Viewpoint: The “Not So” Great Barrington Declaration

Recently, an international group of scientists signed a declaration advocating for achieving herd immunity from coronavirus disease 2019 (COVID-19) by opening communities and business, while protecting the vulnerable with “focused protection.” The Declaration states: “A comprehensive and detailed list of measures, including approaches to multi-generational households, can be implemented, and is well within the scope and capability of public health professionals.” But to be honest, I’m not sure how this can be done.

Currently, the United States is undergoing a third peak of infections on our first wave and the metrics, of cases and test positivity rates are increasing. Hospitalizations are also increasing in a number of states. Nationally, deaths, a lagging indicator, are holding steady but these are expected to rise in the weeks ahead. Hopefully, recent advances in medical treatments will mitigate this occurrence.

For infection preventionists and frontline healthcare workers, the Great Barrington Declaration places their lives and livelihood at risk. A field hospital has been activated in Wisconsin and the state is at risk of running out of hospital beds and trained staff. Similar concerns exist in Iowa and North Dakota.Many other states are also seeing surging of COVID-19 as cold weather approaches.

All agree, that if the healthcare system is overrun, necessitating the use of field hospitals and inexperienced staff, the case fatality rate will soar.

False Narrative of Herd Immunity: The New York Times reported that two of the signatures including one of the primary authors have “proposed that societies may achieve herd immunity when 10 to 20 percent of their populations have been infected with the virus.”

However, most epidemiologists agree that the percentage of the population needed for herd immunity is much higher SARS-CoV-2 has an unmitigated R0 of 5.7.Meaning, on average, one infected patient will spread the disease to 5.7 other individuals. This rate of infection would require 80% of the population to become infected before herd immunity would even start to have an effect.

Kevin Kavanagh, MD

For those who do not believe that SARS-CoV-2 is that infectious, just look at the recent superspreader event at the White House’s Rose Garden. Everyone was tested, but one test was probably a false positive and an infected asymptomatic individual attended the event. The event was held outside but without masks or social distancing.There were just over 200 people at the event. At least three White House journalists and eleven top White House officials have infections linked to the event. This virus is highly infectious.

And there are other major problems with the false narrative of herd immunity:

• First, lasting immunity is in doubt. There have been at least four studies to date which have found neutralizing antibodies to be of short duration in SARS-CoV-2 patients. The most recent, was published in JAMA Network and reported similar results to previous studies, with 58% of individuals with antibodies at baseline becoming seronegative at 60 days.
• Second, the virus is constantly mutating. The websitewww.nextstrain.orgshows the mutations of the SARS-CoV-2 virus. There are hundreds and unfortunately some of them may involve the virus’s spike protein which is the basis for the effectiveness of our immunity, vaccines, and monoclonal antibody therapies. Researchers from Peking University Health Science Center have identified viruses with increased infectivity and 10 strains which were “remarkably resistant to some” monoclonal antibodies.
• Reinfections are starting to be reported, but thankfully still appear to be a rare occurrence.In two of the documented cases, viral RNA was available from both the first and second infection, proving the reinfection. Of concern, is that the patient’s second infection was worse than the first, giving rise to the possibility of immunological enhancement of the disease. This could of course complicate vaccine development. The exact incidence of reinfections is unknown. What is known is that it can occur.

Isolation of Those At a Significant Risk is Not Possible: The 1918 flu pandemic took over two years and four waves for it to completely burnout, a similar time frame may well occur with SARS-CoV-2. How does one protect those at risk for that long of a time? Especially when the at risk comprises about half of the United States adult population.This includes those who are over the age of 65, or who have obesity, type 2 diabetes mellitus, cancer, COPD, chronic kidney disease or heart conditions.Obesity alone is found in over 40% of our adult population.But even those between the ages of 20 and 44 have a 20% risk of hospitalizations.

Emphasis on Mortality as the Only Concern of SARS-CoV-2 Virus: One of the Declaration’s goals is to “minimize mortality.”As knowledge of how to treat advanced disease increases, mortality has decreased. But similar to other fatal illnesses, survival is often associated with lasting disability. Unlike the flu, SARS-C0V-2 affects every organ of the body. During hospitalization there is a 20% chance of cardiac injury.Even in asymptomatic young athletes, MRI scans have been positive in approximately 15% of screened athletes with a positive SARS-CoV-2 test, including those who are asymptomatic or mildly symptomatic.

Mutations and strains of SARS-CoV-2 reported by scientists around the world and gathered by the data collecting service Next Strain

Symptoms can persist for a long time and may be permanent. A study published in Clinical Microbiology and Infection performed a two month follow up of adults with non-critical COVID-19. At 6 months, 30% still had shortness of breath, 40% had fatigue and 23% had disturbances in smell or taste. The symptoms were most prevalent in those patients 40 to 60 years of age. Younger patients may be less likely to have symptoms, but these may develop decades later when their pulmonary and cardiac reserves decrease. There have also been reports of a growing number of long-haulers who experience a myriad of persistent symptoms with chronic fatigue being the most prevalent.

Thus, it is not just death, but the concern for long-term or delayed heart and lung disease which has kept professional athletes from competing.

Return to Normal: The calls to return to the “old” normal disregards the transformation which has occurred both in education and industry. Many companies, the latest being Microsoft, are planning to offer work from home options and hybrid programs.Worker production and satisfaction is up and company costs are down.The same is also true for online shopping and delivery. Shoppers had been rapidly switching to online prior to the pandemic, both for convenience and reduced costs. COVID-19 accelerated this trend, which is unlikely to be reversed. Returning to school can be done safer with social distancing, masks, viral testing and attention to air quality and sanitization. But at-home online education may be incorporated into the curriculum to encourage independent learning and staggered in-school attendance would allow for smaller class sizes and more individual teacher attention.

Misinformation regarding this virus abounds. Cornell University estimates that 38% of media stories have misinformation which has its roots in the White House.Carnegie Mellon University has found much of the misinformation on twitter can be traced back to bots which are similar to the playbooks of Chinese and Russian intelligence agencies.There is even rumors that those who are asymptomatic are not able to spread the virus and that PCR tests are overdiagnosing SARS-CoV-2. Nothing could be further from the truth. Just look at the White House’s Rose Garden event which was a super-spreader event apparently caused by an asymptomatic individual who had a false negative result on a pre-event rapid test. Thus, there was under, not overdiagnosis of an asymptomatic spreader.

There is growing consensus in the United States regarding the recommendation of not going into another lockdown. South Korea did not close their economy, instead their strategy was wearing masks, social distancing, hand hygiene along with abundant testing and contact tracing. This public health strategy was widely accepted by their populous and they stopped the spread of the virus. If the United States followed South Korea’s example, a country of 51.6 million people, we would have lost under 3000 souls.

Using data of excess deaths in the United States, one can assert that as of August 1, 2020, over 200,000 lives have been needlessly lost, since promising therapies are just around the corner.

In all likelihood, this virus will become endemic and we will have to adjust our lives to live with it as safely as we can. Some who are deeply religious, feel this is Mother Nature’s way of protecting the Earth from the abuses of mankind. I am not sure about that, but I am sure we all need to start sacrificing for each other; looking out for each other by following sound public health advice of wearing masks, social distancing and hand hygiene. If we do this, SARS-CoV-2 can be controlled, possibly defeated; if we do not, we will inflict upon ourselves needless fatalities and long-term disabilities which we will have to endure for generations.