Thumbing their noses at both government directives and the coronavirus, right-wing protestors have been massing at state capitols in Michigan, Minnesota, Virginia, and Texas to demand the lifting of stay-at-home orders issued by Democratic governors. President Donald Trump has responded in a way that looks a whole lot like a call to insurrection. On April 17, Trump tweeted “LIBERATE MICHIGAN,” “LIBERATE MINNESOTA,” and ‘LIBERATE VIRGINIA,” apparently mistaking those states for Paris in 1944.
Trump and the Republican Party have been pushing to reopen the American economy immediately, if not sooner, and screw the cost in human lives. This attitude goes a long way toward explaining an article The Federalist ran on March 25.
If you didn’t already know that The Federalist is a right-wing website, you would have after you saw the article’s title: “How ‘Chickenpox Parties’ Could Turn the Tide of the Wuhan Virus.” The author, Dr. Douglas A. Perednia, a retired dermatologist—not a specialist in infectious diseases—makes the standard right-wing talking point that we can’t stay in our homes forever while the US economy crumbles. He adds that we don’t yet have a vaccine that would prevent infection with COVID-19; nor do we have an effective treatment for the virus once contracted. He declares: “It is time to think outside the box and seriously consider a somewhat unconventional approach to COVID-19: controlled voluntary infection.”
Unconventional is one way to put it. Controlled voluntary infection (CVI), explains Dr. Perednia, “involves allowing people at low risk for severe complications to deliberately contract COVID-19 in a socially and medically responsible way so they become immune to the disease. People who are immune cannot pass on the disease to others.”
Who would voluntarily submit to infection with COVID-19? President Donald Trump has an answer: journalists. According to Vanity Fair: “Trump told aides he’s afraid journalists will try to purposefully contract coronavirus to give it to him on Air Force One, a person close to the administration told me.”
Dr. Perednia isn’t thinking of infecting journalists. Dr. Perednia wants to recruit his corps of volunteer guinea pigs from a different group: young people under age 20. Why? Because of herd immunity.
Dr. Perednia explains herd immunity as “the phenomenon whereby contagious infections can no longer spread if a large enough percentage of the population is immune to the disease, and CVI is a means to achieve it.” This phenomenon is real. Dr. Perednia proposes that persons under 20 volunteer to be infected with the coronavirus as they are the demographic with the lowest risk of dying from COVID-19.
Here is where the problems with Dr. Perednia’s plan begin to come thick and fast. First, Dr. Perednia assumes that COVID-19 infection + recovery = immunity in the future. Not necessarily. Future immunity from COVID-19 following recovery is not guaranteed. Reports from South Korea and China indicate that people who apparently recovered from COVID-19 tested positive for the virus after recovery. The World Health Organization (WHO) says that the presence of antibodies to COVID-19 in a person’s blood is no guarantee that he or she will not become reinfected. WHO also said that there is little evidence that herd immunity to COVID-19 is developing.
Second, Dr. Perednia writes that under his proposal, “participants are actively exposed to the mildest form of COVID-19 virus available.” Here’s the problem with that: there is no “mildest form of COVID-19.” There is no way of predicting in advance who or how many of those infected with the coronavirus will experience a mild, severe, or even fatal case of COVID-19.
Third, Perednia’s plan would result in a staggering number of deaths. Dr. Perednia posits that 210 million Americans (60% of the US population) would need to become immune in order for the US to achieve herd immunity. Our health system would collapse. Even assuming a low fatality rate, 210 million Americans infected with the coronavirus would produce a staggering death toll. Out of 640,000 known cases of COVID-19 infection in the US, 30,000 people have died, a fatality ratio of 4.7%. Extrapolating from these figures, if we infect 210 million Americans, then we should expect about 10 million deaths.
Fourth, where does Dr. Perednia propose to find 210 million Americans who have recovered from COVID-19 and thus are immune (a questionable assumption as we have seen)? Remember: Dr. Perednia specifies that these are to be volunteers…and under age 20 (because young people are at the lowest risk of death from COVID-19). There aren’t 210 million Americans under the age of 20, and, even if there were, how many of them would volunteer to be guinea pigs? Will Dr. Perednia enlist his grandkids? Will the offspring of the plutocrats on Trump’s new Council to Re-open America rush to sign up?
We know who the guinea pigs would be. Dr. Perednia’s plan would place the burden of fighting the coronavirus on disenfranchised groups, including Blacks, Hispanics, undocumented immigrants, and low-income individuals. These groups are already suffering the worst from the pandemic. They were already suffering before the pandemic.
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Controlled voluntary infection is not a new idea. Dr. Perednia finds “an interesting historical precedent for CVI”: “chickenpox parties.”
Before a vaccine was developed for chickenpox or German measles, parents would expose their children to a neighbor child who had the disease. The parents did so with the expectation that their own children would thus become infected. This would spark what Dr. Perednia cozily describes as a “little local epidemic” in the neighborhood, and would immunize the children from infection in adult life when chickenpox and German measles are much more severe, even fatal.
Dr. Perednia thinks that because controlled voluntary infection (CVI) was successful at preventing the spread of chickenpox and German measles, CVI will work just as well at checking the spread of COVID-19. But most of the US population was already immune to chickenpox. Therefore, the maximum number of people at risk in a given year throughout the US was at most the birth cohort of that year, about 4 million. By contrast, most of the US population is not immune to COVID-19. Further, chickenpox infections were not severe among children and the majority did not need medical care, although some otherwise healthy children who were infected at the “chickenpox” parties Dr. Perednia describes did die.
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Dr. Perednia has written a prescription that will gladden the hearts of right-wingers. The Right welcomes any scheme, however hare-brained, that seems to hold out the promise that the US economy can be reopened at once, however many people that kills. It’s a dangerous prescription. After The Federalist tweeted Dr. Perednia’s article, Twitter temporarily suspended The Federalist‘s account for recommending a course of action which could endanger public health.
We must halt the stampede to reopen the economy. A comment on Facebook pointed out that the Right poses a false dilemma: go back to work now or let the economy collapse. We aren’t forced to make that choice. We can pay people to stay home and let billionaires lose a little money. Good advice.
1) In writing this article, I had the invaluable help of an epidemiologist who specializes in infectious diseases who has asked to be unnamed. She gave generously of her time and has my sincere thanks. Any errors and all opinions expressed within are mine alone.
2) Towards the end of his article under the subhead, “Potential Limits of This Approach,” Dr. Perednia asks: “Is it possible for patients who have recovered from COVID-19 to be re-infected?” This, he says, is a question which “should be answerable within a relatively short period of time.” ↑
3) Dr. Perednia writes:
Math tells us how many people need to be exposed to an illness or vaccine before herd immunity develops in the community. Crunching data from the MRC Centre for Global Infectious Disease Analysis at Imperial College London implies that based on the Wuhan [sic] virus’s reproduction number, we can achieve herd immunity by immunizing somewhere between 33.3 to 71.4 percent of the population, with an averaged guess of 61.5 percent. ↑