The White House has embraced a proposal to let the coronavirus spread freely among the young and healthy while protecting vulnerable older adults. But the plan, developed and supported by several Stanford faculty members, would likely prove disastrous, public health experts say.
Since March, an international cluster of scientists has been pushing a “targeted” response to the pandemic that would apply only enough restrictions to protect those most at risk of serious illness and death, while developing herd immunity among the rest of the population.
Earlier this month, three of those scientists, including a Stanford epidemiologist and public health policy expert, published a document outlining their proposal, and last week they met with senior members of the Trump administration. After the meeting, Health and Human Services Secretary Alex Azar said in a Twitter post that the conversation was “strong reinforcement” of the White House pandemic response.
Herd immunity, though, is a dangerous gamble, many experts opposed to the idea said Wednesday, after news of the White House support was widely reported. Attempting to achieve population-level immunity without a vaccine could result in many tens of thousands of preventable deaths, opponents say.
The head of the World Health Organization criticized the approach as “not a scientifically or ethically justifiable strategy” in a Twitter post. A global group of infectious disease and public health experts published an opposition paper — titled the “John Snow Memorandum,” named for a founder of modern epidemiology — calling herd immunity “a dangerous fallacy unsupported by scientific evidence.”
Dr. George Rutherford, a UCSF infectious disease expert, said trying to reach herd immunity is “magical thinking.” Stanford virologist Dr. Robert Siegel said the proposal would almost certainly fail.
“If we entertained a policy like this, we could get an awful lot of people infected and find out it didn’t work at all,” said Dr. John Swartzberg, a UC Berkeley infectious diseases expert. “It’s putting all your eggs in a basket and that basket has a lot of holes in it in terms of science.”
The plan is laid out broadly in a document called the Great Barrington Declaration, named after the city in Massachusetts where it was unveiled Oct. 4. The authors include Dr. Jay Bhattacharya, a Stanford professor of medicine, Martin Kulldorff at Harvard University, and Sunetra Gupta at Oxford University. Organizers say 35,000 doctors and scientists have signed the declaration.
“Current lockdown policies are producing devastating effects on short- and long-term public health,” the declaration states. “Keeping these measures in place until a vaccine is available will cause irreparable damage, with the underprivileged disproportionately harmed.”
Instead, the authors recommend an approach they call “focused protection” that isolates and prevents infection among high-risk groups, mostly older adults, while letting everyone else “resume life as normal.” They suggest schools and most businesses should reopen right away and “arts, music, sport and other cultural activities” should resume.
The proposal suggests people wash their hands and stay home when sick, but doesn’t endorse social distancing, face coverings or any other generally accepted public health guidelines.
Bhattacharya said in an email Wednesday that he and the other authors have “grave concerns” about current policies.
“So many scientists are drawn to the declaration because it is consistent with the best available science regarding the epidemic and the consequences of the lockdown,” he said.
Among the signed supporters are at least three Stanford-associated scientists, including Dr. Rajiv Bhatia, an epidemiologist who teaches at Stanford and was a former deputy health officer with San Francisco’s public health department. Bhatia said the proposal isn’t as outrageous as some of its detractors suggest. He described it as a reasonable alternative to universal shelter-in-place restrictions that have had dire economic and social consequences.
But in this hyper-politicized environment, a plan supported by the Trump administration is automatically dismissed, he said.
“The idea behind Great Barrington is we need at the very least to move toward a balanced approach, and give open-minded consideration to all of the alternatives,” Bhatia said. “Public health has been very authoritarian. That is not the public health way, to tell people what to do for months. We’re supposed to get everyone in a room, bring the science, weigh the alternatives, and make it a public process.”
The main argument against a herd immunity approach is that it may not be possible without a vaccine. Herd immunity occurs when enough of a population is immune to a virus that it is no longer able to pass from person to person. Herd immunity is almost always achieved through vaccination.
Most scientists believe that at least 60% of the population would need to be immune to the coronavirus in order to reach population-level immunity. The United States is nowhere near that now. A Stanford study published last month estimates that less than 10% of Americans have been infected. Even in areas with high rates of disease, such as San Francisco’s Mission District, less than 20% of people have been infected.
While there is evidence that infection with the virus offers some short-term immunity, it’s not clear how long that protection lasts. This week scientists published a report on a Nevada man who was re-infected with the virus, though only a handful of such cases have been recorded worldwide.
At a campaign rally in Pennsylvania on Wednesday, President Trump — who was infected with the coronavirus two weeks ago — proclaimed himself and others who have had the virus “immune.” Infectious disease experts say they simply don’t know if that’s the case.
Even if herd immunity is possible, it would take many months to get there and there’s no way of knowing what toll the approach might take in terms of excess deaths and serious illness, said Dr. Art Reingold, an epidemiologist at UC Berkeley.
Early in the pandemic, Reingold was invited to join a group of scientists who were against aggressive lockdowns and wanted to meet with Trump. Reingold did not agree with their approach and said he would go only as a voice of opposition. But the meeting never took place.
“Clearly they have gotten a lot of traction at the White House (since then), because it fits their narrative,” he said.
“Given all the economic harms, I see the appeal,” Reingold said. “The basic unknown with their proposal is how many hospitalizations and deaths would you end up with, and is that an acceptable toll to society. It’s anybody’s guess how many people would die if we followed through with this. But the numbers could be substantial.”
Erin Allday is a San Francisco Chronicle staff writer. Email: eallday@sfchronicle.com Twitter: @erinallday
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Why is a Stanford doctor promoting herd immunity at the White House? Bay Area experts explain the controversy - San Francisco Chronicle
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