COVID-19: Welcome to the Herd! Are you ready?

CORONAVIRUS | SARS-CoV-2 | COVID-19

Agencies: Centers for Disease Control (CDC) / World Health Organization (WHO) / Department of Homeland Security (DHS) / National Institute of Health (NIH) / National Institutes of Allergy and Infectious Diseases / Surgeon General / United States Coronavirus Response Team / British Society for Immunology / World Society of Virology Universities: Harvard University / Yale University / Johns Hopkins University / Stanford University / Imperial College UK Hospitals: Mt. Sinai Hospital / University of Pittsburg Hospital / Vanderbilt Medical School Think Tanks: Cato Institute / University of Nebraska National Strategic Research Institute / Hoover Institute / British Medical Journal (BMJ) / United States National Library of Medicine Virology Journal

Welcome to the Herd

By Jacqueline Cartier

While the motto is “you are not alone”, never in our history, have we felt more isolated. As states begin to open, there is a divide between those who are ready to move forward and those who, because of continued danger, are fearful of public contact. One says, my family is in danger if I don’t return to work; the other says, I am in danger if you do. It helps to understand the shifting scientific data, as we become more proficient at detecting the threat.  

After 7+ weeks of fear and panic, things are beginning to ease. Yet, concern and anxiety remain for many. The culprit… COVID-19. The numbers quoted have been horrific. However, as data replaces predictions, we are gratefully doing much better than anticipated.  We are now adapting to the new information being generated. 

I will begin by saying that I am not a physician or epidemiologist; however, as a crisis management professional, I am often asked to dissect confusing & contradictory information and presenting it in a manner that all can understand, as a result, a different perspective often emerges. 

As we reopen our economy and people return to working and socializing together, it is important to comprehend why we are receiving conflicting information. That understanding helps us to prepare a plan of action for regaining our lives. Separating fact from hyperbole is essential. 

We’ll touch on several pertinent issues, understanding that some may be subject to change as new information becomes available:

Shelter-in-place Orders vs Herd Immunity

Masks & Transmission

Vaccinations

Perspective on Data

Testing 

COVID-19 & Vaccines: The Novel (new) Coronavirus is a variant of the same old culprits SARS & MERS but a stronger variant, called SARS-CoV-2 (79% genetic similarity), and is from the same family as the common cold. It should be noted that we have never been able to develop a vaccine for any of these viruses. The seasonal flu has a vaccine that must be reformulated annually due to mutations, and according to the Centers for Disease Control (CDC), has only a limited efficiency rate, between 19%-60%.

Let’s remember that vaccines take on-average, 8-years to develop, many have taken decades, and some never come to be. Dr. David Nabarro, Professor and Global Health Chair at Imperial College London and former Special Adviser to the United Nations, has warned that in reference to the Coronavirus, we should make no absolute assumptions about a vaccine, adding that one may not appear at all. 

“Expert” Contradictory Statements: As sources of information on the Coronavirus change and numbers continue to increase, we must view the risk in perspective. Balance is essential to creating long-term strategies. Part of the confusion is that well-intentioned specialists began by using projections based on inaccurate models, where even the most senior of experts got it wrong because their base data was flawed. Numbers are no longer theoretical; we have actual results, which are much less threatening than anticipated, causing experts to reverse prior recommendations. 

Just a few weeks ago, the World Health Organization (WHO) insisted that complete societal isolation was the only way to proceed. “Flattening the curve” (where the numbers stop rising) was considered to be the only responsible action anyone should take, with the understanding that the virus could continually resurface until a vaccine was developed.   

People around the globe listened and societies and economies completely shut down. Shelter-in-place went from a recommendation to an order. Every major country obliged… except for Sweden. They chose a herd immunity approach. The mortality rate per capita has been relatively identical. What made Sweden decide on a different route and has it been successful? 

Immunity is a natural bodily function that comes from exposure, either through vaccination or direct contact. Developing that immunity as quickly as possible would save the greatest number of lives. 

The Swedish Model: On April 29th Dr. Mike Ryan, Executive Director of WHO’s Emergencies Program, praised Sweden’s tactics, “I think if we are to reach a new normal, Sweden represents a model, if we wish to get back to a society in which we don’t have lockdowns”.

Sweden determined that it could achieve faster and more accurate results with herd immunity, where 60-80% of the population develops immunity through exposure, ultimately eliminating the possibility of transmission because the virus has nowhere to go. Yale’s medRxiv (health sciences) group says that Coronavirus immunity would last at least 1-year and potentially a lifetime (still too early to determine). 

Lockdown and herd immunity similarities

·        Both require time for immunity to be developed 

·        Both will include deaths of the most vulnerable

·        Both require testing measures

·        Both emphasize additional sanitation procedures (washing hands, cleaning surfaces, etc.)

·        Both require shelter-in-place containment, if exhibiting symptoms (with or without testing)

·        Both approaches include protecting the most vulnerable… the elderly and those who are immunocompromised

·        Both understand the seriousness of this medical crisis

·        Both are effective at containing a pandemic

Those who favor herd immunity over more stringent measures, cite several reasons:

·        A break in societal interactions and cohesiveness

·        The long-term effect on children

·        The toll on mental health

·        Economic collapse

·        Percentage of death rate relative to other health issues

·        The limited target demographic

·        The lack of vaccine development with similar viruses 

One of the most important considerations is the predictable return of the virus, as those in isolation re-engage with others, causing a resurgence which is currently predicted for this fall – creating the V-shape model that will reoccur continually, each time a bit lower than the previous, until it becomes negligible. Harvard University’s TH Chan School of Public Health published a study (March 2020) stating, “One-time interventions will be insufficient to maintain COVID-19”, and went on to say, “these measures may be necessary into 2022”.

Triggering the body’s immune system occurs via vaccine or exposure. Dr. Deborah Birx, MD, United States Coronavirus Response Team Coordinator, discussed exposure immunity with AARP in June. She said, “People shouldn’t be concerned that their antibody levels may wane because, if they do get re-exposed, they’ll make antibodies very quickly”. 

IMMUNITY UPDATE JULY 2020: We may have already reached herd immunity levels (+60%) in high density areas like NYC. On July 7th, according to Dr. Scott Atlas, Stanford University Former Chief of Neuroradiology & Senior Fellow Hoover Institute. As we know, Immunity levels can be achieved through vaccinations (not yet available) and herd immunity (exposure), but it has recently been discovered that T-Cells (T-lymphocyte) an immune system white blood cell, which responds to antigens (foreign substances) in the body, also provides immunity. 

Researchers at the Centre for Infectious Medicine Karolinska Institutet in Sweden, found that people with mild or no symptoms had developed “T-cell” immunity, despite testing negative for Coronavirus antibodies. They found that T-cells could be a source of immunity for twice as many people as Covid-19 antibodies. 

Published on the BioRxiv portal, Marcus Buggert, Assistant Professor at Karolinska, and Professor Hans-Gustaf Ljunggren, co-senior author stated, “Our results indicate that public immunity to Covid-19 is probably significantly higher than antibody tests have suggested”. They found that T-cell response was consistent with measurements taken after approved vaccinations for other viruses such as the flu.

Professor Danny Altmann, British Society for Immunology spokesperson and Professor of Immunology at Imperial College London, said: “Among the many studies of cellular (T cell) immunity to SARS-CoV-2 that have appeared in the past few months, this is one of the most robust, impressive and thorough in the approaches used. “It adds to the growing body of evidence that many people who were antibody-negative actually have a specific immune response as measured in T cell assays, confirming that antibody testing alone under-estimates immunity. 

Yohan Norberg, Sr Fellow at the CATO Institute says that it could take several years to develop a vaccine and that the total lockdown approach of most nations, aimed at flattening the curve, only postpones deaths. “No society can be shut down completely and shut down the economy for more than a year, without ruining society and the economy entirely. That will kill many more people than does the virus.” 

We must keep in mind that you can’t shelter-in-place, if you no longer have a shelter. 

The Numbers: Certainly, even a single life lost is tragic, yet we acknowledge that none of us live a risk-free life. We must evaluate the information received, in perspective, if we are to establish appropriate risk and safety measures. 

Dr. Brendan Carr, Mt. Sinai Emergency Medicine, expressed concern about the health crisis that is developing. People are being deterred from going to the hospital and others are simply too scared. This can be deadly, and all deaths matter, not just those of the virus. Dr. Donald Yealy, Chair of Emergency Medicine at the University of Pittsburgh Medical Center, says that the hospital is only using 2% of its beds for COVID-19 patients. 

Another consideration… dying with the Coronavirus is not the same as dying of the Coronavirus, so we must be cautious about the number of deaths or hospitalizations being attributed to the virus. Also, mortality data includes both confirmed and presumptive (unconfirmed probability) cases. 

Regarding the numbers, maintain perspective:

United States    7/14/20   Population 331 Million

Positive:          3,355,457 .0101 of the population

Deaths:           135,235   .0004      

Transmission: While this virus can produce strong symptoms, according to the Department of Homeland Security (DHS), it is remarkably easy to kill… simple soap & water or I-min of sunlight will do the job. 

According to the CDC, the Coronavirus is mainly transmitted through "respiratory droplets" when symptomatic people sneeze or cough. It is not an airborne virus. Johns Hopkins University says that 86% of those who test positive, are asymptomatic (no sneezing, coughing, or other symptoms). 

Therefore, if Johns Hopkins is correct and 86% of those who test positive are asymptomatic (not coughing or sneezing) and transmission is due primarily to droplets from coughing and sneezing (even on surfaces where droplets land), then those who are asymptomatic provide minimal, although not impossible, danger, especially if they are 6-feet apart. 

This was proven in mid-May by the National Institute of Health (NIH) Center for Biotechnology Information. They conducted a study where “455 contacts were exposed to asymptomatic COVID-19 virus carriers”. The median contact was 4-5 days, and “no severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections were detected in the 455 contacts”. 

Dr. Maria Van Kerkhove, Epidemiologist, Head of WHO’s Diseases and Zoonosis unit, confirms. In early June, she said, “From the data we have, it still seems to be rare that an asymptomatic person actually transmits onward to a secondary individual, It’s very rare.” 

Others also agree. COVID-19 transmission via aerosol is possible but unlikely, according to Josh Santarpia, Research Director of the Countering Weapons of Mass Destruction Program, at the University of Nebraska's National Strategic Research Institute, who said, "To my knowledge, there is no definitive evidence of transmission, where aerosol was the only possible route”. 

As of June, Public health recommendations have been updated by the CDC “to accommodate new scientific evidence, evolving epidemiology, and the need to simplify risk assessment. Recommendations vary on the length of time of exposure, but 15 minutes of close exposure can be used as an operational definition. Brief interactions are less likely to result in transmission.”

The WHO recommends social distancing, which it says involves staying at least 3 feet [not the 6’ minimum being promoted] from someone who is coughing or sneezing [meaning those who are symptomatic, not everyone].

Hydroxychloroquine (Both Chloroquine & Hydroxychloroquine belong to the quinolone family)

World Society of Virology says, “There are many viruses which are more dangerous and fatal than SARS-CoV-2 (COVID-19)”. They also state that “Most people (about 80%) recover from the disease without any treatment.” And, “Although the overall case fatality is predicted to be around 3-4% worldwide, deaths are clustered mainly in aged people and immunocompromised patients”. Current treatments include, “Sera/plasma from COVID-19 recovered patients (containing specific antibodies against the virus) can be used for treatment of infected people. Although there is no effective globally approved treatment against coronavirus the FDA approved drugs chloroquine, hydroxychloroquine, and Favipravir, were found to be effective against the virus.” 

In a study of SARS-CoV in 2005, NIH published a study in the United States National Library of Medicine Virology Journal, by 8-experts from the United States and Canada, reporting, “Chloroquine is effective in preventing the spread of SARS-CoV”. They discovered that, “chloroquine inhibited SARS-CoV infection, when added before or after infection, concluding that Chloroquine, a relatively safe, effective and cheap drug, used for treating many human diseases including malaria, amoebiosis, and human immunodeficiency virus, is effective in inhibiting the infection and spread of SARS-CoV”. Summarizing, “Our data provide evidence for the possibility of using the well-established drug Chloroquine in the clinical management of SARS [SARS-CoV]”. Our current version is SARS-CoV-2 (79% genetic similarity).

Masks: On March 2nd, Surgeon General Jerome Adams urged the public to “Stop buying masks; they are not effective in preventing the general public from catching Coronavirus”. On February 27th William Schaffner, an infectious disease physician and professor at Vanderbilt School of Medicine says, “Wearing a face mask can be uncomfortable and exhausting to use over time; they’re not designed to be worn eight hours a day. Plus, if a mask does not fit your face properly, you may end up touching your face more than if you were not wearing one at all.” 

Dr. Anthony Fauci, Director of the National Institutes of Allergy and Infectious Diseases, told 60-Minutes, “There's no reason to be walking around with a mask. While masks may block some droplets, they do not provide the level of protection people think they do.” Fauci also estimates the vaccine will not be ready for at least another year. 

Dr. Scott Atlas of Stanford University & Hoover Institute agrees. He has stated that the masks being used by most people, provide only minimal protection (2% virus blockage) because 70% of the air (and virus) flow right through the mask, and the rest enters along the sides where there is no seal, thus providing only a minor barrier. The exception is the N95 mask, which filters down to particles 0.3 microns (the Coronavirus measures between .05 and .2 microns). 

The British Medical Journal (BMJ), in a published study on cloth masks states, “Penetration of cloth masks by particles was almost 97%, and medical masks 44%. Moisture retention, reuse of cloth masks, and poor filtration, may result in increased risk of infection. This study is the first RCT (Randomized Clinical Trial) of cloth masks, and the results caution against the use of cloth masks.” Update 3/30/20: “The study found that cloth mask wearers had higher rates of infection than even the standard practice control group of health workers, and the filtration provided by cloth masks was poor compared to surgical masks.” 

The wearing of masks is for different reasons. For those who are coughing and sneezing, non-surgical masks are effective in preventing large particles expelled by the user; the virus itself will slip right through. It also serves as a reminder, that we are still amid an active pandemic and must exercise caution. It’s an added safety measure, around those who are extremely vulnerable… where every precaution should be observed. On a psychological level, it helps some to feel safer. On a legal basis, many states are requiring the wearing of masks in public venues.   

Testing: A notable difference between the two approaches is the targeted objective. While isolation aims for 0% positive cases, herd immunity aims for 100% (equal to 100% vaccinated/immune). 

COVID-19 testing is only valid the moment it is given. Once that person leaves, they may contract the virus at their very next encounter. Thus, unless you are symptomatic and need confirmation; or plan on daily testing, the results of widespread testing may provide entire communities with inaccurate models and individuals with a false sense of security. 

Therefore, as we enter new phases of awareness on how this virus spreads, serology testing for antibodies appears to offer the best source for evaluating our evolving status. 

When it comes to your health, be smart. If you are considered high-risk, take extra precautions. Be respectful of those who may feel differently. 

You’ve got this! Welcome to the herd. 

Jacqueline Cartier is CEO of Winning Images, a public affairs firm, specializing in communications and crisis management, serving government and corporate clients both here and abroad. Cartier is also a newspaper columnist, magazine publisher, and author, who has worked on public policy and controversial issues from the White House to local jurisdictions.  

www.CartierWinningImages.com

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