If we cannot stop COVID-19, can we at least look forward to the point in time when we are all survivors of the disease, and presumably immune? It's a tempting idea, but fatally flawed. Herd immunity can protect individuals, but it won't keep a population safe from a disease that has no vaccine.
Does that sound counterintuitive? Let's take a little tour of what herd immunity actually is, how we'd achieve it, and what the result might be.
As a contagious, deadly disease rips through a population, it leaves two things in its wake: dead bodies and survivors. For many diseases, including (we think) COVID-19, survivors are immune and cannot get the disease again.
For an individual person, immunity is protective. If I am immune to COVID-19, I can go out and not worry about being sick. If everyone else in the world is immune to COVID-19, I am still safe even if I am not immune myself.
The idea of being protected by the immunity of those around you is herd immunity. It's a good thing when we're talking about vaccination. Let's say 95% of people in your town are immunized against measles. If a traveler with measles comes to visit, the disease won't have many opportunities to spread to another person. Vaccines protect most people in the town, and the few people who weren't vaccinated are protected by the simple fact that the disease doesn't have a way to get to them.
Herd immunity doesn't guarantee that everyone will be safe, but it does mean that, on average, outbreaks will fizzle out quickly.
The percentage of people who need to be immune to achieve herd immunity depends on the disease. Measles is very contagious: Each infected person could spread it to 12 to 18 other people in a population where nobody is immune. COVID-19 doesn't spread as easily. The exact number, or R 0, is still being determined, although it's estimated to be in the range of 2 to 3. That means we might be able to achieve herd immunity with only, say, 60% of the population being immune.
Not so fast. "All this talk of 'Oh once we get to herd immunity' fails to recognize that the way in which we get herd immunity is that everybody gets sick," says Ellie Murray, an assistant professor of epidemiology at Boston University School of Public Health.
It might be possible to be infected with the coronavirus without getting very sick, and Murray is quick to note that, but she also pointed out that many people who get infected get very sick. Even those who survive may spend weeks severely ill, may need hospital care, and may suffer organ damage or other long-term consequences. We don't even know what all those consequences might be, since the first people in history to suffer the disease are only a few months into their recovery.
And people would die. The percentage of people who die from COVID-19 is also still being investigated, but put it anywhere from a fraction of a percent to somewhere over 3% (depending on context and on how sure you are that you've counted all the cases). Apply that to the entire United States, and you get millions of deaths.
Herd immunity protects us against measles because, thanks to the vaccine, we don't need to get measles to become immune. For a disease like COVID-19 that has no vaccine, the only way to become immune is to become infected.
In short, "let's get everybody sick" is not a solution to the problem of "how do we avoid getting everybody sick?"
Well, maybe. For a little while. Remember, we don't know how long immunity to COVID-19 would last. Based on what scientists know of other coronaviruses, COVID-19 immunity might only last a year or so.
Even if it turned out that survivors are immune for life, there's another problem. No community would be made of a majority of survivors for very long. Travelers come to visit; babies are born. Before measles vaccination, measles epidemics would occur every few years. That's because it only took a few thousand babies to add enough susceptible people to the population to allow outbreaks to happen again. The numbers would be different with COVID-19, but the principle remains.
The first problem in that question is the word "we." Who is doing the infecting? Who is signing people up for this experiment that certainly will have a death rate? That's not ethical in the least.
But sure, let's assume we're okay with a bunch of people dying unnecessarily. (I, for the record, am not.) Is there a way to infect just the people who are most likely to survive a case of COVID-19? That's the idea behind proposals to reopen schools, or to allow young people to go back to work while keeping older folks sequestered.
The problem with that, says Murray, is that herd immunity does not apply to a population as a whole. It only has meaning within networks of contacts. If your grandpa mostly interacts with people in his assisted living home, and none of them have immunity to the virus, then it just takes one infected visitor-you?-to spark an outbreak that takes off through the entire building.
There's a further problem. Just because we want to infect 60% (or whatever is the herd immunity threshold) of the population, does not mean we can somehow control the outbreak and stop it when it reaches 60%. Epidemics have momentum, and an epidemic that has already infected more than half the population is just going to keep going. After all, if we're willing and able to stop the outbreak, why wouldn't we have stopped it at zero percent, before it kills anybody?
And there's that "we" again. It's deeply unethical to send whole swaths of the population to their deaths, even if statistically we don't know who they are. Coercing or asking for volunteers doesn't meaningfully dodge this problem, and the idea of creating a social structure based on immunity has a terrible, unjust history.
If we do establish herd immunity, it will come at a great cost of human lives. It will likely not be effective for long. And it will not be a way of winning this ordeal against the virus; it will be a confirmation that we have lost.
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