Immunology experts believe that herd immunity requires 60% of a population be infected. The announcement this morning that Donald Trump and his wife have tested positive for the virus suggests that it is still extant and dangerous, even to people who are protected by extraordinary precautions. JL
Donald MacNeil reports in the New York Times:
In the last week, leading epidemiologists have, through different methods, reached the same conclusion: 85 to 90% of the American population is still susceptible to SARS-CoV-2. The number means “herd immunity” is still far off. Even in places where the pandemic hit hard, a French aircraft carrier, the Brazilian city of Manaus and Mumbai, infections did not slow until 60% of the inhabitants were infected. The claim that 50% of Americans have prior immunity and 20% have been immunized by infection,“is convenient arithmetic, but wrong arithmetic.Immunity in 2020 is no closer to being just around the corner than prosperity was in 1930.”
In the last week, leading epidemiologists from respected institutions have, through different methods, reached the same conclusion: About 85 to 90 percent of the American population is still susceptible to SARS-CoV-2, the virus causing the current pandemic.The number is important because it means that “herd immunity” — the point at which a disease stops spreading because nearly everyone in a population has contracted it — is still very far off.The evidence came from antibody testing and from epidemiological modeling. At the request of The New York Times, three epidemiological teams last week calculated the percentage of the country that is infected. What they found runs strongly counter to a theory being promoted in influential circles that the United States has either already achieved herd immunity or is close to doing so, and that the pandemic is all but over. That conclusion would imply that businesses, schools and restaurants could safely reopen, and that masks and other distancing measures could be abandoned.“The idea that herd immunity will happen at 10 or 20 percent is just nonsense,” said Dr. Christopher J.L. Murray, director of the University of Washington’s Institute for Health Metrics and Evaluation, which produced the epidemic model frequently cited during White House news briefings as the epidemic hit hard in the spring.That belief began circulating months ago on conservative news programs like those of Rush Limbaugh and Laura Ingraham. It has been cited several times by Dr. Scott W. Atlas, President Trump’s new pandemic adviser. It appears to be behind Mr. Trump’s recent remarks that the pandemic is “rounding the corner” and “would go away even without the vaccine.”But it is also gaining credence on Wall Street and among some business executives, said prominent public health experts, who consider the idea scientifically unfounded as well as dangerous; its most vocal adherents are calling for mask-wearing and social distancing to end just as cold weather is shifting social activity indoors, where the risk of transmission is higher.Even in places where the pandemic hit especially hard — a French aircraft carrier, the Brazilian city of Manaus, the slums of Mumbai and a neighborhood in Queens, N.Y. — infections did not noticeably slow down until almost 60 percent of the inhabitants were infected. And even those levels may not suffice, given that cases are increasing again in Brazil and in Brooklyn areas that had seen cases spike and then drop off.“Immunity in 2020 is no closer to being just around the corner than prosperity was in 1930,” said Dr. Thomas R. Frieden, a former director of the Centers for Disease Control and Prevention. “The route to immunity without a vaccine would be through graveyards filled with hundreds of thousands of Americans who did not have to die.”In April, in an opinion piece for The Hill that endorsed letting the virus circulate, Dr. Atlas cited the conventional wisdom that herd immunity requires that about 60 percent of people have antibodies. But last week he said on “The Ingraham Angle” that “most of the immunity for this virus is felt to be due to T-cell immunity” and speculated that such immunity was why children rarely became dangerously ill and why Asian countries did well against the virus.(Many reputable medical experts think that children, who suffer many colds, may be protected in that regard. But Asian countries contained the virus through early travel bans, lockdowns, masks and rigorous contact tracing.)The calculations that 85 to 90 percent of all Americans are vulnerable come from numerous sources.On Friday, the C.D.C., citing still-unreleased data from blood samples collected at commercial laboratories across the country this summer, said that less than 10 percent of samples contained antibodies to the virus.Also on Friday, in a study published in The Lancet, Stanford University scientists examined 28,500 blood samples from dialysis centers in 46 states and found antibodies in just over 9 percent.And the epidemic-modeling teams, at the request of the Times, used their models to calculate what percentage of the country is infected; the models were based not on blood sampling but on testing and death data from all 50 states.Dr. Murray’s institute estimated that 29 million Americans, or 9 percent of the population, have had the virus. The Prevention Policy Modeling Lab at Harvard’s T.H. Chan School of Public Health estimated the figure at 41 million, or 12.5 percent.Michael T. Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy, said his team believed it was 10 to 12 percent. The Covid-19 Projections website consulted by Resolve to Save Lives, Dr. Frieden’s health advocacy initiative, calculated it at 16 percent.Each model “has its warts” because they use slightly different assumptions about fatality rates and test accuracy, said Nicolas A. Menzies, a collaborator at the Harvard modeling lab. But all reach similar conclusions: Although some parts of the country were heavily infected in the spring — more than 20 percent of residents of the New York metropolitan area are believed to be immune, for example — the average across the country is far lower.More than 200,000 Americans have already died, and models estimate that if people return to old habits, such as gathering indoors without masks, more than 300,000 and possibly 400,000 could die before a vaccine is widely available.The chief proponents of the idea that herd immunity is somehow close at hand are American and European medical professionals who oppose lockdowns. They contend that most people in the world are immune to the virus thanks to “T-cell immunity” derived from having contracted common colds that were caused by the four relatively benign coronaviruses that have circulated for years.But this theory is unfounded. Helper T-cells are white blood cells that, once “primed” by an initial infection, can linger in the tissues for decades until they meet the same virus again and destroy it, by triggering the production of antibodies and by summoning other virus-killers.(Shane Crotty, a virologist at the La Jolla Institute for Immunology, offered the metaphor of a Lego car. Antibodies recognize the car’s outline and attach themselves, disabling it. But T-cells recognize individual Lego blocks, even internal ones. If the car is already parked inside a human airway cell, for instance, the cell can effectively wave a car part around to attract the attention of primed helper T-cells, which in turn can recruit “killer T-cells” to inject toxic proteins that wipe out both garage and car.)The immunity conferred by a common cold coronavirus appears to last a year or two, immunologists say, and then a person can catch the same cold again. Antibodies against it fade away; primed T-cells remain.Primed T-cells may lower the odds of dying from the new, dangerous coronavirus, Dr. Crotty said, but that has not been proven. There is no evidence that they protect against becoming infected with it.The experts who promote the theory that primed T-cells even stop infections typically are not immunologists. Dr. Atlas, a radiologist, has argued on Fox News since July that “people have immunity, even people that didn’t get the infection.” Dr. James Todaro, an ophthalmologist and, like Dr. Atlas, an early advocate of hydroxychloroquine, has echoed that idea. In Britain, a leading proponent of the theory is Dr. Senetra Gupta, a theoretical epidemiologist at Oxford University.During a congressional hearing last week, Senator Rand Paul, a former eye surgeon, engaged in a heated exchange on the topic with Dr. Anthony S. Fauci, the country’s leading infectious disease expert. The senator argued that New York’s outbreak slowed because of T-cell immunity. Dr. Fauci quickly countered: “If you believe 22 percent is herd immunity, I believe you’re alone in that.”In a later interview, Dr. Fauci said that he “knew of no scientific evidence” that common cold-derived T-cells protect against infection with SARS-CoV-2. Furthermore, he added, any contention that the pandemic was dying out “makes absolutely no sense at all.”Possibly the most detailed version of the unfounded theory was made in a 37-minute video posted to YouTube on Sept. 8 by Ivor Cummins; it has received 1.4 million views.Mr. Cummins, a chemical engineer who typically posts videos about diet and heart disease, used numerous slides of cases and deaths to argue that the epidemic had “largely ended” by June in Europe and by late summer in the United States.The virus, he said, harmed the 20 percent who were vulnerable, whereas “80 percent are already de facto immune through cross-immunity, T-cell mucosal immunity from prior coronaviruses.” Masks and lockdowns had little impact, he claimed, despite abundant evidence from conventional scientists. “Sorry, guys” he added, with a note of disdain. “Science is tough that way.”Dr. Murray said he was amazed at how many people had seen the video.“I’m getting calls about this hokey theory all the time from heads of major consulting companies, C.E.O.s, asking me, ‘Is this video right?’ I’m going to make a video debunking it.”Cases were already rising in Europe when Mr. Cummins posted his video. He dismissed those as cases of “dead virus” found by intensive testing — a supposition that was soon proved hollow when hospitalizations, too, began to rise.The video concluded with a hedge: Although the epidemic was over, Mr. Cummins claimed, Europe might have a winter wave of deaths during which “SARS-CoV-2 might dominate and kick out the influenza deaths.”In Spain and Britain, public health officials believe that the winter wave has already begun, and have reimposed partial lockdowns.The assumption that T-cells primed by common colds offer protection against SARS-CoV-2 is “completely speculative,” said Dr. Crotty of La Jolla, who was a co-author of the first study to show that primed T-cells exist in stored blood. “It’s possible they help. It’s possible they don’t do anything. And it’s possible they are harmful.”So, he said, the claim that 50 percent of Americans have prior immunity and 20 percent have been immunized by infection, so therefore 70 percent herd immunity has been reached, as Mr. Cummins and Senator Paul have suggested, “is convenient arithmetic, but it’s just wrong arithmetic.”He added, “Wearing a mask is much more effective than hoping you and the people around you have pre-existing T-cell memory.”
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