Is COVID-19 “the forever plague”?

Since the publication of the Great Barrington Declaration in October 2020, we have been very critical of it. The document was published as a result of a meeting that took place at the headquarters of the American Institute for Economic Research. The reason that we have been so critical of the GBD is because it advocated a "natural herd immunity" approach to the COVID-19 epidemic. This was a few months before the emergency use authorization for the COVID-19 vaccine was granted. Given the practical difficulties and the observation that natural immunity was not likely to be durable, it was never going to work. If we followed their plan, Herd immunity would be just 3-6 months away. The Brownstone Institute, which is the scientific advisor to Martin Kulldorff, has pivoted to help spread anti vaccine misinformation.

The article that went the opposite direction of Brownstone Institute propaganda went viral. You think I would approve? The article lacks nuance and supports positions to which I am sympathetic with a maximalist fear mongering argument that ends up proposing a solution to the epidemic that is a fantasy.

Dueling fantasy worlds

The article that I referred to went so far in the opposite direction of the GBD that it needed to be called out. The title of the article was "Get Ready for the forever plague" and it was published on July 4th. The ominous image is also present.

COVID-19: Forever Plague

The image of a plague doctor is frightening.

The image used for the article tells you a lot. The concept is that, thanks to the Omicron variant, the only way to stop the Pandemic is to stop it. The best way to support a conclusion is to demonstrate how data and information were. On Friday the author responded to some criticisms and edited the article to its current form, which is still maximalist in its fear mongering. I realize that I might be seen as the same person as the people at the Brownstone Institute. Nothing can be further from the truth, and to support that, I'll quote my co-author on the article, who said "nothing can be further from the truth."

Yamey Tweet

The claim that each Omicron reinfection gives no immunity is nonsense.

We could have avoided this deteriorating situation, as The Tyee repeatedly advised, by eliminating COVID in our communities more than a year ago.

Elimination remains the only long-term and bottom-up strategy that makes any sense in terms of risk reduction. It is also imminently doable with adequate testing, masking, tracing, supported sick leave and targeted goals for reducing transmission.

But our public health officials gambled with the future and chose a fantasy world instead. Now COVID has become a runaway train with unknown biological consequences.

I have said similar things in the past. Elsewhere in the article, I will give him this point as well.

By abandoning the critical goal of stopping or reducing viral transmission about a year ago, authorities have given viral evolution an incredible edge.

In our criticisms of the fantasy world, in which immunity to COVID-19 is lifelong, natural herd immunity is doable, and it is relatively easy to implement focused protection of the elderly. We pointed out that it is not so much vaccines driving new variant that allows a novel virus to circulate in a naive population.

I think he is living in a fantasy world, just a different one than the one public health officials are in. The fusion of conspiracy theorists, the far right, and antivaxxers made public health officials in many countries give up too early. It would require every nation on the planet to implement the suggested NPIs for the elimination of COVID-19 to be possible now. I can't help but wonder how much of a fantasy world Nikiforuk's vision isn't as much of. I give Nikiforuk credit for emphasizing that the GBD fantasy of "natural herd immunity" is detached from reality and that he goes too far in the other direction.

The claim that you can get to zero carbon dioxide is so out of touch with reality that I was tempted to add one of my usual facepalm images here with a sarcastic caption. It could have been possible to achieve zero COVID early in the Pandemic with such measures as well as with massive international cooperation. When the linked article was published, elimination could have been achieved. It would require international cooperation that only happens in fantasy land and ignores the fact that there is an animal reservoir for these coronaviruses that would eliminate them. It isn't "surrender" to admit this, but if the reaction to the criticisms of this article are any indication, that's the sort of accusation I'll see in the comments, with some people expressing extreme "disappointment" with me or even "outrage" If that happens, I will shake my head and explain why COVID-19 isn't that deadly and why "natural herd immunity" is the reason.

I think I might have regretted writing this post. It wouldn't be the first time. Let's take a closer look at some details.

Unsupported and exaggerated claims

The central claim of the article is that Omicron variant have become so transmissible and immune evading that reinfections with them will lead to no immunity to future infections.

New science shows that Omicron and its variants are getting better at evading immune defences induced by vaccines or by natural infection. BA.5, for example, is more transmissible than any previous variant.

As a consequence it is now possible to be reinfected with one of Omicron’s variants every two to three weeks.

The data also shows that each reinfection confers no immunity. A summer infection, for example, will not protect you against a fall infection. But each and every infection will damage your immune system regardless of how mild the symptoms.

The article by Eric Topo describes how much more transmissible and immune evading Omicron BA.5 is than previous versions, but it also states that existing vaccines are still very effective at preventing it. The vaccines are useless because of how Omicron variant are becoming good at evading immunity, which is one of the main themes of the article.

So the virus is getting better at thwarting vaccines and evading immunity. Although vaccine protection against hospitalization and death remains strong, it is being steadily eroded by Omicron’s subvariants. Meanwhile protection against severe disease has declined as the effectiveness of our vaccines progressively wanes.

Nikiforuk admits that the vaccines work well at preventing disease and death, but at the same time he paints a dire picture of the future. Evidence shows that the vaccines are still effective at preventing death and severe disease even from Omicron variant. Is it reasonable to worry that the ability of existing vaccines to prevent death and disease will be eroded by future variants? It's absolutely true. Does it make sense to portray this erosion as inevitable? New vaccines to target newer versions are in the works. I agree with him that the coronviruses is evolving faster than our ability to develop new vaccines to cover them.

In his response to critics, he admits that he overreached.

But to be accurate (and avoid semantic disputes) I should have said that new infections confer so little immunity — because the immune system is unable to remember them — that we must seek every other protection available. The Tyee has made that correction to the original story.
Of course, semantics matter. Perhaps the most succinct criticism of Nikiforuk’s original wording came from a pseudonymous Twitter account, and I liked it enough to quote it directly:

If you look at the New York State reinfection data, you'll see that it's not as common as you might think. The study states that is true.

The authors conclude that vaccinations are the safest way to prevent severe disease, death, and long COVID-19, and should be used. There is a chance of being reinsured with a variant once as early as two to three weeks after a COVID-19 infection, which is incorrect and misleading. The picture is at odds with reality.

In his original article, Nikiforuk cites a VA study on reinfections, although, interestingly enough, he doesn't directly cite the study itself, but rather a post on Eric Topol. It looked at findings from over 257,427 people with one COVID-19 infection, 38,926 people with 2 or more infections, and nearly 5 million uninfected controls, and compared risks and 6-month burdens of all-cause mortality, hospitalization, and a set of pre-defined incident

We don't know if the study will be replicated. Even if one accepts its findings at face value, the main people who argue that infections tend to be mild are anti-vaxxers, and they tend to dismiss the possibility of re-infection.

Progressive destruction of the immune system by SARS-CoV-2

Even though I have a serious problem with his cherry picking and exaggeration, I agree with him that a "let 'er rip" approach is disastrous. The picture of the COVID-19 infections and their effects on the immune system is something that is beyond what data will support. He cherry picks some studies.

According to a video, the ability of vaccines to protect against hospitalization and death is being eroded by variant. The study was looked at by me. The study isn't what it's cracked up to be. It shows that T-cell death can be caused by the disease. It suggests a strategy to block the process known as a caspase. There were 11 patients in the intensive care unit for acute respiratory distress syndrome and 30 patients in the infectious diseases department for symptoms of dyspnea. There were 18 other hospitalized patients that it looked at as well. The paper doesn't say anything about less severe COVID-19 or that it's generalizable to all COVID-19.

There is a paper that examined Omicron B. 1.1.529, a variant that carries multiple spike mutations with high transmissibility, in healhcare workers with different COVID-19 infections histories.

According to the study, Omicron infections after vaccination recall the same antibodies that vaccines triggered against earlier strains, instead of eliciting all new responses to Omicron. This could be a problem with vaccine development. I agree. Is it a foregone conclusion that the continued evolution of Omicron variants will result in a plague in which a lot of the population will get sick? It is not possible to say yes. Based on one study, that is an overgeneralization.

If you think that COVID-19 will destroy society, you need to listen to the claims made by Nikiforuk, who says that what we see now is worse than a virus with a higher mortality rate that passes through the population once and then.

When scientists and skeptics argue that natural immunity is useless, the position of the antivaxers is misrepresented. I like to point out that immunity to some diseases is lifelong, but not for COVID-19. Post-infection immunity to COVID-19 is likely to last a bit longer than post-vaccine immunity, but is far from lifelong, as I have pointed out.

As more and more infections spread through a population, vaccine efficacy will likely diminish. Estimates of vaccine efficacy can be used to compare the rates of infections in unvaccinated andvaccinated populations. The apparent difference between the risk of infections in the unvaccinated and the vaccine-vaccinated population will decrease as the number of people with previous infections increases.

COVID-19 is the final part of the narrative. There is a syndrome called "long COVID" which is a real and concerning phenomenon. It will take years to determine the true burden of long COVID, not to mention to work out fully mechanisms and outcomes, and our resident neurologist, Steve Novella, has discussed the link between COVID-19 infections. Long COVID is likely to be a serious problem in the future. Concerns about long COVID is a good point in the article. It's buried in all the scare mongering.

When allies go too far

The so-called "zero COVID" movement is a new phenomenon on our side. Dr. Ben Mazer noticed this a few days before the article was published.

I would point out how odd it is that the strategy to reach zero carbon was ignored because of the vaccine. Is there a disease that has been eliminated without a vaccine? You know the answer to that. In an earlier article, Nikiforuk said he was confident.

The vaccine reduced the burden of many diseases. They also stopped the disease. It's not wrong that a vaccine-only policy is likely to be less than optimal, but it's clear that he doesn't think much of vaccines. He said that vaccines are important, but not enough, and that it was reasonable to say that. His original article did not leave me with the impression that he discussed this aspect of vaccine. It's quite the opposite. If you don't agree with his article, read it again.

In his response, more or less doubles down on everything in his original article, admitting the error mentioned above, but in essence pointing to the same data cited in the paper.

There is no evidence that anyone can be re-instated every few weeks with a new variant of COVID-19, and there is no evidence that he is doing anything more than killing people.

The first article written by a person? Marty Makary wrote an article titled "We'll have herd immunity by April" We at SBM have not been nice to that article. We haven't been kind to suggest that a let 'er rip approach to the Pandemic is a valid approach. I note that both articles were published in The Wall Street Journal, which has been a breeding ground for anti-vaccine propaganda. Nikiforuk seems to be implying that these doctors represent mainstream public health thought in their approach to the Pandemic. They are not, and those who have criticized his article have been very critical of these academics as well.

It is possible to acknowledge more than one thing at once about the Pandemic without being a "COVID minimizer", as some "zero COVID" advocates are claiming, and acknowledging these multiple things does not validation the complaints of the real COVID-19. They are very bad. Covid-19 is more than just a flu-like illness caused by a different virus, and it also does more bad things than was thought. The cessation of NPIs to slow the spread of COVID-19 has left vulnerable people with a feeling of abandonment and a fear of death. It is possible to be concerned about the rise of variant that are more transmissible and can evade immunity. No, this doesn't mean that those of us who criticize the views of others think that COVID-19 is a good thing.

I would really like to see zero COVID-19. When a novel coronaviruses caused an outbreak of a mysterious pneumonia in China, I would love to go back in time. Japan is an example of how to do it. We are sad that most countries have abandoned effective NPIs, but we are also sad that most countries don't have the same fighting spirit as Japan. It's not realistic to expect them to be as desirable as possible. As a result, COVID-19 is unlikely to be eliminated any time soon, which means that the best that we can do is to promote better ventilation, more masking, get vaccine and boosted, avoid crowded indoor spaces, develop better vaccines, and in general continue to try to minimize That's not "hopium" It is more realistic than strategies like zero carbon dioxide. Public health during a Pandemic has to be based on a realistic assessment of the situation, the tools available to fight the Pandemic, and the political will to use those tools. The world lacks the last of these, something we agree with.