Lockdowns versus herd immunity

NICK EICHER, HOST: Coming up next on The World and Everything in It: lockdowns or herd immunity.

The U.S. death toll from COVID-19 began to slow in mid-May after weeks of social distancing. But the disease has still taken more than 90,000 lives. 

The economic toll is also dire: Damage to and outright destruction of thousands of businesses and the resulting joblessness have led to economic loss that could rival the Great Depression.

BRIAN BASHAM, HOST: There’s a growing consensus that our economy cannot survive indefinite lockdown. But how do we reopen in a way that prevents outbreaks that overwhelm hospitals? 

WORLD reporter Jill Nelson now on the different approaches different countries are taking to answer that question.

AUDIO: SOUND FROM BEACH

JILL NELSON, REPORTER: It’s Saturday afternoon in San Clemente, California, and local beaches are crowded. People are tired of quarantine, its many demands, and its economic toll. That’s why the perspective of people like Scott Atlas, a former neuroradiology chief at Stanford Medical Center, has so much appeal.

ATLAS: If we totally prevent human interaction, we are preventing immunity in the population. This is very important to understand. Ninety-nine percent of people who get this infection are either asymptomatic or have very mild illness.

Atlas, who’s also a senior fellow at the Hoover Institution, claims lockdowns do more harm than good. Among those harms: economic devastation and forecasted deaths due to undiagnosed cancer treatments and other delayed medical visits.

Many in Atlas’ camp also have theories about the nature of the virus. They claim it’s far too contagious to be contained and will eventually result in the same infection rate around the world. They say herd immunity is our passport through this ugly season.

And Atlas says that means we need to do a better job protecting high risk groups and letting the virus circulate among low-risk groups.

ATLAS: There’s absolutely no rationale for closing K through 8 schools. There’s no scientific basis for doing that. 

This mirrors the approach Sweden embraced from day one. The Scandinavian country made the bold decision to keep K-through-8 schools open and avoid lockdowns. Groups over 50 are banned but restaurants and other businesses that follow national guidelines can stay open. That stands in stark contrast to other countries in Europe.

Anders Tegnell is Sweden’s chief epidemiologist. He helped direct his country’s approach and claims lockdowns don’t prevent deaths; they just delay them. Earlier this month he updated Sweden’s progress in a video posted online.

TEGNELL: We think that we are reaching maybe a quarter of the population in the Stockholm area that have had the disease by now. And we believe that’s part of the reason the disease is slowing down now that a quarter of the population is immune. 

Andrew Noymer is an epidemiologist at the University of California in Irvine. He says Tegnell’s theory is unproven and comes at a high cost.

NOYMER: Sweden does not have flattering mortality statistics. Literally, elderly Swedes are being sacrificed for this policy of more freedom.

In mid-May, Sweden had 343 deaths per million, surpassing the United States’ per capita deaths and ranking 6th in the world for countries over 10 million people. Some say Sweden’s approach could prove even more disastrous for the United States because of its higher urban density and worse average health. And early economic projections show Sweden may not fare much better than the United States and Germany in terms of unemployment and GDP.

Atlas doesn’t look to Sweden as the model we should follow and blames Sweden’s death rate on its failure to protect nursing homes. But he does agree with Tegnell’s immunity theory. And he says the mortality rate of the virus is lower than many claim.

ATLAS: There have been three dozen studies all over the world that say the fatality rate is in the order of 0.1, 0.2, 0.3 percent. I don’t know the exact number because we don’t have the correct denominator, the number of infected people.

Noymer disagrees and puts the fatality rate around 0.6 percent. That would make COVID-19 six times more deadly than influenza with the ability to spread much faster and farther. Others in his field say the fatality rate is closer to 1 percent, making it 10 times more deadly than influenza. Many have pointed out that we don’t know the threshold for COVID-19 immunity or how long it lasts.

What you believe about fatality rates and immunity affects the policies you embrace as the economy begins to open. Atlas supports school openings, but Noymer believes it’s too early to decide. He points out that children bring the virus into the home. 

Sweden’s approach also assumes there won’t be a vaccine any time soon. 

Even if a vaccine takes years to develop, Noymer says it makes sense to delay deaths.

NOYMER: My take is that as this goes on and on, clinicians will get better and better at treating it. So the death to case ratio will decline over time as doctors, physicians get a better handle on clinical approaches.

Atlas and Noymer do agree on a few things. First, COVID-19 isn’t going away soon, and contact tracing will not save the day. New Zealand is among the countries that locked down early and employed massive testing. It now boasts a fatality rate of only four deaths per million. But Noymer says the scope and scale of contact tracing necessary to achieve similar results in the United States is beyond reach.

NOYMER: It’s one thing to talk about contact tracing when we’re all on lockdown and we have three contacts per week but what about when we start opening up and have 30 contacts per week?

Second, both recommend a slow reopening of the economy that includes social distancing measures and some testing. Atlas says Americans are already prepared  for that. But exactly how that plays out over the coming months in terms of fatalities versus economic gain remains to be seen.

Reporting for WORLD, I’m Jill Nelson in San Clemente, California.

(Photo/iStock)

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