, Professor of Global Public Health at Edinburgh University and an adviser to the Scottish government, bluntly called the declaration neither ‘scientific’ nor ‘accurate’.

But what is surprising is that signatories include renowned researchers, including Sunetra Gupta of the University of Oxford, Jay Bhattacharya of Stanford University, and Martin Kulldorff of Harvard University — so then why hasn’t this been published through the scientific channels? Why, instead of making scientific arguments, are the signatories making vague statements and recommendations? If anything, the declaration seems more political than scientific in nature.

The fact that the whole thing was hosted by the American Institute for Economic Research (AIER), a right-wing libertarian think tank also doesn’t help the case. AIER now claims to have over 100,000 signatures, coming from “public health scientists, medical practitioners, and the general public”. This murky approach that avoids scientific practice and boasts signatures from ‘experts and the public’ is reminiscent of the practices of climate change deniers. Unsurprisingly, AIER has also expressed opinions against climate change action, calling it a “political belief” and “silly scaremongering“.

That reputed scientists associated themselves with this type of institute and signed a vague and unrealistic document that could best be described as ‘fringe’ once again screams politics and right-wing economics, not science. There’s another concerning similarity with climate change denial here: the only thing the declaration truly managed to achieve is to create the illusion that there is a genuine scientific debate when this really isn’t the case.

It’s an old strategy, prevalent since the ‘tobacco wars’, where a group of companies and scientists tried to argue that cigarettes aren’t bad for you. The plan was to make it seem like scientists are divided, even if it was just a handful of scientists. The same strategy was picked up by climate change deniers (if you want an excellent read on that, Merchants of Doubt is an excellent place to start).

Here’s how a scientific debate goes:  In May, Gupta published a study claiming that the coronavirus may have infected half of the UK population already. She turned out to be wrong — in London, the most heavily affected area, the proportion of those infected was closer to 18%. There’s nothing wrong with that, that’s why we have science in the first place, to put forth hypotheses and scrutinize them thoroughly. This was an actual scientific divide.

With this declaration, Gupta and co-signatories are essentially placing themselves outside of scientific debate and into the political spotlight. It’s no surprise that the likes of US Senator Rand Paul were all over this. Paul, also a libertarian, has been a staunch opponent of pandemic prevention measures, distorting the facts on multiple occasions, something for which he has been called out by actual researchers.

At the end of the day, this is what the Barrington Declaration stands to offer: fuel for people like Rand Paul to pursue their policy outside of scientific questioning.

Understandably, we’re all exhausted from the pandemic. We’re tired of the uncertainty and hearing that no clear end is in sight. But searching for easy, misleading fixes is not the way to go. It won’t be easy, but there is a light at the end of the tunnel, and we will reach it — the scientific way.

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