The demographics, virology, and public health dimensions of, and earlier parallels to, the COVID-19 coronavirus pandemic suggest that the current approach to the outbreak in the U.S. and Europe (other than the U.K.) might be on a wrong and dangerous track. In the U.S., this is partly due to Donald Trump’s self-serving blunders, but not entirely. While there are no perfect responses in the current environment (the availability of a vaccine would change everything), the following facts need to be considered.
COVID-19 is essentially innocuous in anyone under 50, but is frequently extremely damaging or fatal for those over 60, and particularly over 70. But although it is often claimed (by NIH Infectious Diseases director Anthony Fauci at Trump’s Friday the 13th national emergency announcement, for instance) that this is due to their immune systems’ being “weak,” or because they are more likely to have underlying conditions, the extreme differential between the impact on this age group and others is reminiscent of an earlier outbreak where those factors did not apply. The 1918 “Spanish” flu pandemic killed upwards of 50 million people worldwide. Of the half-million estimated deaths in the U.S., 92% were under 65, and a full half were between 20 and 40 years old.
The best theory for this selective impact comes from a research group at the University of Arizona, who note that this cohort was exposed to a virus with related properties that circulated around 1900, when they were children that (instead of protecting them) primed their immune systems to respond to the later virus in an inappropriate and damaging fashion. Older people severely affected by COVID-19 also exhibit such immune hyper-reactivity, suggesting that they may have been primed by a pathogen exposure in the 1950s, before the less vulnerable population was born.
So, while old people must strenuously avoid being infected regardless of their current health status, for everyone else, particularly young adults and children, a different policy should be in effect. Vaccination is the safest way to establish “herd immunity,” the condition in which the general population is largely resistant to an infection, and its members, even if they become infected, are therefore incapable of spreading it. Until there is a vaccine for COVID-19, however, the only route to herd immunity is for those who can be infected without getting sick, become so.
That’s why closing schools, colleges, theaters, museums, etc. is a bad idea. Of course, older people (including faculty over 60, who could teach by videolink) should stay away from all of these, but young people could attend and participate with little effect. Shutting down these facilities is less a benefit to public health than to the legal exposure of their owners and administrators. Certainly, attendees would become COVID-19-positive, but they mainly would be oblivious to it. They would need to be warned to keep their distance from their elderly relatives, and vice-versa, but this applies to the prevailing shut-down regime as well, where students and thwarted theatergoers are not prohibited from socializing or being at large. However, just as a tiny percentage of people die from the flu, meningitis, and food poisoning in any public and institutional setting, there would inevitably be a few adverse COVID-19-associated events at schools and colleges. This would lead to huge lawsuits, particularly in the U.S., making an open policy, however desirable, difficult to achieve.
Nonetheless, large sectors of the economy, here and abroad, are nearly collapsing because of fears that are not entirely justified. Apart from impeding and prolonging the establishment of herd immunity, misery is being sown in terms of lost education and arts events, scarcity, and loss of employment. “Disaster capitalism” (in Naomi Klein’s coinage) will ensure that the streamlining will be permanent and many of the jobs will not return. Of course, there will be some benefits, like the curtailment of the environmentally devastating behemoth-cruise industry, but many restaurants and cultural institutions will disappear forever.
It’s a scandal of major proportions that the Trump administration suppressed evidence of the epidemic at its early stages and abolished, well before that, the Center for Disease Control Pandemic Task Force, making sure that the U.S. was ill-equipped to test people. Clearly, it’s important to know who has the virus, even if most people won’t be affected by it. But Trump was interested in keeping the numbers of confirmed cases down. So now we are saddled with bad policy based on misconceptions, and a venal and incompetent administration poised to make it worse.
The U.K. has implemented a COVID-19 management policy at odds with that in Europe and the U.S., which is designed to accelerate herd immunity, as proposed here. The government has received pushback for its non-consultative, top-down approach. It would be a mistake to petition for anything of this sort from a government with authoritarian and racist proclivities. The institutional shutdowns in the U.S. have been voluntary, and when they are reversed, as they must eventually be, that will be voluntary as well. The faster that carefully managed social mixing in the low-vulnerability groups occurs, the sooner herd immunity will be achieved. The institutions and their members who are at the vanguard in coming out of the cold, making it easier for others, will earn the gratitude of society as a whole.
NOTE: The number of serious cases under 50 has turned out to be greater in recent days than was evident before. (Those in small children are still vanishingly small). Any restoration of school and campus life needs to take this into account, but the arguments presented continue to be sound.