Scores of Massachusetts doctors and scientists are among the thousands who have signed onto an open letter that criticizes the idea of using herd immunity as a response to the coronavirus pandemic, even as the idea appears to have gained influential supporters in the White House.
The John Snow Memorandum (named for a pioneering epidemiologist, not a “Game of Thrones” character) was published last week in the influential journal The Lancet. A website collecting signatures says it has since garnered more than 4,800 signatures plus endorsements from scientific and public health organizations.
The letter calls the idea of using natural infection-based herd immunity a “dangerous fallacy unsupported by the scientific evidence."
William Hanage, an epidemiologist at the Harvard T. H. Chan School of Public Health who was one of the original authors of the letter, said there are ways to control the coronavirus pandemic but “uncontrolled transmission is not one of them."
“The overwhelming number of public health folks and health care folks would never say they believe in herd immunity through infection,” said Dr. Nahid Bhadelia, an infectious disease physician at Boston Medical Center and an associate professor of medicine at Boston University School of Medicine.
Bhadelia, also one of the original authors of the letter, said proponents of the strategy, in an “abnegation of responsibility,” want to “let it rip but have no plan for when health systems get overwhelmed.”
The New York Times reports that President Donald Trump’s science adviser, Scott Atlas, a powerful force inside the White House, and administration officials have denied advocating for herd immunity, but they have praised the ideas in a document called the Great Barrington Declaration., which was developed at a think-tank meeting in the Massachusetts town of Great Barrington.
That document argues that authorities should allow the coronavirus to spread among young healthy people while protecting the elderly and the vulnerable, thus achieving herd immunity, the point where enough people have been infected to stall transmission of the virus. The message is aligned with President Trump’s vocal opposition on the campaign trail to lockdowns, despite the country’s current struggle with renewed surges of the virus.
The John Snow Memorandum argues, “Any pandemic management strategy relying upon immunity from natural infections for COVID-19 is flawed."
The herd immunity approach could lead to “significant” illness and death across the entire population, the letter says. (Some experts have estimated it could lead to more than 1 million deaths in the United States.)
The letter also recites a litany of other problems with the approach, arguing that it’s not clear how long immunity lasts after you get sick, thus raising the possibility of an indefinite risk to vulnerable populations and recurrent epidemics; the long-term effects of the virus on people who get it and survive are unknown; the wave of infections would overwhelm health care systems; and more health care workers would get sick, die, or be traumatized as they treat a continuing flow of patients.
Hanage said the herd immunity idea may be what people, weary of coronavirus restrictions, want to hear, but it’s “unfortunately not possible.”
“It offers the idea that we can just go back to normal, and it doesn’t say anything about how we’re going to do the most important part of it,” protecting the vulnerable, he said.
If a virus is going to be allowed to spread that can kill people’s grandparents, he said, “You ought to give some indication of how you’re going to stop the grandparents being infected.”
He also said the proposal was “incredibly casual about large numbers of young people becoming infected” when studies indicate there are long-term effects on younger people, including a high rate of heart muscle damage.
""It’s disgraceful," he said. “Suggesting that this is something that should just be allowed to happen is against all public health principles.”
Dr. Abraar Karan, an internal medicine physician at Brigham and Women’s Hospital, said that for multiple reasons, the Great Barrington Declaration is “not a smart declaration. It’s not the response that we need right now."
"Inflammation in the heart, brain fog, lung scarring, ongoing fatigue —these are all symptoms that you can see in patients of all different kinds of ages and we’re still trying to understand these effects,” he said.
If hundreds of thousands or millions more people are allowed to get sick, “you will see many more of these effects," he said.
He also said, “They’re proposing something that’s completely hypothetical. It’s not pragmatic, and they have no way to actually implement this."
Discussing the herd immunity idea is “distracting and taking away from limited resources, time and attention” that could be devoted to stepping up efforts to fight the virus through measures such as testing, tracing, isolation, mask-wearing, eye protection, and ventilation, he also said.
“When something like the Great Barrington Declaration comes about, it takes up everybody’s attention for a number of days,” he said. “Every day we lose with this virus is an exponentially worse day because the virus spreads quickly."
Ellie Murray, an epidemiologist at Boston University, said, “Herd immunity is not a plan and the Great Barrington Declaration is at best wishful thinking.”
“Infection-acquired herd immunity represents a failure to control the pandemic and will lead to a large loss of life. It is almost certainly not possible to keep vulnerable people from being infected while infection spreads within the rest of the population,” she said in an e-mail.
“Furthermore, we don’t even understand the full spectrum of vulnerability to COVID – many otherwise healthy people are suffering serious long-term consequences of what initially seemed to be mild infection,” she said.
Bhadelia said a projection of a possible million deaths from the proposal was “probably pretty accurate.”
“It’s a lot of people, and death is not the only outcome. Before we get to the death number, the hospitalization numbers will overwhelm us,” she said.
She said that the proposal has been described as an anti-lockdown proposal. But without a plan to protect the vulnerable or to treat the number of people who will get seriously ill, she said, “I actually see that as a declaration that’s rushing us toward lockdown.”
Dr. Ashish Jha, dean of the Brown University School of Public Health, said last week in a tweet that the Great Barrington Declaration was “junk science. And like junk food, tastes great but zero nutritional value.”
Material from The New York Times was used in this report.
Martin finucane can be reached at firstname.lastname@example.org.