This pandemic has spawned an army of instant armchair epidemiologists not only from scientific and medical laypeople, but from scientists and physicians who, frankly, have no training or experience in epidemiology beyond some perfunctory medical school/grad school course. Their pontifications have been disastrous for public policy and public cooperation. Nowhere has this ignorance reigned more supreme than with the concept of Herd Immunity. I’ve written about it here, if the reader wishes to come up to speed.
Essentially, when at least 70% of a population has survived an infectious disease, the resulting immunity makes them unable to become diseased again. This sufficiently breaks the transmission chain so that the remaining members are unlikely to get ill, and if some do, they are isolated cases for the most part. Those few are protected by the immunity of the majority. It’s getting to 70% immunity that’s the nightmare. We have 248,734 dead as of this morning, and will have surpassed the quarter-million mark in two days (just 8 months into this pandemic). So when people say we should open the economy full-throttle with no mitigation protocols in place in order to achieve herd immunity, what they are saying is that we should suffer 4.8 million dead at the current case fatality rate of 2.1% as we get to 70% of 328 million people infected.
That’s not medicine.
That’s butchery.
Our numbers are as low as they are because of all the mitigation efforts that have been employed. Eight months in and we only have 11,365,323 confirmed cases, according to Johns Hopkins. Now when we consider that up to 45% of cases can be asymptomatic, that puts us at around 24,000,000 total cases in the US, or 10% of the population. having been infected. 10% is not 70%. That leads us to our first bit of erroneous guidance from some, namely, that places such as New York, New Jersey, Connecticut, and Rhode Island who were hit hard earlier this year, and whose numbers plateaued throughout the late Spring and Summer, had achieved herd immunity at a much lower percentage (around 20% infected), as evidenced by their sustained plateaus.
The data suggest otherwise. Here are the graphical Data from Johns Hopkins Coronavirus Resource Center’s page on the states. Let’s look at the states that supposedly hit herd immunity and where they are as of this morning:
So what do we notice? New York is half-way to its Springtime peak.
New Jersey has just surpassed their Springtime Peak.
Connecticut and Rhode Island have just doubled their Springtime peaks.
Oops. That’s not supposed to happen when herd immunity has been achieved. But the beauty of being an internet sensationalist is that there are no governing bodies, editorial boards, etc. to hold one accountable. How many of the recently infected in the above four states believed themselves to be under the protection of a herd immunity they really didn’t understand?
{A note on the graphs. The very end of the data line usually dips down at the very end because of the uncertainty of the last-reported data, which are usually incomplete for a few days after initial reports. It takes a few days of consistent trending downward to accept that a true decline is in progress.}
{Also, the graphs represent the number of new cases per day}
Our armchair experts also suggested that the rest of the country, especially rural states, would experience no real impact because people were so spread out. I disagreed then and held out the following scenario:
When we reopened the economy people would hit the road and resume travel. They would feel safe in rural areas and not use mitigation strategies at the gas stations, truck stops, and fast food restaurants all along the Interstate Highway System, all of which employ local residents. The employees would contract the virus, bring it to their families, and then to their small, intimate country churches and local bars. The results would be catastrophic for rural communities. Five months later that’s exactly what has come to pass. Let’s look at what were held to be some of the safest places in the nation:
So let’s keep this short and sweet. Reaching herd immunity at anything less than 70% population infection is fantasy and wishful thinking. Believing it can happen at 20% is hallucinogenic.
We either get serious about mitigation and flatten the curve, or we see these numbers skyrocket beyond where they are now. With Thanksgiving, Christmas, Chanukkah, and the rest of the holidays and their shopping season upon us, I really don’t see reduction of numbers happening.
Quite the opposite, actually.
Herd Immunity? Forget you ever heard of herd immunity. That’s the result of either 4+ million dead from infection, or a good vaccination program. It benefits a lucky few, and even those will not be spared the sting of death among family and friends.
Mask. Distance. Reduce contact time. Frequent hand washing. Liberal use of hand sanitizer.
Rinse and repeat.
God Bless.
Thank you Dr. Nadal for this info. There have been studies before and after this virus outbreak that say that masks are ineffective against coronavirus. Are they effective in the prevention of receiving and/or transmitting the virus? Or is it more of a psychological thing to do so people can feel good about themselves and/or to get done what they need to get done?
Thank you, Michael. Can you share those studies, please?
If you want to get together with other people, outdoors is by far the safest, and even then that 6 feet of distance is a good plan. Outdoors is 20 times less risk than being indoors with other people, though as we head in to winter, outdoor meetings will become less doable – some states more difficult than others when temps are freezing, and snow or ice are on the ground. Don’t go out to bars and restaurants where you will be taking your masks off to eat and drink indoors. I just saw a report in the news that 900 employees of Mayo Clinic have gotten sick with Covid recently, and of those who caught it at work, the majority had eaten in a break room with a mask off. Remember that originally, China told the world this was NOT a contagious disease, though they knew otherwise, and when they admitted to the world – oops, it’s contagious, they insisted it was in droplets from sneezes and coughs, but it was not aerosolized. The best evidence shows it is clearly an aerosol, meaning, anyone who has this in their airway is very likely to be transmitting very tiny particles when they talk or breathe. The tiny particles can stay airborne for hours, even after the infected person leaves the room, and these particles can travel more than 6 feet. Without a mask, if you are indoors in a public building where people have been breathing or talking – there is nothing between you and any virus in the air. Masks are not 100% guaranteed to prevent all infections, but if you want to be in a public building where other people have been – that mask is the only thing between you and the virus. If you take your mask off to eat, drink, smoke cigarettes, take a break, talk to people – if you are going to take it off, it’s the same as not wearing a mask. Or, I’ve seen photos of election workers with the mask down where it covers the mouth and not the nose. That means if anyone came through carrying the virus – there is really nothing between that worker and the virus in the air that they can so easily breathe in. If you wear the mask and you don’t cover the nose, that is the same as not wearing a mask at all. What were they thinking? And a study at Duke University showed that if you want to wear a fleece mask, you would be better off with nothing at all, but if you want to wear a “gaiter” mask or bandana – those are not much help either, but anything made with fleece is worse than useless. Disposable masks and surgical masks performed well in the Duke studies from a few months ago. Avoiding crowds is generally a good thing.
“It looks like now that the fatality rate of a person who gets infected with this, on average, is around six times that of the seasonal flu — so around the 0.6 [percent] range,” say Amesh A. Adalja, MD, an emerging infectious disease specialist with the Johns Hopkins University Center for Health Security. Some suggest as many as 86% are asymptomatic –
Results of a quick internet search: https://www.news-medical.net/news/20201009/86-percent-of-the-UKs-COVID-19-patients-have-no-symptoms.aspx
If true, and I think it very well might be even higher, mortality among those infected is less than 0.1%, similar to the flu. Still, highly infectious and has caused many deaths. A horrible horrible virus.
On the other side, according to the CDC: “During June 24–30, 2020, U.S. adults reported considerably elevated adverse mental health conditions associated with COVID-19. Younger adults, racial/ethnic minorities, essential workers, and unpaid adult caregivers reported having experienced disproportionately worse mental health outcomes, increased substance use, and elevated suicidal ideation.” In addition, many people don’t like losing their livelihood — some have little else to keep them going — over a small risk of death.
Regarding masks, the jury is still out as to how effective they are in stopping the spread of COVID-19, and it should continue to be investigated; in the meanwhile, it stands to reason that they are worth using.
Many unanswered questions, and still much uncertainty. Curious, though, posting this now, in the shadow of an effective vaccine…
pt-109, I do not understand why are you are saying “the jury is still out.” The meta-analysis of more than 170+ studies, and more than 25,000 people published a few months ago is the best available evidence, which I explained in detail in a separate post that for some reason is not visible currently. For anyone who understand medical research, the answer is extremely clear. The link to the meta-analysis is here. I will check with Dr. Nadal and see whether my previous post somehow got lost in cyberspace or if it is just awaiting moderation – will check before investing that much time in explaining a second time. However, the jury is not out on this – masks REDUCE the risk but do not ELIMINATE the risk. People who are inadequately educated on research methods or who cherry pick a handful of poorly designed studies may think differently, but the study in Lancet, by Chu et all (2020), with data from 25, 697 people, concluded that masking reduces the risk. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31142-9/fulltext
And the death rate is not the entirety of the problem. I know a number of people who had Covid months ago, who are still unable to work. One healthy (non-obese) 35 year old man with no pre-existing medical conditions now has hear disease and high blood pressure, and such severe fatigue and weakness he is unable to work more than 4 months after Covid, and he is not the only one I know like that. There have been more than one research study on heart problems after Covid, including one with MRI evidence of the heart being affected after Covid, in people who didn’t have heart disease previously. Now there is a news article on this at https://www.yahoo.com/lifestyle/dr-fauci-just-warned-scary-173504219.html That article quotes Fauci as saying there also can be longer term lung problems, kidney problems, neurological problems, and more – all of which can be found in the medical literature in studies of people who have had Covid and have not yet recovered after months of disability.
Hello, Gerard. I read about the mask studies months ago so hard for me to remember where they came from. My recollection is that respectable sources initially said they were not necessary but then changed the recommendation (not sure why). Even Dr. Fauci said in March that they were not necessary. Do you know if there are studies that support wearing masks? Thank you.
Here’s another example, if eminent Gerry doesn’t censor it (when one is old and realizes one hasn’t much left to control, at least not in this life, perhaps not even one’s own bowels, one tends to go into hyper-control mode in one’s few remaining “domains” – no pun intended): https://thefederalist.com/2020/11/23/many-studies-find-that-cloth-masks-do-not-stop-viruses-like-covid/
According to my wife, I should just come to terms with the reality that I’m just an idiot. I told her I already know that, but she thinks my stupidity goes deeper than I’m willing to allow. That, and wearing a full-face mask tends to make me look better in public. Oh, so confusing… I’ll think I’ll wear the mask even after COVID-19 is history.
pt-109, I read the article at the Federalist, and I see the author is Lisa Mair who has a Master’s of Science in Food Science and Nutrition and has been an advocate for natural health for decades. That definitely makes her an expert in epidemiology (not) and in virology (not). I am an MD with an additional year of research training beyond residency. Although my own specialty is not in infectious disease, the year of research training was in a program intended to train MD’s and PhD’s for being able to design research studies, analyze medical research, to be prepared to conduct research from start to publication, and to understand research that is out there to be read. I was in a competitive program with physicians from every medical specialty. This does not mean I know everything, but I’m not an 8th grade dropout or anything, and I do know a good bit about how to read and understand scientific research, which many people can’t, though many people think they can. One of my posts was entirely lost, so let me say that in epidemiology, it’s often not possible to do randomized controlled trials – you can’t, for example randomize some people to wear a mask and be around Covid patients, and others to NOT wear masks and be around Covid patients and compare which group develops more cases of illness. For this type of situation, the best that one can do is an observational study – some people choose to mask, some not, and you observe the difference – rather than do an experiment and force some people to be in harms way with no protection. Of the possibilities for an observational study, the gold standard is a meta-analysis which is a study of studies. If you had 10 studies of 50 people each, but you could pool the data and re-analyze, now you have 500 people and you can have greater trust in the result – because if it was just one study of 50, it’s a small number, and you can’t tell for certain if you would get the same result – especially if some of the studies were a little borderline – the difference seen is perhaps small. In the meta-analysis by Chu et al. in Lancet earlier this year, they had 170 different studies, from 16 countries, 6 continents, health care settings, and community (non-health care settings). There was data from more than 25,000 people. This meta-analysis showed that masking does reduce the risk. IF you had a very small study of 2 people, and neither one got sick, OR both got sick, in either case, the result is “no difference.” But in the case of 2 people, one masked, one not masked, if neither one gets sick and there is no difference – it could be because neither one of them was even near anyone who was sick. If you are in an area that is really low for Covid, there is hardly anyone sick – maybe the person with no mask would have caught the virus IF he had been around someone sick, but he never happened to run into any sick people. So, you could have a study that shows “no difference” but there really would have been a difference if you had done the test with a larger group of people OR if you were in a setting where there were people transmitting virus. One of the good things about this meta-analysis from Lancet is that many of the included studies were studies done during corona virus epidemics, including Covid, SARS, and MERS, so done during epidemics, when many people were sick, and with corona virus – though not all were with corona virus. But that is a good thing that so many of these had been done and were included. Plus, having from so many countries – you can’t say, well, of course it worked in such and such country because of some particular reason, but that would not be true in other countries – but they did include research from every continent, and not just from hospitals or medical offices, but general public. And having 25,000 would give most researchers confidence that a positive result means something. If you have a small study and “no difference,” you’re not necessarily sure, but with a study this large showing a difference – yes, that is the best available evidence that masks do work to reduce the risk. There are a lot of ways to design a study so that there is “no difference,” but you find a difference, it’s probably real, especially when it is the work of so many researchers – if one person came up with a study that was an outlier, you could – did they fake the data some way? But here, many studies, 170+ pooled together show there really is evidence, masking makes a difference to reduce the risk. One other good study was at Duke University where they showed that fleece masks truly are worse than none at all – this past summer – they mechanically used a system to blow virus through masks and see which kinds of masks would protect. Turns out cotton masks and disposable surgical masks worked, but bandanas and gaiter type masks did not work well, and fleece, worse than no mask. So if you turned around and did a study comparing fleece to no mask, you could say – see, they all got sick, masks do not work, but it’s only that type of mask that does not work. But – believe what you want. I am always amazed when people in general with no research training at all, think they know how to evaluate the research – it’s more than just picking one random study or picking one you like, and deciding this one must be true because it came to the conclusion you like.
Dr. Shuping,
Thanks for your thoughtful post. One of mine (with evidence) got lost also, which is why I thought Dr. N had started to crack down on evidence like the main stream media, and hence my (now looking ridiculous) advise to take some laxatives. Anyway, the first third of your latest post highlights your credentials, which are impressive. The second third of your post explains the value of confidence intervals and statistical uncertainty. Good! Of course, there are subtleties that you don’t mention. For example, when you combine many studies and there is significant heterogeneity in the results, it often limits a simple interpretation. Of course, in observational studies, people who take precautions such as warning a mask are not the same people (comparability) than those who don’t. They differ in so many regards that confounding and residual confounding are both likely, i.e., where complete statistical control for confounding is not possible. Then my favorite third of your post, the final third, is where you insult me. It only confirms what my wife has been saying for years, and even if I’m not totally onboard with your assessment, my wife is. So, two against one — you win. If you take my kids as well (and please do), it’s now four to one. I lose in a landslide! If I were being a little twit, I would point out only the fact that I said the jury is still out — and that masks make intuitive sense. But that was long ago…. alas…. in my younger days on this thread.
Now, more on point with Dr. N’s original post, which only marginally had to do with masks….
https://www.americanthinker.com/articles/2020/11/could_todays_covid_surge_have_been_avoided.html