Don’t bet on ‘herd immunity’

benfell

See updates for April 20, 2020, May 14, 2020, and July 12, 2020 at end of post

I’ve been hearing from passengers that they themselves think or they know somebody who thinks they had COVID-19 as early as last November. Obviously, nobody can be sure—these aren’t “confirmed cases.” But the obvious suggestion here is that the novel coronavirus has been in the wild longer than thought and that more people have had it than thought.

And if that’s the case, then we might be farther along to “herd immunity,” where few enough people remain susceptible that we can re-open society, than we presently know. That is, if herd immunity is actually a thing.

I also know, as I watch my own thought processes, with the realization that, given my history, my symptoms are likely to be mild if even noticeable, that this is a disease that lends itself to hypochondria:

  • I woke up at around 3 am one morning with a heavy cough, the kind that one has to spit out to be rid of. Was that it? Or was it my hypersensitivity to a neighbor smoking a cigarette?

  • I’ve been waking up since that coughing incident with difficulty breathing in the wee hours—only in the wee hours—of the morning. Is this it? Or really because a neighbor is out smoking every morning at this time? Getting up, getting a drink of water, and letting it pass has seemed to help. Taking a second shower in the evening, to wash off allergens (it’s spring time and lots of stuff is in bloom) I’ve accumulated during the day, has seemed to help. Finally, I just purchased and installed an air purifier—it seems to be helping a lot.

  • I had a sudden flash of dizziness and lightheadedness one afternoon, that I thought might suggest a fever, as I was seated in the very chair I am now, writing this. Was that it? Or was I just tired? Or was it some other dread disease? Or was it just a sign, heaven forbid, that I’m getting old? (I’ll be 61 later this month.)

It’s important to note here that I am hypersensitive to tobacco smoke and an awful lot of people in Pittsburgh, especially in the South Hills (where I live), smoke; they often come into my car reeking of it. Difficulty breathing at night was also a problem when I was a cab driver in the San Francisco Bay Area and I allowed people to smoke in my cab. I literally had to start telling them they couldn’t, long before California passed a workplace smoking prohibition. This could easily account for the symptoms I describe but of course, we’re all terrified of coronavirus now, so it’s easy to jump to a conclusion that that must be it.

None of my own experiences really reach the bar where I can really be suspicious that I’ve suffered COVID-19. That said, the fact I’m an Uber and Lyft driver in Allegheny County, where as of this writing, there have been 947 confirmed cases and 43 deaths,[1] and have given hundreds of rides, including to medical workers who are on the front lines of this, since all this began, suggests I am at high risk of exposure and may already have been exposed. So the question nags.

This is all terribly, terribly weak stuff, no substitute for actual tests. But testing has been, to put it all too mildly, a problem.[2]

A study reported by the Guardian[3] would be the sort of study that is needed, assuming

  • the antibody test is both valid and reliable, and
  • that people with the antibodies who are well are in fact immune.

Replications of this study would need to be done, at least, across wider geographic regions and possibly to test for variables I have not considered (this is not my field), to begin to get a sense of an upper bound to further spread—the approach of that vaunted “herd immunity.”

The trouble is, both those assumptions I listed are, at best, weak.[4] And what this strongly suggests is that “herd immunity” won’t offer a quick way out of our present dilemma. We’re hoping for a vaccine[5] or a treatment and I wouldn’t bet on either being imminent.

Update, April 20, 2020: Antibody tests, which only might show some immunity to COVID-19,[6] were rushed into production and distribution. Many are unreliable.[7] And I’m guessing it’s going to be real hard to know if you’ve got a reliable one or an unreliable one.

Here the problem is with false positives, where a person is reported to possess antibodies to the novel coronavirus when, in fact, they do not.[8] The problem with the swab tests are with false negatives, reporting a person to be clear of COVID-19, when they are not.[9]

This likely directly undermines[10] the study reported by the Guardian that suggested that COVID-19 had infected more people than previously believed.[11] I have added a citation below.

Update, May 14, 2020: When I wrote “The pandemic and a crisis of illegitimate authority” and this post, I essentially thought of a possible vaccine for COVID-19 as one might in terms of the old admonition against counting your chickens before they’ve hatched and didn’t bother to look into it further. I was more optimistic in the latter post (this one) than the former. It turns out that, as with the antibody-based protection that arises from being exposed to the disease,[12] and that some rely on for “herd immunity,”[13] there are nuances, including the possibility that a vaccine isn’t possible.[14] This, in addition to that it will take time to mass produce and distribute a vaccine should it be found,[15] should be absolutely unsurprising, and I’ve updated these posts, including adding citations here, accordingly.

The ugly truth here, and it’s not one I want to hear either, is that we as a species may well have to live with the novel coronavirus for many years to come. There’s a lot that needs to be rethought, including how we treat each other as human beings, should this prove to be the case, that we really need to be rethinking anyway, and—I don’t care what your political predilections are—our present political and economic order is simply not up to this task.

Update, July 12, 2020: Y’all know I’m not a sugar-coating kind of guy anyway, but I don’t think there is a way to sugar-coat the possibility that some who survive a bout with COVID-19 might remain vulnerable to reinfection and that this may well eliminate the possibility of “herd immunity.”[16] I’ve already warned against counting on herd immunity (above). Now I get to notice that the news with the novel coronavirus keeps getting worse. We don’t know where bottom is with this.

  1. [1]Center for Systems Science and Engineering, “COVID-19 United States Cases by County,” April 18, 2020, Johns Hopkins University, https://coronavirus.jhu.edu/us-map↩
  2. [2]Christie Aschwanden, “Sorry, Immunity to Covid-19 Won’t Be Like a Superpower,” Wired, April 16, 2020, https://www.wired.com/story/sorry-immunity-to-covid-19-wont-be-like-a-superpower/; David Benfell, “When ‘good’ news might not be so good,” Not Housebroken, April 2, 2020, https://disunitedstates.org/2020/04/02/when-good-news-might-not-be-so-good/; Jennifer Levitz, Mike Cherney, and Daniel Michaels, “U.S. Coronavirus Death Toll Passes Italy, Becoming World’s Highest,” Wall Street Journal, April 11, 2020, https://www.wsj.com/articles/health-officials-plead-for-public-to-observe-a-locked-down-easter-11586592822; Yascha Mounk, “This Is Just the Beginning,” Atlantic, March 25, 2020, https://www.theatlantic.com/ideas/archive/2020/03/national-shutdown-least-bad-option/608683/; Wall Street Journal, “Testing for Coronavirus: What We Know About Covid-19 Tests and Treatment,” April 14, 2020, https://www.wsj.com/articles/who-has-covid-19-what-we-know-about-tests-for-the-new-coronavirus-11585868185↩
  3. [3]Kari Paul, “Antibody study suggests coronavirus is far more widespread than previously thought,” Guardian, April 17, 2020, https://www.theguardian.com/world/2020/apr/17/antibody-study-suggests-coronavirus-is-far-more-widespread-than-previously-thought↩
  4. [4]Christie Aschwanden, “Sorry, Immunity to Covid-19 Won’t Be Like a Superpower,” Wired, April 16, 2020, https://www.wired.com/story/sorry-immunity-to-covid-19-wont-be-like-a-superpower/; Steve Eder, Megan Twohey, and Apoorva Mandavilli, “Antibody Test, Seen as Key to Reopening Country, Does Not Yet Deliver,” New York Times, April 19, 2020, https://www.nytimes.com/2020/04/19/us/coronavirus-antibody-tests.html↩
  5. [5]Andrew Nikiforuk, “Don’t Bet on a Vaccine,” Tyee, May 13, 2020, https://thetyee.ca/Analysis/2020/05/13/Vaccine-Not-Likely/; Christopher Rowland, Carolyn Y. Johnson, and William Wan, “Even finding a covid-19 vaccine won’t be enough to end the pandemic,” Washington Post, May 11, 2020, https://www.washingtonpost.com/business/2020/05/11/coronavirus-vaccine-global-supply/↩
  6. [6]Christie Aschwanden, “Sorry, Immunity to Covid-19 Won’t Be Like a Superpower,” Wired, April 16, 2020, https://www.wired.com/story/sorry-immunity-to-covid-19-wont-be-like-a-superpower/↩
  7. [7]Steve Eder, Megan Twohey, and Apoorva Mandavilli, “Antibody Test, Seen as Key to Reopening Country, Does Not Yet Deliver,” New York Times, April 19, 2020, https://www.nytimes.com/2020/04/19/us/coronavirus-antibody-tests.html↩
  8. [8]Steve Eder, Megan Twohey, and Apoorva Mandavilli, “Antibody Test, Seen as Key to Reopening Country, Does Not Yet Deliver,” New York Times, April 19, 2020, https://www.nytimes.com/2020/04/19/us/coronavirus-antibody-tests.html↩
  9. [9]Christopher Weaver, “Questions About Accuracy of Coronavirus Tests Sow Worry,” Wall Street Journal, April 2, 2020, https://www.wsj.com/articles/questions-about-accuracy-of-coronavirus-tests-sow-worry-11585836001↩
  10. [10]Steve Eder, Megan Twohey, and Apoorva Mandavilli, “Antibody Test, Seen as Key to Reopening Country, Does Not Yet Deliver,” New York Times, April 19, 2020, https://www.nytimes.com/2020/04/19/us/coronavirus-antibody-tests.html↩
  11. [11]Kari Paul, “Antibody study suggests coronavirus is far more widespread than previously thought,” Guardian, April 17, 2020, https://www.theguardian.com/world/2020/apr/17/antibody-study-suggests-coronavirus-is-far-more-widespread-than-previously-thought↩
  12. [12]Christie Aschwanden, “Sorry, Immunity to Covid-19 Won’t Be Like a Superpower,” Wired, April 16, 2020, https://www.wired.com/story/sorry-immunity-to-covid-19-wont-be-like-a-superpower/↩
  13. [13]David Benfell, “Don’t bet on ‘herd immunity,’” Not Housebroken, April 20, 2020, https://disunitedstates.org/2020/04/18/dont-bet-on-herd-immunity/↩
  14. [14]Andrew Nikiforuk, “Don’t Bet on a Vaccine,” Tyee, May 13, 2020, https://thetyee.ca/Analysis/2020/05/13/Vaccine-Not-Likely/↩
  15. [15]Andrew Nikiforuk, “Don’t Bet on a Vaccine,” Tyee, May 13, 2020, https://thetyee.ca/Analysis/2020/05/13/Vaccine-Not-Likely/; Christopher Rowland, Carolyn Y. Johnson, and William Wan, “Even finding a covid-19 vaccine won’t be enough to end the pandemic,” Washington Post, May 11, 2020, https://www.washingtonpost.com/business/2020/05/11/coronavirus-vaccine-global-supply/↩
  16. [16]D. Clay Ackerly, “My patient caught Covid-19 twice. So long to herd immunity hopes,” Vox, July 12, 2020, https://www.vox.com/2020/7/12/21321653/getting-covid-19-twice-reinfection-antibody-herd-immunity↩